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Alzahrani MA, Ofisan SB, Alshumaymiri NI, Alghuwainem M, Altamimi M, Alali AY, Rabie M, AboSkena AK, Almaymuni K, Almannie R, Binsaleh S. Effect of St. John's Wort ( Hypericum perforatum L.) on Male Sexual and Reproductive Health: A Narrative Review. Biomedicines 2023; 11:2800. [PMID: 37893173 PMCID: PMC10604084 DOI: 10.3390/biomedicines11102800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/01/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Hypericum species are widely acknowledged for their biological attributes, with notable attention being paid to Hypericum perforatum, commonly known as St. John's wort (SJW) within the Hypericum section of the Hypericaceae family. This species is among the most thoroughly investigated herbal medicines, particularly in terms of its application in the management of mild to moderate depression. SJW is used to treat depression, menopausal symptoms, attention-deficit hyperactivity disorder (ADHD), somatic symptom disorder, obsessive-compulsive disorder, and skin conditions, such as wounds and muscle pain. However, the usefulness and effectiveness of SJW for male sexual and reproductive health (SRH) are not well known. OBJECTIVE To assess the current evidence in the literature on the effect of SJW on male SRH. METHODS This narrative review followed a predetermined protocol and used MEDLINE and PubMed to identify articles published in English on the effects of SJW on male SRH. The search used various keywords, such as "Hypericum Perforatum", "St. John's Wort", and terms related to sexual and reproductive health issues. Articles published between the inception of the database and August 2023 were included. RESULTS We identified 12 articles published from 1999 to 2019, the majority of which were experimental and conducted on animals. These studies demonstrate variability in terms of design, sample size, type of SJW extract used, the dosage administered, and duration of treatment. Studies have indicated potential sexual dysfunction (SD) due to SJW, which includes reduced libido, delayed ejaculation, delayed orgasm, and erectile dysfunction. Additionally, reproductive toxicity has been suggested, as evidenced by spermicidal effects through the inhibition of sperm motility, abnormal spermatozoa, chromosomal aberrations, and DNA denaturation. Furthermore, some studies have reported potential adverse events during maternal exposure, inhibition of fertilization, and disruption of reproductive parameters. CONCLUSIONS Our review suggests that the safety and efficacy of SJW in the treatment of human SRH remain unclear. Further comprehensive, well-designed studies with larger samples, longer exposure periods, and specific dosages are needed to clarify SJW's effects of SJW. Therefore, consultation with healthcare professionals before using herbal remedies or supplements is crucial.
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Affiliation(s)
- Meshari A. Alzahrani
- Department of Urology, College of Medicine, Majmaah University, Al-Majmaah 11952, Saudi Arabia
| | - Salman Bin Ofisan
- College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj 16273, Saudi Arabia
| | - Nasser I. Alshumaymiri
- College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj 16273, Saudi Arabia
| | - Muath Alghuwainem
- College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj 16273, Saudi Arabia
| | - Muath Altamimi
- College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj 16273, Saudi Arabia
| | - Ali Y. Alali
- College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj 16273, Saudi Arabia
| | - Muhammad Rabie
- College of Science, Alexandria University, Alexandria 21568, Egypt
| | - Ahmed K. AboSkena
- Department of Pharmaceutical, College of Pharmacy, Ahram Canadian University (ACU), 6th of October 12451, Egypt
| | - Khalid Almaymuni
- College of Medicine, Majmaah University, Al-Majmaah 11952, Saudi Arabia
| | - Raed Almannie
- Division of Urology, Department of Surgery, Faculty of Medicine, King Saud University Medical City, King Saud University, Riyadh 11461, Saudi Arabia
| | - Saleh Binsaleh
- Division of Urology, Department of Surgery, Faculty of Medicine, King Saud University Medical City, King Saud University, Riyadh 11461, Saudi Arabia
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Antiproliferative Effects of St. John's Wort, Its Derivatives, and Other Hypericum Species in Hematologic Malignancies. Int J Mol Sci 2020; 22:ijms22010146. [PMID: 33375664 PMCID: PMC7795730 DOI: 10.3390/ijms22010146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/03/2020] [Accepted: 12/24/2020] [Indexed: 12/14/2022] Open
Abstract
