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St Johns Wort

Hypericum perforatum is the most medicinally important species of the Hypericum genus, commonly known as St. John's wort.

General Use

St. John's wort has been known for its medicinal properties as far back as Roman times. The herb is regarded as a vulnerary, and can speed the healing of wounds, bruises, ulcers and burns. It is popularly used as a nervine for its calming effect, easing tension and anxiety, relieving mild depression, and soothing women's mood swings during menopause. The bittersweet herb is licensed in Germany for use in mild depression, anxiety, and sleeplessness. It is said to be helpful in nerve injury and trauma, and was used in the past to speed healing after brain surgery. Its antispasmodic properties have been thought to ease uterine cramping and menstrual difficulties. St. John's wort may also be used as an expectorant.

The hypericin in St. John's wort possesses antiviral properties that are said to be effective against certain cancers. An infusion of the plant taken as a tea has been helpful in treating bed-wetting in children. The oil has been used internally to treat colic, intestinal worms and abdominal pain. The plant's medicinal parts are its fresh leaves and flowers. This herbal remedy has been extensively tested in West Germany, and is dispensed throughout Germany as a popular medicine called Johanniskraut. Commercially prepared extracts are commonly standardized to contain 0.3% hypericin.
In April 2002 The National Center for Complementary and Alternative Medicine (NCCAM) in the United States released the results of a large-scale multi-site study which reported that St. John's wort is no more effective than a placebo for treating major depression of moderate severity.

Precautions

There are a number of important precautions to observe in using St. John's wort. Pregnant or lactating women should not use the herb at all. Persons taking prescription antidepressants of any kind should not use St. John's wort at the same time, as the herb may precipitate a health crisis known as serotonin syndrome. Serotonin syndrome is potentially life-threatening, and is characterised by changes in level of consciousness, behaviour, and neuromotor functioning as a result of increased levels of the neurotransmitter serotonin in the central nervous system. Drug interactions are the most common cause of serotonin syndrome. Several cases of serotonin syndrome have been reported in patients who were taking St. John's wort by itself or in combination with SSRIs, fenfluramine (Pondimin), or nefazodone (Serzone). Persons using the herb should discontinue it a minimum of two weeks prior to any surgery requiring general anaesthesia, as it interacts with a number of intravenous and inhaled anaesthetics.

Side-Effects

When used either internally or externally, the herb may cause photodermatitis in humans with fair or sensitive skin, following exposure to sunlight or other sources of ultraviolet light. There have also been some case reports of side-effects in breast-feeding women taking hypericum extract. Changes in the nutritional quality and flavour of the milk, as well as reduction or cessation of lactation, have been reported. In addition, St. John's wort has been known to cause headaches, stiff neck, nausea or vomiting, and high blood pressure in susceptible individuals.

Interactions

St. John's wort has a number of problematic interactions with many drugs. It has been reported to interact with amphetamines, asthma inhalants, decongestants, diet pills, narcotics, tryptophan and tyrosine (amino acids), as well as antidepressant medications and certain foods. It has also been reported to interfere with the effectiveness of birth control pills, indinavir (Crixivan) and other AIDS medications.

Anaesthesiologists have reported that the herb increases bleeding time in patients under general anaesthesia. Patients should always consult a mainstream health practitioner before using St. John's wort, and should discontinue taking it at least two weeks prior to major surgery.

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