CNS Drugs

, Volume 9, Issue 6, pp 431–440 | Cite as

Hypericum Extract

Potential in the Treatment of Depression
  • David Wheatley
Leading Article

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.

Keywords

Adis International Limited Imipramine Amitriptyline Hypericin Maprotiline 

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Copyright information

© Adis International Limited 1998

Authors and Affiliations

  • David Wheatley
    • 1
  1. 1.Charter Chelsea ClinicLondonEngland

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