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Hypericum Extract

Potential in the Treatment of Depression

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Summary

Extracts of the plant Hypericum perforatum (St John’s Wort) have been used in herbal medicine since antiquity. In Germany, such extracts currently outsell fluoxetine as a treatment for depression. The active constituent of hypericum extracts is unknown, but does not appear to be hypericin, the constituent by which the extracts are standardised.

Hypericum exhibits many of the effects of other antidepressants in animal models of depression. Clinical data indicate that hypericum is an effective anti-depressant. In the 14 double-blind placebo-controlled trials that have been performed to date, 55.1% of patents receiving hypericum were classified as responders (defined as those patients showing a 50% reduction in the severity of depression from baseline), compared with 22.3% of patients receiving placebo. In similar comparative trials, hypericum was shown to be as effective as standard tricyclic antidepressants (imipramine, amitriptyline and maprotiline).

Hypericum appears to be very well tolerated. In a recent comparative trial, 63% of patients receiving hypericum (LI 160) reported that they experienced no adverse effects during treatment. In contrast, only 36% of amitriptyline-treated patients reported no adverse effects (p < 0.05). Hypericum was also associated with significantly less dry mouth and drowsiness than amitriptyline. Photosensitivity has been reported in cows that have eaten large quantities of hypericum; however, no cases of photosensitivity have been reported in humans.

Data indicate that hypericum is a well tolerated alternative to synthetic drugs for the treatment of mild-to-moderate depression, particularly in patients who are intolerant of standard antidepressants. Trials comparing the effect of hypericum with selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors and other newer antidepressants, and assessing the effect of higher dosages in patients with severe depression, are required to fully determine the place of hypericum in the treatment of depressive illness.

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References

  1. Lohse MJ, Muller-Oerlinghausen B. In: Schwabe U, Paffrath D, editors. Arznieverordnungsreport ’94. Stuttgart: Gustav Fischer, 1994: 354–70

    Google Scholar 

  2. Monthly marketing data. Institute for Medical Statistics. Frankfurt: IMS, 1997 Dec

    Google Scholar 

  3. Coffey T. The history and folklore of North American wild-flowers. Boston: Houghton Mifflin, 1993: 64-6

    Google Scholar 

  4. Grigson G. The Englishman’s flora. London: Hart-Davis, MacGibbon, 1958: 83–9

    Google Scholar 

  5. Porcher FP. Resources of the southern fields and forests: medical, economical and agricultural: prepared and published by order of the surgeon-general. Richmond (VA) 1863. Reprint. New York: Arno Press, 1970

    Google Scholar 

  6. Nahrstedt A, Butterweck V. Biologically active and other constituents of the herb of Hypericum perforation. Pharmacopsychiatry 1997; 30 Suppl. II: 129–34

    Article  Google Scholar 

  7. Cott JM. In vitro receptor binding and enzyme inhibition by Hypericum perforatum extract. Pharmacopsychiatry 1997; 30 Suppl. II: 108–12

    Article  Google Scholar 

  8. Müller WE, Rolli M, Schäfer C, et al. Effects of hypericum extract (LI 160) in biochemical models of antidepressant activity. Pharmacopsychiatry 1997; 30 Suppl. II: 102–7

    Article  Google Scholar 

  9. Teufel-Mayer R, Gleitz J. Effects of long-term administration of hypericum extracts on the affinity and density of the central serotonergic 5-HT1A and 5-HT2A receptors. Pharmacopsychiatry 1997; 30 Suppl. II: 113–6

    Article  Google Scholar 

  10. Özturk Y, Aydin S, Özturk N, et al. Effects of certain hypericum species on the central nervous system of mice [abstract]. Phytomedicine Int J Phytother Phytopharmacol 1996/7; 3 Suppl. 1: 102

    Google Scholar 

  11. Özturk YTesting of antidepressant effects of hypericum species on animal models. Pharmacopsychiatry 1997; 30 Suppl. 2: 125–8

  12. Butterweck V, Wall A, Liefl: ander-Wulf, et al. Effects of the total extract and fractions of Hypericum perforatum in animal assays for antidepressant activity. Pharmacopsychiatry 1997; 30 Suppl. II: 117–24

    Article  Google Scholar 

  13. Winterhoff H, Butterweck V, Nahrstedt A, et al. Pharmacologische Untersuchungen zur antidepressiven Wirkung von Hypericum perforatum L. In: Loew D, Rietbrock N, editors. Phytopharmaca im forschund Klinischer anwendung. Steinkopf: Dannstadt, 1995: 39–56

