History and Origins
A plant of many faces, St. John's wort (Hypericum perforatum) is regarded as wildflower, weed, and an herb. As a healthful plant it has interested herbalists since the earliest Greek herbals. The first century Greek physicians Galen and Dioscorides recommended it as a diuretic, wound healing herb, and a treatment for menstrual disorders. In the sixteenth century Paracelsus, who ushered in the era of mineral medicines, used St. John's wort externally for treating wounds and for allaying the pain of contusions.

In the Middle Ages, remarkable, even mystical properties were bestowed upon the herb. It was used as a talisman to protect one from "demons." Harvesting herbs during Medieval times meant collecting the herb on a specific day, often a day with religious significance. Whether the mention of a specific holy day was simply a means by which to convey the best time of year to harvest the herb, or whether it is believed that collection on that day imbued the herbs with greater power, is subject to speculation. St. John's wort, as you might guess, is best harvested on St. John's day (June 24th), which is often the time of peak blooming. If a sprig of the herb were placed under the pillow on St. John's Eve, St. John himself may even appear in a dream, blessing the dreamer for another year.

The name Hypericum derives from the Greek name for the plant "hyperikon." The word roots are hyper (meaning over) and eikon (meaning image). Botanists from the time of Linnaeus, the father of modern botanical science, have attempted to describe the origins in various ways. One meaning translating to "almost over ghosts" refers to mystical properties attributed to the plant from Medieval times. The common name St. John's wort derives from Anglo-Saxon tradition, when the plant was considered to drive away evil spirits and ward off the devil's temptations.

St. John's wort is native to Europe, occurring throughout that continent, except the extreme North. Hypericum is a large genus with about 300 species. Hypericum perforatum is a much-branched perennial herb growing from one to three feet high. The leaves are covered by translucent dots easily seen by holding the leaves up to a light; these are the perforations that give the plant its species designation "perforatum". When the fresh flowers are crushed, they exude a blood-red juice, which stains the fingers blue-violet.

Herb or Weed?
While St. John's wort is native to Europe, it is naturalized in waste places and along roadsides in Asia, Africa, North and South America and Australia. It is one of those European native plants that has followed European settlers wherever they have traveled in the world. The plant was introduced by early settlers to North America, and by 1793, the first recorded specimen, grown without cultivation, was collected in Pennsylvania.

Especially vigorous populations in western North America and Australia have made it a serious weed problem. It is particularly aggressive in rangelands with dry summers. Historically, the greatest economic importance of the herb focuses on St. John's wort as serious weed of rangelands in Europe, Asia, North and South Africa, Australia, and eastern and western North America. Its economic impact is considered detrimental because it invaded pastures, leaving them a blaze of yellow flowers. Most North American scientific studies devoted to the plant ironically have focused on how to eradicate the plant. Despite its value as a medicinal plant, eradication programs have been developed in Canada, California and Australia to eliminate this invasive foreigner. A natural enemy of the plant, the Chrysolina beetle has been used in California and introduced into Canada as a natural biological control to kill the plant. Now interest is again turning to how the herb can be used in medicine.

Twentieth Century Use
Given the superstitions surrounding the herb, physicians had dismissed it as a folk medicine by the mid-nineteenth century. Interest in the medicinal uses of the plant was kept alive by Eclectic medical practitioners in the United States, who found it to be a useful wound healing agent, especially for lacerations involving damage to nerves, as well as a diuretic, astringent, nervine, and mild sedative. A survey among physicians conducted in 1938 by a German physician, Dr. Gerhard Madaus, found that St. John's wort preparations were being utilized for nerve conditions, and disorders induced by "excessive intellectual efforts." It was also being used for neuroses, general restlessness and insomnia.

In Europe, St. John's wort it is still widely used as a medicinal plant, in home remedies and pharmacy products. A tea made from the plant is popularly used as a mild nerve tonic for the treatment of anxiety, depression, insomnia, and general unrest. It is also used as a diuretic, and for the treatment of gastritis. Vegetable oil preparations of the flowers are used externally for the treatment of hemorrhoids and inflammation. According to Dr. Dennis Awang, alcoholic tinctures and vegetable oil extracts of the flowers are official remedies in the pharmacopeias of eastern European countries such as the Czech Republic, Slovakia, Poland, Romania, Russia. Dr. Awang also writes that two preparations are widely prescribed in Russia as antibacterials, which are claimed to be more effective against Staphylococcus aureus than sulfanilamide (sulfa drugs).

St. John's Wort and Depression
In the past decade, most of the scientific attention on St. John's wort and its preparations has been to study its potential for use in the treatment of mild to moderate forms of depression. The preparations enhance mood over a long period of time, generally not producing positive results for at least two to three weeks, and often taking two to three months before producing beneficial results. This shows one of the general differences traditionally recognized for herbal medicines. They often take a relatively long period of time to produce beneficial results compared with "magic bullet" conventional medicines, whose effects are often experienced immediately or within a few hours of treatment.

