The safety of St John's wort (<i>Hypericum perforatum</i>) in pregnancy and lactation: A systematic review of rodent studies

Avila, Catharine; Whitten, Dawn; Evans, Sue

doi:10.1002/ptr.6099

Cited by 11 publications

(6 citation statements)

References 43 publications

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“…In our previous study on whole extracts, St. John’s wort showed no significant effects up to a concentration of 30 μg/ml extract for all types of in vitro experiments, namely cell viability, apoptosis, genotoxicity, metabolic activity, and inhibition/induction of placental cell differentiation ( Spiess et al, 2021 ). In general, there is a lack of adequate clinical studies on the genotoxicity of St. John’s wort, as well as tests on reproductive toxicity, and fertility ( Greeson et al, 2001 ; Avila et al, 2018 ). Well known issues such as phototoxicity ( Onoue et al, 2011 ) and interactions with other medications ( Nicolussi et al, 2020 ) must be taken care of also during administration in pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Advanced in Vitro Safety Assessment of Herbal Medicines for the Treatment of Non-Psychotic Mental Disorders in Pregnancy

et al. 2022

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When confronted with non-psychotic mental disorders, pregnant women often refrain from using synthetic drugs and resort to herbal medicines such as St. John’s wort, California poppy, valerian, lavender, and hops. Nevertheless, these herbal medicines have not yet been officially approved in pregnancy due to lack of safety data. Using a variety of in vitro methods (determination of cytotoxicity, apoptosis induction, genotoxicity, effects on metabolic properties, and inhibition/induction of differentiation) in a commonly used placental cell line (BeWo b30), we were previously able to show that extracts from these plants are likely to be safe at the usual clinical doses. In the present work, we wanted to extend our safety assessment of these herbal medicines by 1) looking for possible effects on gene expression and 2) using the same in vitro methods to characterize effects of selected phytochemicals that might conceivably lead to safety issues. Proteomics results were promising, as none of the five extracts significantly affected protein expression by up- or down-regulation. Protopine (contained in California poppy), valerenic acid (in valerian), and linalool (in lavender) were inconspicuous in all experiments and showed no adverse effects. Hyperforin and hypericin (two constituents of St. John’s wort) and valtrate (typical for valerian) were the most obvious phytochemicals with respect to cytotoxic and apoptotic effects. A decrease in cell viability was evident with hypericin (≥1 µM) and valtrate (≥10 µM), whereas hyperforin (≥3 µM), hypericin (30 µM) and valtrate (≥10 µM) induced cell apoptosis. None of the tested phytochemicals resulted in genotoxic effects at concentrations of 0.1 and 1 µM and thus are not DNA damaging. No decrease in glucose consumption or lactate production was observed under the influence of the phytochemicals, except for valtrate (at all concentrations). No compound affected cell differentiation, except for hyperforin (≥1 µM), which had an inhibitory effect. This study suggests that extracts from St. John’s wort, California poppy, valerian, lavender, and hops are likely to be safe during pregnancy. High plasma concentrations of some relevant compounds—hyperforin and hypericin from St. John’s wort and valtrate from valerian—deserve special attention, however.

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Section: Discussionmentioning

confidence: 99%

Advanced in Vitro Safety Assessment of Herbal Medicines for the Treatment of Non-Psychotic Mental Disorders in Pregnancy

et al. 2022

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“…Acanthopanax, commonly known as ciwujia or Siberian ginseng, is a traditional Chinese medicine that ameliorates cognitive dysfunction induced by cholinergic blockade (Li et al, 2016). Hypericum perforatum, also called St. John's wort, has been used as an antidepressant agent and a cognitive enhancer in rodents (Avila et al, 2018). Hypericum perforatum has been shown to induce positive effects on both mood and short-term verbal memory (Yechiam et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Improved Resting-State Functional Dynamics in Post-stroke Depressive Patients After Shugan Jieyu Capsule Treatment

Yao

Wang

et al. 2020

Front. Neurosci.

