|The Side Effects of Hypericum|
St. John's wort has an excellent safety record during centuries of folk medicine. Recent medical studies confirm this safety. The extensive use of hypericum in Germany (sixty-six million daily doses in 1994) has not resulted in medical reports of serious drug interactions or even toxicity after accidental overdose.
No substance is perfectly safe. Indeed, substances which are essential to human life are, when ingested in sufficient quantities, very harmful. Hence the warning label on all over-the-counter medications: "Safe when used as directed." Even common table salt -- a necessary mineral to human existence -- is deadly when taken in excess.
In exploring side effects, one must compare the relative dangers -- how toxic is one substance as compared to another? Aspirin is less toxic than morphine but more toxic than, say, vitamin C.
One must also compare the dangers with the relative benefits. One must weigh the damage caused by the illness with the potential damage caused by the treatment. Chemotherapy involves some of the most toxic chemicals known to medicine but when compared to not using these chemicals -- death by cancer -- they become medically acceptable.
In both categories, hypericum is impressive.
As to toxicity, hypericum is safer than aspirin. Five hundred to one thousand people die each year in the United States from aspirin, usually from internal bleeding. Hypericum, by comparison, does not have a single recorded human death in 2,400 years of known medicinal use.
In fact, the only fatal toxicity known is in certain light-skinned animals, such a sheep, who die not from ingesting large quantities of St. John's wort while grazing, but of exposure to sun after. (This is why hypericum is considered a dangerous weed in Australia and is listed in Common Poisonous Plants and Mushrooms of North America, by Nancy J. Turner and Adam F. Szczawinski.) Hypericum increases the animals' susceptibility to sunlight, and they become sick and sometimes die from extreme sunburn. Medically, it's known as phototoxicity -- the overexposure to light (photo) is harmful (toxic).
This phenomenon, while theoretically possible in humans, has not been documented in the recommended doses for depression. Not a single case of phototoxicity has been reported in human medical studies at depression-dosage levels. Even in AIDS research involving intravenous hypericum doses thirty-five times greater than the recommended dose for depression, the phototoxic effects have been few and never deadly. (High doses of hypericum are being medically investigated for its antiviral properties.)
The potential for phototoxicity should be kept in mind, however, if one has a prior hypersensitivity to sunlight, or if one is taking other photosensitizing drugs such as Chlorpromazine and Tetracyclines.
In a study of 3,250 patients taking hypericum, only 2.4 percent experienced any side effects at all.
The side effects reported tended to be mild. Gastrointestinal irritations accounted for 0.6 percent, allergic reactions for 0.5 percent, tiredness for 0.4 percent, and restlessness for 0.3 percent.
(Interestingly, in fifteen studies involving 1,008 patients, the side effects in the control group given a harmless placebo were slightly higher than that of hypericum4.8 percent for the placebo group and 4.1 percent for hypericum. The dropout rate of the placebo group was higher, too1.8 percent for the placebo group compared with 0.4 percent for hypericum.)
A higher figure was reported by the British Medical Journal in a review of six hypericum studies. In these, 10.8 percent of the patients reported side effects with hypericum (similar to the ones listed above), while 35.9 percent reported side effects taking prescription antidepressants. Even at this higher rate, the British Medical Journal concluded the side effects of hypericum were "rare and mild."
The British Medical Journal also calls for more studies on the long-term potential side effects of hypericum, a recommendation we wholehearted endorse. We can, however, consider facts that lie outside the strict standards of medical reporting. For example, the extensive use of St. John's wort in 2,400 years of folk and herbal medicine as well as the twenty-million people in Germany who have been taking hypericum for more than a year and have not reported any long-term side effects different or more prevalent than those of the shorter-term medical studies.
Some of the most troublesome side effects of prescription antidepressants -- reduced sexual drive or dysfunction, adverse interaction with alcohol or other drugs, dry mouth, and headache -- were not reported by patients taking hypericum.
Further, hypericum's side effects went away soon after the patients stopped taking it. There were no "nonreversible" side effects; that is, no permanent harm was done and all side effects were quickly reversed as soon as the patients no longer took hypericum.
The side effects of hypericum are mild, indeed, when compared to the symptoms of depression. At the extreme are the 21,000 suicides (70 percent of all suicides) that are a direct result of untreated depression. Studies have shown that for every suicide there are ten unsuccessful suicide attempts and one hundred people who are seriously contemplating suicide.
Untreated depression is the number-one cause of alcoholism, drug abuse, eating disorders, and other addictions. A significant percentage of divorces, spousal and child abuse, absenteeism from work, lost jobs, and bankruptcies are attributed to untreated depression.
It is estimated that losses associated with depression in the United States amount to more than forty billion dollars each year. And who can put a price on the daily suffering of the twelve million Americans and 1.2 million Canadians who have depression but are not being treated?
Compared with the symptoms of depression, the side effects of hypericum seem insignificant. For most people suffering symptoms of depression, the potential benefits far outweigh the possible risk of taking hypericum.
The low side-effect profile of hypericum -- especially when taken in the dosage recommended for the treatment of depression -- puts it in the category of herbs, vitamins, minerals, and over-the-counter medications.
Ever watchful for potential side effects, well-informed consumers can take hypericum with confidence.