Hypericum is a widely present plant, and extracts of its leaves, flowers, and aerial elements have been employed for many years as therapeutic cures for depression, skin wounds, and respiratory and inflammatory disorders. Hypericum also displays an ample variety of other biological actions, such as hypotensive, analgesic, anti-infective, anti-oxidant, and spasmolytic abilities. However, recent investigations highlighted that this species could be advantageous for the cure of other pathological situations, such as trigeminal neuralgia, as well as in the treatment of cancer. This review focuses on the in vitro and in vivo antitumor effects of St. John’s Wort (Hypericum perforatum), its derivatives, and other Hypericum species in hematologic malignancies. Hypericum induces apoptosis in both myeloid and lymphoid cells. Other Hypericum targets include matrix metalloproteinase-2, vascular endothelial growth factor, and matrix metalloproteinase-9, which are mediators of cell migration and angiogenesis. Hypericum also downregulates the expression of proteins that are involved in the resistance of leukemia cells to chemotherapeutic agents. Finally, Hypericum and its derivatives appear to have photodynamic effects and are candidates for applications in tumor photodynamic therapy. Although the in vitro studies appear promising, controlled in vivo studies are necessary before we can hypothesize the introduction of Hypericum and its derivatives into clinical practice for the treatment of hematologic malignancies.
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Fisk J, Khalid S, Reynolds SA, Williams CM. Effect of 4 weeks daily wild blueberry supplementation on symptoms of depression in adolescents. Br J Nutr 2020; 124:181-188. [PMID: 32151287 DOI: 10.1017/s0007114520000926] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Adolescence is an important period for cognitive maturation and emotional regulation, and this age group is particularly vulnerable to developing depression. Diets rich in fruits and vegetables have been associated with decreased risk of developing depressive disorders across the lifespan, maybe due to the high flavonoid content of these foods. Previously, we have shown increases in transient positive affect (PA) in both children and young adults 2 h after administration of a wild blueberry (WBB) intervention. Here, using a randomised double-blind, placebo-controlled trial, we investigated the effects of 4 weeks, daily WBB supplementation (containing about 253 mg anthocyanins) on transient and chronic mood in adolescents. Healthy 12-17-year old (n 64, thirty-five females) participants were randomly assigned to receive either a WBB or matched placebo supplementation. Depression and anxiety symptoms were assessed before and after the intervention period using the Mood and Feeling Questionnaire and Revised Child Anxiety and Depression Scale. Transient affect was assessed before, 2 weeks and at 4 weeks using PA and negative affect. Following the intervention period, there were significantly fewer self-reported depression symptoms in participants who were supplemented with WBB compared with placebo (P = 0·02, 95 % CI -6·71, -5·35). There was no between-group effect on anxiety symptoms or on transient affect. Further investigation is required to identify specific mechanisms that link flavonoids consumption and mood. If replicated, the observed effects of WBB supplementation may be a potential prevention strategy for adolescent depression and may have benefits for public mental health.
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Affiliation(s)
- Jeni Fisk
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, BerkshireRG6 6BZ, UK
| | - Sundus Khalid
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, BerkshireRG6 6BZ, UK
| | - Shirley A Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, BerkshireRG6 6BZ, UK
| | - Claire M Williams
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, BerkshireRG6 6BZ, UK
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Khan H, Perviz S, Sureda A, Nabavi SM, Tejada S. Current standing of plant derived flavonoids as an antidepressant. Food Chem Toxicol 2018; 119:176-188. [DOI: 10.1016/j.fct.2018.04.052] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/20/2018] [Accepted: 04/22/2018] [Indexed: 01/29/2023]
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Sarris J. Herbal medicines in the treatment of psychiatric disorders: 10-year updated review. Phytother Res 2018; 32:1147-1162. [DOI: 10.1002/ptr.6055] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Jerome Sarris
- NICM Health Research Institute, School of Science and Health; Western Sydney University; Westmead NSW Australia
- Department of Psychiatry, The Melbourne Clinic, Professorial Unit, ARCADIA Research Group; The University of Melbourne; Melbourne VIC Australia
