Hypericaceae (Clusiaceae) Perforate St. John’s wort Hyperici herba; Hyperici oleum Aerial parts, including dried flowering tops; oil extract of herb The main active components are the hypericins (naphthodianthrones), which include hypericin, isohypericin, pseudohypericin and protohypericin; and the hyperforins (prenylated phloroglucinols) including hyperforin, adhyperforin and their derivatives. Flavonoids including kaempferol, quercetin glycosides, hyperoside, biapigenin and amentoflavone, other polyphenolic constituents including caffeic and chlorogenic acids, and a volatile oil are also present (Butterweck 2009; Russo et al. 2014). Much of the research, and most of the clinical studies, have been conducted using special extracts such as WS® 5570®, Li160® and Ze 117. These products are standardised to hypericins (approximately 0.3%) and sometimes to hyperforin and flavonoids (variable amounts). For details on compositions and individual trials, see Kasper et al. (2012), and for the importance of each type of constituent, see Butterweck (2009). Preparations with low hyperforin content (see drug interaction section) are also available (e.g. Ze 117). Many clinical studies have been carried out on St. John’s wort (SJW), not all of good quality. The most recent Cochrane review evaluated 29 randomised double-blind trials (5489 patients with mild-to-moderately severe depression) comparing extracts of the herb with placebo or conventional antidepressants, administered between 4 to 12 weeks. Overall, SJW extracts were found to be superior to placebo, and with similar effectiveness to standard antidepressants, but with fewer side effects. SJW is often prescribed by physicians in German-speaking countries, where the study results were more favourable than from elsewhere (Linde et al. 2008). More recent reviews of randomised controlled clinical trials and other evidence (e.g. Gastpar 2013; Kasper et al. 2012; Russo et al. 2014) confirm the usefulness of SJW as an alternative to conventional antidepressants and conclude that it has a favourable safety profile, with adverse event rates similar to those of placebo and lower than that of synthetic antidepressants, but that potential drug interactions are a concern. Preparations containing low amounts of hyperforins (see drug interaction section) are available (e.g. Ze 117) and have been shown to retain antidepressant activity (Nahrstedt and Butterweck 2012), although the evidence for their efficacy is not as strong. A hyperforin-rich cream was found to strengthen skin barrier function by reducing radical formation (78% compared to 45% placebo) and stabilising stratum corneum lipids during visible/near-infrared (VIS/NIR) irradiation over 4 weeks in human volunteers (Haag et al. 2014). Hyperici oleum (HO), the oil extract of SJW, was tested for anti-inflammatory activity using a sodium lauryl sulphate test. Three oil-in-water creams containing 15% (w/v) of HO were formulated, and all demonstrated significant anti-inflammatory effects in an in vivo study. All possessed some antimicrobial activity, with the olive oil extract being the most potent (the others were palm and sunflower oils) (Arsić et al. 2011).
St. John’s Wort
Hypericum perforatum L.
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