Adverse effects profile of the herbal antidepressant St. John's wort (Hypericum perforatum L.)

@article{Ernst1998AdverseEP,
  title={Adverse effects profile of the herbal antidepressant St. John's wort (Hypericum perforatum L.)},
  author={Edzard Ernst and Julia I Rand and Joanne Barnes and Clare D Stevinson},
  journal={European Journal of Clinical Pharmacology},
  year={1998},
  volume={54},
  pages={589-594}
}
AbstractObjective: This paper provides a systematic review of adverse drug reactions (ADRs) associated with the use of extracts of the herb St. John's wort (Hypericum perforatum L.) for the treatment of mild to moderate depression. Methods: Searches of four computerized literature databases were performed for records of (ADRs). Manufacturers of hypericum products, the international drug monitoring centre of the World Health Organization (WHO) and the national drug safety monitoring bodies of… 

St John's wort (Hypericum perforatum): drug interactions and clinical outcomes.

TLDR
Possible pharmacodynamic interactions with selective serotonin re-uptake inhibitors and serotonin (5-HT(1d)) receptor-agonists such as triptans used to treat migraine were identified and are associated with an increased risk of adverse reactions.

St. John's wort (Hypericum perforatum): a review of the current pharmacological, toxicological, and clinical literature

TLDR
The data suggest that therapeutic preparations of Hypericum extract appear to exert potentially significant pharmacological activity within several neurochemical systems believed to be implicated in the pathophysiology of depression.

MECHANISMS OF DRUG ACTION The experimental and clinical pharmacology of St John's Wort (Hypericum perforatum L.)

TLDR
Although pre-clinical and short-term clinical studies demonstrate antidepressant activity, the lack of long-term use and efficacy, and the heterogeneity of patients, interventions, extract preparations from previous clinical studies suggests that more careful and controlled studies are needed to determine the long- term efficacy of hypericum in mild-to-moderate depression.

Hypericum Perforatum: A ‘Modern’ Herbal Antidepressant

TLDR
Until now, the pharmacokinetic profile of the flavonoids in humans after oral administration of an alcoholic H. perforatum extract has been investigated in only one study, but more data are available for rutin and the aglycone quercetin after administration of pure substances or other flavonoid sources.

The experimental and clinical pharmacology of St John's Wort (Hypericum perforatum L.)

  • P. Nathan
  • Psychology, Biology
    Molecular Psychiatry
  • 1999
TLDR
Although pre-clinical and short-term clinical studies demonstrate antidepressant activity, the lack of long-term use and efficacy, and the heterogeneity of patients, interventions, extract preparations from previous clinical studies suggests that more careful and controlled studies are needed to determine the long- term efficacy of hypericum in mild-to-moderate depression.

Hypericum perforatum ): drug interactions and clinical outcomes

TLDR
The medicines which interact with the herbal remedy St John’s wort (SJW), and the mechanisms responsible, are identified and the product information of the licensed medicines involved has been amended to reflect these newly identified interactions.

St John's wort: a systematic review of adverse effects and drug interactions for the consultation psychiatrist.

TLDR
This evidence-based presentation of the literature includes a brief description of pharmacodynamics and clinical applications, followed by a systematic review of adverse effects, toxicity, and drug interactions.

Better tolerability of St. John's wort extract WS 5570 compared to treatment with SSRIs: a reanalysis of data from controlled clinical trials in acute major depression

TLDR
WS 5570 was devoid of effects of sedation, anticholinergic reactions, gastrointestinal disturbances, and sexual dysfunction often found during treatment with SSRIs and other synthetic antidepressants.
...

References

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St John's wort as an antidepressant

TLDR
It is concluded from a meta-analysis that hypericum extracts are more effective than placebo for treating mild to moderately severe depressive disorders.

St. John's Wort, an anti-depressant? A systematic, criteria-based review.

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St John's wort for depression—an overview and meta-analysis of randomised clinical trials

TLDR
There is evidence that extracts of Hypericum perforatum (St John's wort) are more effective than placebo for the treatment of mild to moderately severe depressive disorders.

LI 160, an extract of St. John's wort, versus amitriptyline in mildly to moderately depressed outpatients--a controlled 6-week clinical trial.

TLDR
LI 160 was clearly superior to amitriptyline, particularly in relation to anticholinergic and Central Nervous System adverse events, and could confer an advantage in improving compliance for antidepressant pharmacotherapy.

Benefits and Risks of the Hypericum Extract LI 160: Drug Monitoring Study with 3250 Patients

TLDR
Effectiveness and acceptance of a 4-week treatment with hypericum extract LI 160 were investigated by 663 Private practitioners and in about 30% of the patients, the situation normalized or improved during the therapy.

[Treatment of depressive symptoms with a high concentration hypericum preparation. A multicenter placebo-controlled double-blind study].

TLDR
Treatment with an innovative highly concentrated hypericum preparation resulted in an appreciable improvement in the symptoms of depression, and the 70% response rate, corresponding to that of chemical antidepressants, showed an anxiolytic effect.

Hypericin and pseudohypericin: pharmacokinetics and effects on photosensitivity in humans.

TLDR
Doses used in this study were higher than typical doses in current commercial preparations, frequency of side effects was equal to placebo medication and UV light sensitivity was not or only marginally increased, and there was no correlation between total hypericin plasma concentrations and photosensitivity.

Effectiveness and tolerance of the hypericum extract LI 160 compared to maprotiline: a multicenter double-blind study.

A randomized, double-blind study examining the effectiveness and tolerance of a standardized hypericum preparation when compared to maprotiline was performed in a group of 102 patients with

Effectiveness and tolerance of the hypericum extract LI 160 in comparison with imipramine: randomized double-blind study with 135 outpatients.

TLDR
In the LI 160 group fewer and milder side effects were found as compared to imipramine, and the analysis of CGI revealed comparable results in both treatment groups.

Multicenter double-blind study examining the antidepressant effectiveness of the hypericum extract LI 160.

TLDR
Seventy-two depressive patients of 11 physicians' practices were treated in a double-blind study with hypericum extract LI 160 or with placebo, and a significant improvement in all four psychometric tests in the active group as compared to the placebo group.