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Dhingra S, Parle M. Herbal Remedies and Nutritional Supplements in the Treatment of Depression: A Review. ACTA ACUST UNITED AC 2016. [DOI: 10.5455/bcp.20120729090446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Sameer Dhingra
- Swift School of Pharmacy, Swift Group of Colleges, NH-1, Rajpura-Ambala Road, Rajpura (Punjab) INDIA
- Pharmacology Division, Department of Pharmaceutical Sciences, Guru Jambheshwar University of Science and Technology, NH-10, Hisar (Haryana) INDIA
| | - Milind Parle
- Pharmacology Division, Department of Pharmaceutical Sciences, Guru Jambheshwar University of Science and Technology, NH-10, Hisar (Haryana) INDIA
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Seifritz E, Hatzinger M, Holsboer-Trachsler E. Efficacy of Hypericum extract WS(®) 5570 compared with paroxetine in patients with a moderate major depressive episode - a subgroup analysis. Int J Psychiatry Clin Pract 2016; 20:126-32. [PMID: 27161105 PMCID: PMC4950448 DOI: 10.1080/13651501.2016.1179765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES efficacy and tolerability of WS(®) 5570 for the treatment of acute mild-to-moderate depression, has been demonstrated in various studies. Here, we present a subgroup analysis of a double blind, randomised trial to compare the therapeutic efficacy of WS(®) 5570 with paroxetine in patients suffering from a major depressive episode with moderate symptom intensity. METHODS moderate depression was defined by a baseline Hamilton Depression Rating Scale (HAM-D) total score between 22 and 25. Patients received, after a single blind placebo run-in phase of 3-7 d, either 3 × 300 mg/d WS(®) 5570 or 20 mg/d paroxetine for six weeks. The change of the HAM-D total score was used to describe the efficacy of WS(®) 5570 compared with paroxetine in the subgroup of patients with moderate depression. RESULTS the reductions of the HAM-D total score were significantly more pronounced in patients treated with 3 × 300 mg/d WS(®) 5570 compared to 20 mg/d paroxetine. CONCLUSIONS patients treated with WS(®) 5570 not only showed a reduction in depression severity score but also yielded greater response and remission rates compared with patients treated with paroxetine. Keypoints Various studies showed the efficacy and tolerability of WS(®) 5570 for the treatment of acute mild-to-moderate depression. Beneficial effects of WS(®) 5570 have been also shown in patients with moderate-to-severe depression. In this study reductions of the HAM-D total score were significantly more pronounced in patients with moderate depression treated with WS(®) 5570 compared with paroxetine. Patients treated with WS(®) 5570 not only showed a reduction in depression severity score but also yielded greater response and remission rates compared with patients treated with paroxetine.
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Affiliation(s)
- Erich Seifritz
- a Department of Psychiatry, Psychotherapy, and Psychosomatics , Psychiatric Hospital, University of Zurich , Zurich , Switzerland
| | - Martin Hatzinger
- b Psychiatric Services Solothurner Spitäler & University of Basel , Basel , Switzerland
| | - Edith Holsboer-Trachsler
- c Psychiatric Clinics of the University of Basel , Center for Affective, Stress and Sleep Disorders (ZASS) , Basel , Switzerland
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Psychophytomedicine: an overview of clinical efficacy and phytopharmacology for treatment of depression, anxiety and insomnia. Holist Nurs Pract 2015; 28:275-80. [PMID: 24919098 DOI: 10.1097/hnp.0000000000000040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVE WS(®) 5570 is a Hypericum (St. John's wort) dry extract that is available as a medicinal product in coated tablets and has a marketing authorisation for the acute treatment of mild to moderate major depression in Germany. METHODS This article summarizes the current state of knowledge regarding the clinical efficacy and safety of WS(®) 5570. RESULTS In randomised, double-blind, controlled clinical trials the antidepressant effect of the drug was superior to that of the placebo and at least comparable to that of paroxetine. The beneficial effect of WS(®) 5570 is particularly pronounced with respect to the core symptoms of depression. There is evidence that the drug may also be effective in moderate to severe depression and in prophylactic continuation treatment after recovery from an acute episode. CONCLUSIONS WS(®) 5570 has a very favourable safety profile, with adverse event rates on one level with placebo and lower than that of synthetic antidepressants in randomised, controlled clinical trials. It may therefore also be an option for patients who do not tolerate other antidepressant drugs. Patients with polydrug treatment should nevertheless use the drug with caution, due to its potential for interactions.
