Hypericum: A review

Hypericum
JuanitaHFNE

Juanita Agboola is the editor in chief of HFNE and an expert in mental health online. She has been writing about online behaviour, mental health and psychology issues since 2012. All Guides are reviewed by our editorial team which constitutes various clinical psychologists, PhD and PsyD colleagues.

In this guide, we talk about Hypericum: A review of what it is, therapeutic potential, what are the most common uses and some things to consider when using hypericum.  

Hypericum: A review of potential benefits

Here we will discuss “Hypericum: A review of the potential benefits”. You probably haven’t actually heard about the scientific name Hypericum perforatum but you may have heard the commercial name St. John’s wort. Yes, you are probably having that “ah, of course” moment.

Well, for those who haven’t heard about hypericum or St. John’s wort,  here is a brief introduction. This is considered a herbaceous perennial plant that is native to Europe and Asia. It is believed that the word hypericum comes from the Greek word “hyper” which means over and “eikon” or image and the name St. John’s wort seems to have been adopted as the flowers bloom around June 24th or St. John’s Day. 

Hypericum or St John’s wort can be found in different presentations such as tablets, tinctures, topical preparations, among others and can be found in pharmacies, health-food stores, and herbal medicine practitioners.

The pharmacological and chemical composition has been well-studied. This is how scientists have determined the sedative and astringent properties of the plant by treating conditions such as excitability, neuralgia, fibrositis sciatica, menopausal neurosis, anxiety, depression and as a nerve tonic for the treatment of wounds (Barnes et al, 2001).   

Hypericum: A review

Moreover, Greeson et al. (2000), added that the Oily Hypericum preparations can help when applied externally, to treat minor burns, wounds, inflammation of the skin and nerve pain. Also, in countries like Germany, Hypericum is highly regarded for the treatment of depression where it can get prescribed approximately 20 times more often than antidepressant medication fluoxetine. 

There have been therapeutic potential benefits in the treatment of ovarian carcinoma, uterine cancers, stomach cancers, and tumors of the lymph. Some others have reported the application in bronchial asthma, diarrhea, dysentery, neurasthenia, nervous depression, hysteria, chronic catarrh, rabies, worms, hemorrhages, and bladder problems, to name a few (Saddique et al., 2010).

There is still a lot of research needing to be done to understand the specific mode or modes of purported antidepressant activity. However, some research has shown that hypericum may have a significant influence on catecholamine neurotransmission where it seems to inhibit neurotransmitter metabolism, modulates the neurotransmitter receptor density and sensitivity and synaptic reuptake inhibition, similar to conventional antidepressant medications (Greeson et al, 2000). 

Subsequently, this results in increased synaptic availability of the neurotransmitters that are thought to be implicated in clinical depression such as serotonin, norepinephrine, and dopamine. In addition, there may be evidenced that indicated hypericum may modulate certain neuroendocrine pathways, resulting in a stimulation of the release of cortisol attenuating its production.  

Hypericum: Historical approach

This plant has a long history of almost 2400 years and has been always known for its healing benefits since the fifth century B.C. Also, it has been identified that some species of Hypericum have been used by Amerindian tribes (Cherokee, Iroquois and the Montagnais).

“Among the first most effective and widely spread pharmaceutical uses of H. perforatum in Europe after the 16th century was the use of the distilled oil of the herb as a therapy for wounds and bruises. It was so effective that surgeons not only used it to clean wounds but also included it in the first official pharmacopoeia of London as Oleum Hyperici” (Saddique et al., 2010). 

Hypericum: A review

Reports from the 1800s showed evidence of being used for urinary afflictions, diarrhea, jaundice, menorrhagia, hysteria, nervous imbalances with depression and tropical trauma. 

Moerman (1998) cited by Saddiqe et al. (2010) mentioned that the use of this plant by the Cherokee Indians is described as “an emmenagogue, an antidiarrheal, a febrifuge (infusion), a treatment for sores and venereal diseases (using a milky substance, possibly the sap), a hemostat for nosebleed (as a snuff), a snakebite remedy (root chewed and used as a poultice), and a root infusion as a wash to give infants strength”. 

In addition, the Montagnais Indians decocted the plant and used it like cough medicine and the Iroquois used hypericum as a febrifuge and also to prevent sterility.

Active components of Hypericum Perforatum

Studies related to the chemical components of hypericum have found the following active compounds:

  • Naphthodianthrones: including hypericin, pseudohypericin, isophypericin, and protohypericin. 
  • Phloroglucinols: such as hyperforin.
  • Flavonoids: include flavonols (kaempferol, quercetin), flavones (luteolin), phenylpropanes, glycocides (hyperside, isoquercitrin, and rutin), biflavones (biapigenin), amentoflavone, myricetin, hyperin, oligomeric proanthocyanadins, and miquelianin, all of which are biogenetically related.
  • Liophilic compounds: include phloroglucinol derivatives and oils.
  • Additional compounds: such as tannins, xanthones, phenolic compounds and hyperfolin. 

Pharmacological activities

Hypericum has some known benefits such as anti-depressant, anti-bacterial and anti-viral, anti-HIV properties, anticancer, neuroprotective, among others.

Antidepressant activity

Although the exact mechanism of action for the antidepressant effect of hypericum is still unclear, the main focus has been shifted to one of the components termed “hypericin” that is said to be responsible for the depressant effects. However, conflicting evidence also suggests it is “hyperforin”, one of the other components the one responsible for treating depression.