How it works
A number of recent studies have focused on the pharmacological mechanisms and clinical use of St. John's wort for the treatment of depression. A 1984 study by Suzuki and co-workers demonstrated that hypericin, a red component abundant in the flowers of St. John's wort, inhibited type A and type B monoamine oxidase. Monoamine oxidase inhibitors have been used for the treatment of depression because they help to curb an enzyme that breaks down monoamine, which is a precursor of norepinephrine, a neurotransmitter. Neurotransmitters carry nerve impulses through particular nerve pathways. It has been suggested that some types of clinical depression may results from a decrease in the effectiveness of neurotransmitters in the brain. Since hypericin was shown to inhibit types A and B monoamine oxidase, it was suggested as a possible basis for the anti-depressant activity of the plant, though the results are not conclusive. Other mechanisms of action could be involved.

While many St. John's wort products available in both the European and American market are standardized to hypericin, this compound has not been unequivocally linked to the herb's antidepressant activity. While some studies suggest that hypericin or hypericin-like compounds may be linked to antidepressive activity, those conclusions have recently come into question. The active constituent is still not clearly known.

Clinical Studies
Early trials in 1984, showed that after taking a standardized extract of St. John's wort, 15 women had improvements in symptoms of anxiety including depression, insomnia, and feelings of worthlessness, among other indicators. This sparked more research. Up to 1993 there had been 25 controlled clinical studies measuring the antidepressive effectiveness of St. John's wort, involving 1592 individual patients. Dosages ranged between 300-900 mg of an extract (representing all constituents in the tops of the plants), for two to sixteen weeks in duration. Fifteen of the studies were placebo-controlled studies and ten studies compared St. John's wort-containing preparations with other substances. Unfortunately, most of the studies conducted from up to 1989 included preparations containing both St. John's wort and valerian. Therefore, it was not possible to attribute any beneficial effects specifically to one herb or the other. While these studies showed good benefits with few or no reports of side effects, credible clinical studies on St. John's wort begin with trials in 1987.

A recent 1994 randomized placebo-controlled double blind study by a psychiatrist, an internal specialist, and a general practitioner in Austria evaluated the effect of St. John's wort on 105 out-patients diagnosed with mild to moderate depression or temporary depressive moods. Patients were given the equivalent of 300 mg of St. John's wort extract (standardized to a hypericin content of 0.9 mg) or a placebo preparation three times per day (900 mg per day) for a period of 4 weeks. The results of eight patients both in the placebo group and treatment group were not assessed in the final results. In the treatment group 67 percent were assessed to respond to treatment, while only 28 percent responded in the placebo group. Treatment group patients were assessed as having significant improvements in depressive mood indicators (feeling of sadness, hopelessness, helplessness, and uselessness), as well as emotion fear, and symptoms of difficult or disturbed sleep. No significant side effects were observed. These researchers concluded that compared with synthetic antidepressants, the St. John's wort extract produced side effects of minor significance, and that the extract can be recommended for the treatment of mild and moderate depression. However, the authors cautioned that while St. John's wort was evaluated to be safe and effective treatment for mild to moderate forms of depression (as determined by the Hamilton depression scale, a standard used to classify forms of depression), that St. John's wort preparations were not suitable for serious depression. Serious or severe depression can included psychotic symptoms such as delusion, depression with increased suicidal risk, or intense depression that does not allow for the normal continuation of profession or family life. In these cases, more intensive treatment under the case of psychiatric professionals is required.

Generally speaking, the results of one study can only point to the need for more studies. Scientific consensus on safety and effectiveness is not achieved until studies are repeated and replicated, show similar outcomes, and involve a relatively large number of patients. To date, there are over 20 clinical studies on St. John's wort preparations, which can be evaluated for results. Consequently, in 1995, E. Ernst, a researcher with the Centre for Complementary Health Studies and Postgraduate Medical School at the University of Exeter authored a critical assessment of all controlled clinical trials on the use of St. John's wort as a treatment for depression. Ernst's literature search revealed fourteen St. John's wort studies conducted using a placebo for comparison, and four studies comparing St. John's wort extracts to standard antidepressive drugs. Analyzing the quality of the studies using a scoring system assessing eleven different factors, the author concluded that eight placebo controlled studies, and three of the four standard drug comparison studies met the rigorous evaluative criteria. The cumulative data of all the studies was then evaluated, and it was concluded that St. John's wort extract was superior to placebo in alleviating symptoms of depression. It was also found to be equally effective to standard medication. Furthermore, the St. John's wort preparations had a clear advantage over standard medications - a much lower frequency of adverse reactions. The conclusion - St. John's wort is a safe and effective for symptomatic treatment of mild to moderate forms of depression.