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Ishola IO, Chatterjee M, Tota S, Tadigopulla N, Adeyemi OO, Palit G, Shukla R. Antidepressant and anxiolytic effects of amentoflavone isolated from Cnestis ferruginea in mice. Pharmacol Biochem Behav 2012; 103:322-31. [DOI: 10.1016/j.pbb.2012.08.017] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 08/06/2012] [Accepted: 08/19/2012] [Indexed: 11/16/2022]
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Malenfant D, Summers K, Seney S, McBain D, Petrlich L, Watson S, Vanderhoek L, Samadi N, Bonner A, Pope J. Results of a Pilot Randomized Placebo-Controlled Trial in Primary and Secondary Raynaud's Phenomenon with St. John's Wort: Detecting Changes in Angiogenic Cytokines When RP Improves. ISRN RHEUMATOLOGY 2011; 2011:580704. [PMID: 22389797 PMCID: PMC3263747 DOI: 10.5402/2011/580704] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 06/27/2011] [Indexed: 11/23/2022]
Abstract
Objectives.To perform a 6-week double-blind RCT in Raynaud's phenomenon (RP) comparing the plant extract St. John's Wort (SJW) to placebo. Methods. RP patients having at least 7 attacks per week were stratified by primary and secondary RP and within secondary by systemic sclerosis or other connective tissue disease. Subjects completed a daily standardized diary recording all RP attacks (frequency, duration and severity). Serum levels of 18 inflammatory and angiogenic cytokines were measured pre- and post-treatment. Results. Eighteen patients completed the study; 8 received SJW and 10 placebo. The decrease in mean number of attacks per day was 0.75 with SJW and 1.01 with placebo, P = 0.06. Attack duration and severity were not different between groups. Cytokine analyses demonstrated no between-groups differences. Combining treatment groups, those with >50% improvement in frequency of attacks yielded a significant increase in E-selectin (P = 0.049), MMP-9 (P = 0.011), G-CSF (P = 0.02), and VEGF (P = 0.012) pre- versus post-treatment. A ≥50% improvement in severity of attacks corresponded to a significant increase in levels of sVCAM-1 (P = 0.003), sICAM-1 (P = 0.007), and MCP-1 (P = 0.004). Conclusions. There were no clinical or biomarker benefit of SJW versus placebo in RP. However, combining all patients, there were changes in some cytokines that may be further investigated.
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Affiliation(s)
- Déanne Malenfant
- Department of Medicine, University of Western Ontario, London, ON, Canada N6A 5C1
| | - Kelly Summers
- Screening Laboratory for Immune Disorders, Lawson Health Research Institute, London, ON, Canada N6A 4V2
- Department of Microbiology & Immunology, University of Western Ontario, London, ON, Canada N6A 5C1
| | - Shannon Seney
- Screening Laboratory for Immune Disorders, Lawson Health Research Institute, London, ON, Canada N6A 4V2
| | - Donna McBain
- Rheumatology, St. Joseph's Health Care London, London, ON, Canada N6A 4V2
| | - Lisa Petrlich
- Rheumatology, St. Joseph's Health Care London, London, ON, Canada N6A 4V2
| | - Sharon Watson
- Rheumatology, St. Joseph's Health Care London, London, ON, Canada N6A 4V2
| | - Louise Vanderhoek
- Rheumatology, St. Joseph's Health Care London, London, ON, Canada N6A 4V2
| | - Nooshin Samadi
- Department of Medicine, University of Western Ontario, London, ON, Canada N6A 5C1
- Rheumatology, St. Joseph's Health Care London, London, ON, Canada N6A 4V2
| | - Ashley Bonner
- Department of Mathematics and Statistics, McMaster University, Hamilton, ON, Canada L8S 4K1
| | - Janet Pope
- Department of Medicine, University of Western Ontario, London, ON, Canada N6A 5C1
- Rheumatology, St. Joseph's Health Care London, London, ON, Canada N6A 4V2
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Klemow K, Bartlow A, Crawford J, Kocher N, Shah J, Ritsick M. Medical Attributes of St. John's Wort (Hypericum perforatum). OXIDATIVE STRESS AND DISEASE 2011. [DOI: 10.1201/b10787-12] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Solomon D, Ford E, Adams J, Graves N. Potential of St John's Wort for the treatment of depression: the economic perspective. Aust N Z J Psychiatry 2011; 45:123-30. [PMID: 20977305 DOI: 10.3109/00048674.2010.526094] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The burden of rising health care expenditures has created a demand for information regarding the clinical and economic outcomes associated with complementary and alternative medicines. Meta-analyses of randomized controlled trials have found Hypericum perforatum preparations to be superior to placebo and similarly effective as standard antidepressants in the acute treatment of mild to moderate depression. A clear advantage over antidepressants has been demonstrated in terms of the reduced frequency of adverse effects and lower treatment withdrawal rates, low rates of side effects and good compliance, key variables affecting the cost-effectiveness of a given form of therapy. The most important risk associated with use is potential interactions with other drugs, but this may be mitigated by using extracts with low hyperforin content. As the indirect costs of depression are greater than five times direct treatment costs, given the rising cost of pharmaceutical antidepressants, the comparatively low cost of Hypericum perforatum extract makes it worthy of consideration in the economic evaluation of mild to moderate depression treatments.