The mechanism of action has been suggested as the inhibition of the uptake of serotonin (5HT), dopamine (DA) and norepinephrine (NE) from the synaptic cleft of interconnecting neurons and a possible second mechanism is the ability to bind to the major neuro-inhibitory receptor GABA receptors, to block the binding of GABA decreasing central nervous system (CNS) depression (Shrivastava et al., 2017). 

Antimicrobial/Antifungal activity

Chemical component Hyperforin has been reported to have antibacterial properties against bacterias such as Staphylococcus aureus, Streptococcus pyogenes and Corynebacterium diphtheriae. However, it has been reported that the antibacterial properties of this component are only observed when administered in high concentrations and only towards Gram-positive bacteria. 

A recent 2017 study suggests that hypericum has been used to treat cuts, abrasions and other wounds for thousands of years. It has been suggested it has anti-inflammation and antibacterial properties. In addition, it has been suggested the chemical components can act against the influenza virus. 

Antifungal properties have been studied in the use of essential oil and a water-soluble fraction of an alcohol extract and both exhibited antifungal activity against Microsporum gypseum, Trichophyton rubrum, Aspergillus flavus, Curvularia lunata and Fusarium vasiinfectum, according to reports from Khosa and Bhatia (1982) cited by Saddiqe et al., (2010).

In another study, the essential oil also was able to display antifungal properties against Aspergillus nigger but didn’t have an effect on Candida albicans. 

Hypericum: A review

Anticancer

The components hyperforin and hypericin have been associated with anticancer properties. Studies have suggested that hyperforin inhibits tumor cell growth in vitro, this was especially true for inhibiting the cell growth of leukemia cells, brain glioblastoma cells, and normal human astrocytes. 

In addition, it has been evidenced that hypericin alone has a weak inhibitory effect on cancerous cell growth but methanolic extracts of hypericum in combination with hypericin lead to a long-lasting effect of cell growth inhibition, decreasing phototoxicity.

Neuroprotective properties

It has been evidenced in mice that hypericum serves as a neuroprotective agent against Parkinson’s disease. Additionally, it has been suggested hypericin may interfere with the onset of Alzheimer’s disease. 

Wound-healing effects

As we have discusses already, hypericum is widely known for its healing properties. The hypericum oil infusion has been used to speed up the healing process of burns and open wounds. Part of the effect is believed to be due to the antibacterial properties. 

Drug interactions

Previous studies have suggested that higher or excessive doses of hypericum may potentiate MAO inhibitor therapy. Barnes et al. (2010) indicate that certain interactions between St John’s wort and certain prescribed medicines can lead to a loss of or reduction in therapeutic effect of these prescribed medicines.

Some of the identified drugs that may possibly interact with hypericum include but are not limited to: 

  • Indinavir
  • Warfarin
  • Ciclosporin
  • Digoxin
  • Theophylline 
  • Oral contraceptives

Additionally, it has been suggested that there could be an increased serotoninergic effect in people taking hypericum concurrently with SSRIs or Selective Serotonin Reuptake Inhibitors such as sertraline or paroxetine. 

Hypericum: A review

In regards to interaction with alcohol, a study found no effect of hypericum in blood alcohol concentration as well as no changes in cognitive-motor performance. Other studies have reported also no pharmacological interaction with ethanol. 

However, it has been hypothesized that hypericum may interfere with anesthetic drugs, but there is no support in the current literature about the interaction between them. 

Are there any side effects?

A European study of 3250 patients revealed that the most commonly reported side effects were:

  • Gastrointestinal irritations
  • Allergic reactions
  • Fatigue 
  • Restlessness 

They also identified that when side effects do occur they are generally mild, transient and very similar to placebo effects. Other drug-comparison studies (TCAs) have identified nausea, abdominal pain, loss of appetite, diarrhea, dizziness/confusion, fatigue/sedation, dry mouth, restlessness, and headache. 

In addition, a rare side effect has been identified when hypericum is used at high doses and that is photosensitization and symptoms of phototoxicity include dermal erythema, rash, and pruritis. 

Barnes et al., (2010) also found in their study that “Collectively, the data indicate that St John’s wort is well-tolerated. Adverse effects are generally mild; the most common adverse effects reported are gastrointestinal symptoms, dizziness, confusion, and tiredness/sedation” 

Why is this blog about Hypericum: A review, important?

Hypericum or St John’s wort can be found in many presentations and it can be found in your local pharmacy or health-food stores. Additionally, you don’t need a prescription for it. 

As we discussed, there are many reasons why hypericum is preferred by many and it is safe and natural, simulating the effects of antidepressant medication but with fewer side effects. 

Even though studies have shown evidence of antidepressant effects due to the components from hypericum, still more research is required to clarify and review the potential therapeutic benefits across many medical conditions. 

Additionally, if you are planning to use hypericum as a depression treatment or any of the other potential uses, we advise you to consult it with a health professional. 

Please feel free to comment in the comments section below. 

Recommended reading

References

Shrivastava, M. and Dwivedi, L.K. (2017) The therapeutic potential of hypericum: A review

Barnes, J., Anderson, L.A and Phillipson, J.D. (2001)St John’s wort (Hypericum perforatum L.): a review of its chemistry, pharmacology and clinical properties

Saddiqe, Z., Naeem, I. and Maimoona, A. (2010) A review of the antibacterial activity of Hypericum perforatum L.

Greeson, J., Sanford, B. and Monti, D. (2001) St. John’s wort (Hypericum perforatum): a review of the current pharmacological, toxicological, and clinical literature

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