    Chapter  Google Scholar 

  14. Brockmöller J, Reum T, Bauer S, et al. Hypericin and pseudohypericin: pharmacokinetics and effects on photosensitivity in humans. Pharmacopsychiatry 1997; 30 Suppl. 2: 94–101

    Article  Google Scholar 

  15. Linde K, Ramirez G, Mulrow CD, et al. St John’s Wort for depression: an overview and meta-analysis of randomised clinical trials. BMJ 1996; 313: 253–8

    Article  PubMed  CAS  Google Scholar 

  16. Hänsgen KD, Vesper J, Ploch M. Multi-center double-blind study examining the antidepressant effectiveness of hypericum extract LI 160. J Geriatr Psychiatry Neurol 1994; 7 Suppl. 1: 15–8

    Article  Google Scholar 

  17. Halama P. Wirksamkeit des Johanniskrautextractes LI 160 bei depressiver Verstimmung. Nervenheilkunde 1991; 10: 250–3

    Google Scholar 

  18. Harrer G, Schmidt U, Khun U. ‘Alternative’ depressions-behandlungmit einem hypericum-extrakt. Therapiewoche Neurologie-Psychiatrie 1991; 5: 710–6

    Google Scholar 

  19. Hoffman J, Kuhl ED. Therapie von depressiver zustanden mit hypericin. Z Allgemeinmed 1979; 55: 776–82

    Google Scholar 

  20. Hübner WD, Lande S, Podzuweit H. Hypericum treatment of mild depression with somatic symptoms. J Geriatr Psychiatry Neurol 1994; 7 Suppl. 1: 12–5

    Article  Google Scholar 

  21. Konig CD. Hypericum perforatum L (gemeines Johanniskraut) als Therapeutikum bei depressiven Verstimmungszustanden: eine Alternative zu synthetischen Arzneimittelm [thesis]. Basel: University of Basel, 1993

    Google Scholar 

  22. Lehrl S, Woelk H. Ergebnisse von Messungen der kognitiven Leistungsfähigkeit bei Patienten unter der Therapie mit Johanniskraut. Nervenheilkunde 1993; 12: 281–4

    Google Scholar 

  23. Osterheider M, Schmidtke A, Beckmann H. Behandlung depressiver Syndrome mit Hypericum (Johanniskraut): eine placebokontrollierte Doppelblindstudie. Fortschr der Neurologie-Psychiatrie 1992; 60 Suppl. 2: 210–1

    Google Scholar 

  24. Quandt J, Schmidt U, Schenk N. Ambulante Behandlung leichter und mittelschwerer depressiver Verstimmungen. Der Allgemeinarzt 1993; 2: 97–102

    Google Scholar 

  25. Reh C, Laux P, Schenk N. Hypericum-Extrakt bei Depressionen: eine wirksame Alternative. Therapiewoche 1992; 42: 1576–81

    Google Scholar 

  26. Schlich D, Braukmann F, Beckmann H. Behandlung depressiver Zustände mit Hypericin. Zur Therapie depressiver Verstimmungen. Psycho 1987; 13: 440–7

    Google Scholar 

  27. Schmidt U, Schenk N, Schwartz I, et al. Zur Therapie depressiver Verstimmungen. Psycho 1989; 15: 665–71

    Google Scholar 

  28. Schmidt U, Sommer H. Johanniskraut-Extrakt zur ambulanten Therapie der Depression. Fortschr Med 1993; 111: 339–42

    PubMed  CAS  Google Scholar 

  29. Sommer H, Harrer G. Placebo-controlled double-blind study examining the effectiveness of a hypericum preparation in 105 mildly depressed patients. J Geriatr Psychiatry Neurol 1994; 7 Suppl.: 9–11

    Article  Google Scholar 

  30. Ditzler K, Gessner B, Schatton WFH, et al. Clinical trial on Neuropas versus placebo in patients with mild to moderate depressive symptoms: a placebo-controlled, randomised double-blind study. Complementary Ther Med 1994; 2: 5–13

    Article  Google Scholar 

  31. Bergmann R, Nubner J, Demling J. Behandlung leichter bis mittelschwerer depressionen. Therapiewoche Neurologie-Psychiatrie 1993; 7: 235–40

    Google Scholar 

  32. Harrer G, Hubner WD, Podzuweit H. Effectiveness and tolerance of the hypericum extract LI 160 compared to maprotiline: a multi-center double-blind study. J Geriatr Psychiatry Neurol 1994; 7 Suppl.: 24–8