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Affiliation(s)
- Daniela Solomon
- School of Population Health, University of Queensland, Brisbane, Herston, Queensland, Australia.
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Polyphenol characterization and encapsulation in β-cyclodextrin of a flavonoid-rich Hypericum perforatum (St John's wort) extract. Lebensm Wiss Technol 2010. [DOI: 10.1016/j.lwt.2010.01.016] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Nahrstedt A, Butterweck V. Lessons learned from herbal medicinal products: the example of St. John's Wort (perpendicular). JOURNAL OF NATURAL PRODUCTS 2010; 73:1015-21. [PMID: 20408551 DOI: 10.1021/np1000329] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The example of St. John's wort offers convincing evidence for the concept that modern methods of pharmacological and phytochemical research are effective in advancing the development of traditional herbal remedies. As a consequence of these efforts, it is known today that several compounds from different structural groups and with different mechanisms of action seem to be responsible for the observed antidepressant efficacy of St. John's Wort. Co-effectors in the extract improve the bioavailability of active constituents such as hypericin (1) (pharmacokinetic synergy). Unwanted side effects are preventable without remarkable loss of activity when the responsible constituent(s) are carefully removed during the extraction process, as demonstrated for hyperforin (3), which is responsible for the induction of cytochrome P450 (CYP)-metabolizing enzymes (CYP3A4, in particular). On the basis of our findings, it is likely that positive interactions between single compounds occur more frequently in traditionally used herbal preparations than is known presently.
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Affiliation(s)
- Adolf Nahrstedt
- Institute of Pharmaceutical Biology and Phytochemistry, Westfalische Wilhelms-Universitat, D-48149 Munster, Germany.
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Wang Y, Shi X, Qi Z. Hypericin prolongs action potential duration in hippocampal neurons by acting on K+ channels. Br J Pharmacol 2010; 159:1402-7. [PMID: 20233218 DOI: 10.1111/j.1476-5381.2009.00513.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND PURPOSE Synaptic deficiency is generally accepted to be involved in major depression, and accordingly classic antidepressants exert their effects through enhancing synaptic efficiency. Hypericin is one of the major active constituents of extracts of St. John's Wort (Hypericum perforatum L.) with antidepressive actions, but little is known about its therapeutic mechanisms. Our aim was to explore whether hypericin has a modulatory effect on neuronal action potential (AP) duration by acting on voltage-gated ion channels. EXPERIMENTAL APPROACH We used voltage-clamp and current-clamp techniques in a whole-cell configuration to study primary cultures of neonatal rat hippocampal neurones. We measured the effects of extracellularly applied hypericin on AP duration as well as on voltage-gated Na(+), I(A) and I(K) currents. KEY RESULTS Extracellularly applied hypericin dose-dependently increased AP duration but barely affected its amplitude. Further analysis revealed that hypericin inhibited both transient I(A) and delayed rectifier I(K) potassium currents. In contrast, hypericin exerted no significant effect on both Na(+) peak current and its decay kinetics. CONCLUSIONS AND IMPLICATIONS Extracellularly applied hypericin increased AP duration, which might be ascribed to its effect on I(A) and I(K) currents. As a small increase in AP duration could lead to a dramatic increase in synaptic efficiency, our results imply that hypericin might exert its antidepressant effects by enhancing presynaptic efficiency.