Hypericism and other Cautions
It is important to note that St. John's wort should not be taken at the same time as widely prescribed conventional antidepressive drugs. Monoamine oxidase (MAO) inhibiting antidepressants are not prescribed with other classes of antidepressant drugs. Since MAO-inhibiting activity has been linked to St. John's wort, it would be potential dangerous in combination with conventional, widely prescribed antidepressants such as Prozac. Depression is a condition that requires professional medical diagnosis and treatment. If you are being treated for depression and are taking or contemplating taking St. John's wort, this treatment option should be discussed with your health care professional, especially if he or she has prescribed other drug therapies.

The weed eradication programs targeting St. John's wort are sparked in part because of the herb's potential toxicity to livestock, particularly sheep causing "photodermatitis" or "photo-toxicity". A condition called "hypericism," was first recorded in 1787. When light-skinned livestock, such as sheep, goats, horses, and cattle ingest the plant, then are exposed to bright sunlight, they develop welts on the skin, and other symptoms. Dark-skinned animals are unaffected. This photodermatitis is the result of the interaction of sunlight and oxygen with the pigment hypericin, after it has been ingested, absorbed though the intestinal wall, and reaches the blood without being eliminated by the liver or kidneys. The photosensitization does not occur, and has not been recorded, from external contact with the plant by animals or humans.

This reaction has generally not been reported in humans. Side effects are not reported in clinical studies on using St. John's wort for depression. The pure synthesized compound hypericin (in assessing potential anti-HIV activity) has caused photodermatitis in humans. Fair-skinned individuals should be advised of the potential problem, especially after ingesting St. John's wort, then being exposed to bright sunlight.

According to the German government's official monograph on the subject, a dose of 2-4 g of herb (0.2-1.0 mg hypericin), are used for mild antidepressant action (MAO inhibitor), or nervous disturbances. But remember, depression is not like the common cold. It is not a condition subject to self-diagnosis or self-treatment. Therefore, professional medical advice is essential when considering the use of St. John's wort for the treatment of mild to moderate forms of depression.

St. John's Wort Oil
St. John's wort oil is used for bruises, is anti-inflammatory, and is often used by herbalists to help speed healing of wounds and sores. St. John's wort oil has antiphlogistic qualities, in other words, it helps to reduce inflammation. Externally it is applied to bruises, sprains, burns, skin irritations, or any laceration accompanied by severed nerve tissue. The German government allows such external St. John's wort preparations to be labeled for the treatment or after treatment of sharp or abrasive wounds, myalgias (muscular pain) as well as first degree burns.

This is not a new herbal treatment, but one that has been handed down for hundreds of years. Once known to pharmacists as "red oil" or "Hypericum liniment," it was still available in pharmacies in the early twentieth century. The practice of soaking the flowers in olive oil, infusing the oil in the sun, then using the oil internally as a diuretic and external application for wounds dates at least to the time of the first edition of Gerarde's Herball (1597).

It is simple to make St. John's wort oil. The herb is harvested just as the plant comes into bloom. Take about one cupful of the fresh flowers, adding a sufficient quantity of olive oil to just cover the flowers. The fresh herb should be finely cut or crushed, covered with the oil, then placed in the sun or warm area for two to three weeks until the herb imparts its qualities to the oil. Shaking it once a day helps to bring more plant cell surfaces in contact with the menstruum, enhancing this simple extraction process. Once the allotted time (2-3 weeks) has passed, the herb should be pressed, strained from the oil, then stored in a dark, closed container in a cool place.

The yellow flowers will turn the oil a deep blood-red color. Basically you are extracting the pigment, hypericin, considered one of the biologically active compounds of the plant, found in the flowers as little black dots along the petal margins. It is best to use the fresh flowers, as hypericin may degrade upon drying. Store the oil for up to a year in a cool dark place.

References:

1. Awang, DVC. St. John's Wort. Canadian Pharmaceutical Journal, 1991,124:33-35.
2. Bombardelli, E. and P. Morazzoni. Hypericum perforatum, Fitoterapia, 1995, 62(1):43-68.
3. Crompton, C. W., I. V. Hall, K. I. N. Jensen, and P. D. Hildebrand. The Biology of Canadian Weeds. 83. Hypericum perforatum L., 1988, Canadian Journal of Plant Sciences. 68:149-62.
4. Foster, S. Herbs for Your Health, Loveland, Colorado: Interweave Press, 1996.
5. Ernst. E. St. John's Wort, An Anti-Depressant? A Systematic, Criteria-Based Review. Phytomedicine 1995, 2(1):67-71.
6. Hahn, G. Hypericum perforatum (St. John's Wort) - A Medicinal Herbs Used in Antiquity and Still of Interest Today. The Journal of Naturopathic Medicine, 1992, 3(1):94-96.
7. Harrer, G. and H. Sommer. Treatment of Mild/Moderate Depressions with Hypericum. Phytomedicine. 1994, 1(1):3-8.
8. Hobbs, C. St. John's Wort. HerbalGram 1988/1989, 18/19:24-33.
9. Reichert, R. St. John's Wort Extract as a Tricyclic Medication Substitute for Mild to Moderate Depression. Quarterly Review of Natural Medicine, 1995, (Winter):275-278.