    Article  Google Scholar 

  33. Kugler J, Weidenhammer W, Schmidt A, et al. Therapie depressiver Zustände. Z Allgemeinmed 1990; 66: 21–9

    Google Scholar 

  34. Vorbach EU, Hubner WD, Arnoldt KH. Effectiveness and tolerance of the hypericum extract LI 160 in comparison with imipramine: randomized double-blind study in 135 outpatients. J Geriatr Psychiatry Neurol 1994; 7 Suppl. 1: 19–23

    Article  Google Scholar 

  35. Warnecke G. Beeinflussung klimacterische Depressionen. Z Allgemeinmed 1986; 62: 1111–3

    Google Scholar 

  36. Vorbach EU, Arnold KH, Hubner WD. Efficacy and tolerability of St Johns Wort extract hypericum extract LI 160 in patients with severe depressive incidents according to ICD-10. Pharmacopsychiatry 1997; 30 Suppl.: 81–5

    Article  PubMed  CAS  Google Scholar 

  37. Kniebel R, Burchard JM. Therapie depressiver Verstimmungen in der praxis. Z Allgemeinmed 1986; 64: 689–96

    Google Scholar 

  38. Steger W Depressiver Verstimmungen. Z Allgemeinmed 1985; 61: 914–8

    Google Scholar 

  39. World Health Organization. International classification of diseases. 9th rev. Geneva: World Health Organization, 1988

    Google Scholar 

  40. World Health Organization. International classification of diseases. 10th rev. Geneva: World Health Organization, 1992

    Google Scholar 

  41. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd rev. ed. Washington, DC: American Psychiatric Association, 1987

    Google Scholar 

  42. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994

    Google Scholar 

  43. Wheatley D. LI 160, an extraxt of St. John’s Wort, versus amitriptyline in mildy to moderately depressed outpatients — a controlled 6-week clinical trial. Pharmacopsychiatry 1997; 30 Suppl. II: 77–80

    Article  Google Scholar 

  44. Lane R, Baldwin D, Preskorn S. The SSRIs: advantages, disadvantages and differences. J Psychopharmacol 1995; 9(2): 163–78

    PubMed  CAS  Google Scholar 

  45. Woelk H, Burkhard G, Grunwald J. Benefits and risks of the Hypericum extract LI 160: drug monitoring with 3250 patients. J Geriatr Psychiatry Neurol 1994; 7 Suppl. 1: 34–8

    Article  Google Scholar 

  46. Leuschner J. Preclinical toxicological profile of hypericum extract LI 160 [abstract]. Phytomedicine Int J Phytother Phytopharmacol 1996/7; 3 Suppl. 1: 104

    Google Scholar 

  47. Beaumont G, Baldwin D, Lader M. A criticism of the practice of prescribing subtherapeutic doses of antidepressants for the treatment of depression. Hum Psychopharmacol 1996; 11: 283–91

    Article  Google Scholar 

  48. Dunbar GC, Cohn LF, Feighner JP. A comparison of paroxetine, imipramine and placebo in depressed outpatients. Br J Psychiatry 1991; 159: 394–8

    Article  PubMed  CAS  Google Scholar 

  49. Mendels J, Johnson R, Mattes J, et al. Efficacy and safety of b.i.d. doses of venlafaxine in a dose-response study: Psychopharmacol Bull 1993; 29: 169–74

    CAS  Google Scholar 

  50. Rosenberg C, Damso N, Fuglum E, et al. Citalopram and imipramine in the treatment of depressive patients in general practice: a Nordic multicentre clinical study. Int Clin Psychopharmacol 1994; 9 Suppl. 1: 41–8

    Article  Google Scholar 

  51. Fish D. What is an effective dose? [letter] BMJ 1997; 314: 826

    Article  PubMed  CAS  Google Scholar 

  52. Moore MV. More on what is an effective dose [letter]. BMJ 1997; 314: 826

    Article  PubMed  CAS  Google Scholar 

  53. Gill G. Systematic review of all pertinent trials is required to establish guidelines [letter]. BMJ 1997; 314: 826–7

    Article  PubMed  CAS  Google Scholar 

  54. Tan RS. Low dose tricyclic antidepressants are effective in treating major depression [letter]. BMJ 1997; 314: 827

    PubMed  CAS  Google Scholar 

  55. Burrows GD, Norman T. Antidepressants: clinical aspects. Stress Med 1997; 13: 167–72

    Article  Google Scholar 

  56. Wheatley D, Smith D, editors. Psychopharmacology of cognitive and psychiatric disorders in the elderly. London: Chapman & Hall, 1997

    Google Scholar 

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  1. Charter Chelsea Clinic, 7 Radnor Walk, London, SW3 4PB, England

    David Wheatley

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Wheatley, D. Hypericum Extract. Mol Diag Ther 9, 431–440 (1998). https://doi.org/10.2165/00023210-199809060-00002

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