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Affiliation(s)
- Y Wang
- Department of Physiology, Medical College of Xiamen University, Xiamen, China
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Canning S, Waterman M, Orsi N, Ayres J, Simpson N, Dye L. The efficacy of Hypericum perforatum (St John's wort) for the treatment of premenstrual syndrome: a randomized, double-blind, placebo-controlled trial. CNS Drugs 2010; 24:207-25. [PMID: 20155996 DOI: 10.2165/11530120-000000000-00000] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Premenstrual syndrome (PMS) is a common condition. Some of the most widely prescribed medications are selective serotonin reuptake inhibitors (SSRIs), based on the hypothesized role of serotonin in the production of PMS symptoms. PMS sufferers, especially those experiencing mild to moderate symptoms, are often reluctant to take this form of medication and instead buy over-the-counter preparations to treat their symptoms, for which the evidence base with regard to efficacy is limited. Hypericum perforatum (St John's wort) influences the serotonergic system. As such, this widely available herbal remedy deserves attention as a PMS treatment. OBJECTIVE To investigate the effectiveness of Hypericum perforatum on symptoms of PMS. STUDY DESIGN This randomized, double-blind, placebo-controlled, crossover study was conducted between November 2005 and June 2007. SETTING Institute of Psychological Sciences, University of Leeds, Leeds, UK. PARTICIPATION 36 women aged 18-45 years with regular menstrual cycles (25-35 days), who were prospectively diagnosed with mild PMS. INTERVENTION Women who remained eligible after three screening cycles (n = 36) underwent a two-cycle placebo run-in phase. They were then randomly assigned to receive Hypericum perforatum tablets 900 mg/day (standardized to 0.18% hypericin; 3.38% hyperforin) or identical placebo tablets for two menstrual cycles. After a placebo-treated washout cycle, the women crossed over to receive placebo or Hypericum perforatum for two additional cycles. MAIN OUTCOME MEASURES Symptoms were rated daily throughout the trial using the Daily Symptom Report. Secondary outcome measures were the State Anxiety Inventory, Beck Depression Inventory, Aggression Questionnaire and Barratt Impulsiveness Scale. Plasma hormone (follicle-stimulating hormone [FSH], luteinizing hormone [LH], estradiol, progesterone, prolactin and testosterone) and cytokine (interleukin [IL]-1beta, IL-6, IL-8, interferon [IFN]-gamma and tumour necrosis factor [TNF]-alpha) levels were measured in the follicular and luteal phases during Hypericum perforatum and placebo treatment. RESULTS Hypericum perforatum was statistically superior to placebo in improving physical and behavioural symptoms of PMS (p < 0.05). There were no significant effects of Hypericum perforatum compared with placebo treatment for mood- and pain-related PMS symptoms (p > 0.05). Plasma hormone (FSH, LH, estradiol, progesterone, prolactin and testosterone) and cytokine (IL-1beta, IL-6, IL-8, IFNgamma and TNFalpha) levels, and weekly reports of anxiety, depression, aggression and impulsivity, also did not differ significantly during the Hypericum perforatum and placebo cycles (p > 0.05). CONCLUSION Daily treatment with Hypericum perforatum was more effective than placebo treatment for the most common physical and behavioural symptoms associated with PMS. As proinflammatory cytokine levels did not differ significantly between Hypericum perforatum and placebo treatment, these beneficial effects are unlikely to be produced through this mechanism of action alone. Further work is needed to determine whether pain- and mood-related PMS symptoms benefit from longer treatment duration. Trial registration number (International Standard Randomised Controlled Trial Number Register) ISRCTN31487459.
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Affiliation(s)
- Sarah Canning
- Institute of Psychological Sciences, University of Leeds, Leeds, UK.
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Sarris J, Kavanagh DJ. Kava and St. John's Wort: current evidence for use in mood and anxiety disorders. J Altern Complement Med 2009; 15:827-36. [PMID: 19614563 DOI: 10.1089/acm.2009.0066] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Mood and anxiety disorders pose significant health burdens on the community. Kava and St. John's wort (SJW) are the most commonly used herbal medicines in the treatment of anxiety and depressive disorders, respectively. OBJECTIVES The objective of this study was to conduct a comprehensive review of kava and SJW, to review any evidence of efficacy, mode of action, pharmacokinetics, safety and use in major depressive disorder, bipolar disorder, seasonal affective disorder (SAD), generalized anxiety disorder, social phobia (SP), panic disorder (PD), obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). METHODS A systematic review was conducted using the electronic databases MEDLINE, CINAHL, and The Cochrane Library during late 2008. The search criteria involved mood and anxiety disorder search terms in combination with kava, Piper methysticum, kavalactones, St. John's wort, Hypericum perforatum, hypericin, and hyperforin. Additional search criteria for safety, pharmacodynamics, and pharmacokinetics were employed. A subsequent forward search was conducted of the papers using Web of Science cited reference search. RESULTS Current evidence supports the use of SJW in treating mild-moderate depression, and for kava in treatment of generalized anxiety. In respect to the other disorders, only weak preliminary evidence exists for use of SJW in SAD. Currently there is no published human trial on use of kava in affective disorders, or in OCD, PTSD, PD, or SP. These disorders constitute potential applications that warrant exploration. CONCLUSIONS Current evidence for herbal medicines in the treatment of depression and anxiety only supports the use of Hypericum perforatum for depression, and Piper methysticum for generalized anxiety.
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Affiliation(s)
- Jerome Sarris
- School of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Queensland, Brisbane, Australia.
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Effects of Hypericum perforatum (St. John's wort) on hot flashes and quality of life in perimenopausal women: a randomized pilot trial. Menopause 2009; 16:307-14. [PMID: 19194342 DOI: 10.1097/gme.0b013e31818572a0] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this pilot double-blind, randomized clinical trial, which initially targeted breast cancer survivors, was to obtain preliminary evidence of the effect of Hypericum perforatum extract (St. John's wort extract) compared with placebo on symptoms and quality of life of symptomatic perimenopausal women. We also assessed practical difficulties in recruiting women to such a trial. METHODS Symptomatic perimenopausal women aged 40 to 65 years who experience hot flashes (three or more per day, Heart and Estrogen/Progestin Replacement Study scale) were randomly assigned to receive ethanolic St. John's wort extract (900 mg TID) or placebo. The women were asked to keep a daily diary during the week before randomization and during the week before the 3-month follow-up (primary outcome) to record hot flash frequency and intensity. A hot flash score (frequency x severity) was calculated. The Menopause-Specific Quality of Life questionnaire was used to assess menopause-specific quality of life. RESULTS Forty-seven women were randomized. After 12 weeks of treatment, a nonsignificant difference favoring the St. John's wort group was observed in the daily hot flash frequency (St. John's wort, -2.3 +/- 3.6; placebo, -1.0 +/- 2.2; P = 0.11) and the hot flash score (-3.8 +/- 8.3 and -1.8 +/- 6.5, respectively; P = 0.10). After 3 months of treatment, compared with the placebo group, women in the St. John's wort group reported significantly better menopause-specific quality of life (P = 0.01) and significantly fewer sleep problems (P = 0.05). CONCLUSIONS Hypericum perforatum may improve quality of life in ways that are important to symptomatic perimenopausal women, but these results need to be confirmed by a larger clinical trial.
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Borrelli F, Izzo AA. Herb-drug interactions with St John's wort (Hypericum perforatum): an update on clinical observations. AAPS JOURNAL 2009; 11:710-27. [PMID: 19859815 DOI: 10.1208/s12248-009-9146-8] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Accepted: 09/21/2009] [Indexed: 12/15/2022]
Abstract
St John's wort (SJW) extracts, prepared from the aerial parts of Hypericum perforatum, contain numerous pharmacologically active ingredients, including naphthodianthrones (e.g., hypericin and its derivatives), phloroglucinols derivatives (e.g., hyperforin, which inhibits the reuptake of a number of neurotransmitters, including serotonin), and flavonoids. Such extracts are widely used for the treatment of mild-to-moderate depression. As a monotherapy, SJW has an encouraging safety profile. However, relevant and, in some case, life-threatening interactions have been reported, particularly with drugs which are substrate of cytochrome P450 and/or P-glycoprotein. Well-documented SJW interactions include (1) reduced blood cyclosporin concentration, as suggested by multiple case reports as well as by clinical trials, (2) serotonin syndrome or lethargy when SJW was given with serotonin reuptake inhibitors, (3) unwanted pregnancies in women while using oral contraceptives and SJW, and (4) reduced plasma drug concentration of antiretroviral (e.g., indinavir, nevirapine) and anticancer (i.e., irinotecan, imatinib) drugs. Hyperforin, which is believed to contribute to the antidepressant action of St John's wort, is also strongly suspected to be responsible of most of the described interactions.
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Affiliation(s)
- Francesca Borrelli
- Department of Experimental Pharmacology, University of Naples Federico II, Via D. Montesano 49, 80131, Naples, Italy.
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Abstract
Purpose: Many patients look to complementary and alternative medicine for a herbal solution to depression. This literature review summarizes recently published research on the treatment of depression using St. John's wort ( Hypericum perforatum). Conclusions: The compounds in St. John's wort herbal preparations are more effective than placebo and, in several studies, more effective than common antidepressant medications in treating minor depression. However, the efficacy of St. John's wort for treating major depression, cyclothymia, or bipolar disorder is less evident. Although some studies are promising in the treatment of these major disorders, research support is lacking, and it is a controversial aspect of Hypericum therapy. Practice implications: As with any herbal treatment, risks from adverse reactions and drug interactions exist. Providers have an ethical and legal obligation to stay current in knowledge and to provide useful, accurate information to patients.
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Butterweck V, Schmidt M. St. John's wort: role of active compounds for its mechanism of action and efficacy. Wien Med Wochenschr 2007; 157:356-61. [PMID: 17704987 DOI: 10.1007/s10354-007-0440-8] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Accepted: 05/10/2007] [Indexed: 11/26/2022]
Abstract
St. John's wort (Hypericum perforatum L., SJW) contains numerous compounds with documented biological activity. Constituents that have stimulated the most interest include the naphthodianthrones hypericin and pseudohypericin, a broad range of flavonoids, and the phloroglucinols hyperforin and adhyperforin. According to the actual state of scientific knowledge the total extract has to be considered as the active substance. Although there are some open questions, the bulk of data suggests that several groups of active compounds are contributing to the antidepressant efficacy of the plant extract.
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Affiliation(s)
- Veronika Butterweck
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL 32608, USA.
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Sarris J. Herbal medicines in the treatment of psychiatric disorders: a systematic review. Phytother Res 2007; 21:703-16. [PMID: 17562566 DOI: 10.1002/ptr.2187] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
This paper reports a critical review of 27 herbal medicines and formulas in treating a broad range of psychiatric disorders (in addition to anxiety and depression), including obsessive-compulsive, seasonal affective, bipolar depressive, psychotic, phobic and somatoform disorders. Ovid Medline, Pubmed and the Cochrane Library were searched for pharmacological and clinical evidence of herbal medicines with psychotropic activity. A forward search of later citations was also conducted. Whilst substantial high-quality evidence exists for the use of kava and St John's wort in the treatment of anxiety and depression respectively, currently there is insufficient robust clinical evidence for the use of many other herbal medicines in psychiatric disorders. Phytotherapies which potentially have significant use in psychiatry, and urgently require more research are Rhodiola rosea (roseroot) and Crocus sativus (saffron) for depression; Passiflora incarnata (passionflower), Scutellaria lateriflora (scullcap) and Zizyphus jujuba (sour date) for anxiety disorders; and Piper methysticum (kava) for phobic, panic and obsessive-compulsive disorders. While depression and anxiety are commonly researched, the efficacy of herbal medicines in other mental disorders requires attention. The review addresses current issues in herbal psychotherapy: herbal safety, future areas of application, the relationship of herbal medicine with pharmaceuticals and the potential prescriptive integration of phytomedicines with synthetic psychotropic medicines. Particular attention is given to clinical and safety issues with St John's wort and kava.
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Affiliation(s)
- Jerome Sarris
- School of Medicine, Department of Psychiatry, University of Queensland, Brisbane, Australia.
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