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Shugan Jieyu Capsule (SG), a Chinese herbal medicine mainly composed of Acanthopanax and Hypericum perforatum, has been used to ameliorate cognitive impairments and emotional problems induced by post-stroke depression (PSD), while the altered brain dynamics underlying the ameliorative effects of SG have remained unclear. Our study focused on investigating the potential neurobiological mechanisms of SG in improving the cognitive function of PSD patients via restingstate functional magnetic resonance imaging (fMRI). Fifteen PSD patients (mean ages: 64.13 ± 6.01 years) were instructed to take 0.72 g of SG twice a day for 8 weeks. PSD patients underwent fMRIs, the 24-item Hamilton Depression Scale (HAMD-24) and the Montreal Cognitive Assessment (MoCA) at baseline and the end of intervention, and these assessments were also performed on twenty-one healthy controls (HC) (mean ages: 60.67 ± 6.95 years). Additionally, the dynamic amplitude of low-frequency fluctuations (dALFF) and functional connectivity (dFC) were determined to reveal changes in dynamic functional patterns. We found that taking SG significantly reduced the depressive symptoms assessed by HAMD-24 and improved cognitive functions assessed by MoCA in PSD patients. Furthermore, at baseline, PSD patients showed decreased dALFF in the right precuneus and increased dFC between the right precuneus and left angular gyrus, compared with HC. After intervention, the dALFF and dFC variances of the abnormal patterns were reversed. Additionally, the dALFF variance in the right precuneus was positively correlated with MoCA scores in PSD patients after SG treatment. Collectively, our results indicate that SG may improve the cognitive function of PSD patients through alteration of brain dynamics. Our findings lay a foundation for the exploration of the neurobiological mechanisms of SG in ameliorating symptoms of PSD patients.

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“…[ 44 ] Hypericum perforatum L, also known as St. John wort, has been clinically used to treat depression symptoms and improve cognitive function. [ 45 ] Studies suggested the positive effects on mood and short-term verbal memory after using Hypericum perforatum L. [ 46 ] Consequently, SGJYC naturally deserves to have anti-depressive effects. It noted that SGJYC has been confirmed to have similar effects but fewer adverse reactions than escitalopram in alleviating depressive symptoms.…”

Section: Resultsmentioning

confidence: 99%

Meta-analysis of Shugan Jieyu Capsule for depression in patients with coronary heart disease

Liu,

Gu,

Lei

2023

Medicine

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Introduction: Shugan Jieyu Capsule (SGJYC) has been prescribed to treat primary and secondary depression; however, whether it can benefit depression of patients with coronary heart disease (CHD) remains controversial. This meta-analysis aimed to evaluate the efficacy and safety of SGJYC in treating depression in patients with CHD. Patient concerns: A total of 644 CHD patients with depression were selected from China National Knowledge Infrastructure, Wanfang, China Biomedical Database, MEDLINE, the Cochrane library from their inceptions until June, 2021. Diagnosis: All patients with CHD or coronary artery disease were confirmed to suffer from depression based on recognized criteria. Intervention: Patients were assigned randomly to receive SGJYC-based regimens or conventional antidepressants alone. Outcomes: Meta-analysis of 6 studies showed that antidepressants (MD, 2.12; 95% confidence interval [CI], 0.73~3.50) or sertraline (MD, 2.15; 95%CI, 0.61~3.68) significantly alleviated depression level compared to SGJYC; however, SGJYC plus antihypertensive drugs (AHD) (MD, −8.33; 95%CI, −13.90 ~ −2.75) significantly improved depression symptoms compared to AHD. A significant difference in risk of adverse cardiac events (risk ratios [RR], 2.72; 95%CI, 1.07~6.94) between SGJYC and sertraline was detected in patients with simple CHD. Conclusions: SGJYC has a poor effect on depressive symptoms, and the effect of combination with AHD is better than AHD but its efficacy and cardiac safety are inferior to antidepressants.

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The safety of St John's wort (Hypericum perforatum) in pregnancy and lactation: A systematic review of rodent studies

Cited by 11 publications

References 43 publications

Advanced in Vitro Safety Assessment of Herbal Medicines for the Treatment of Non-Psychotic Mental Disorders in Pregnancy

Advanced in Vitro Safety Assessment of Herbal Medicines for the Treatment of Non-Psychotic Mental Disorders in Pregnancy

Improved Resting-State Functional Dynamics in Post-stroke Depressive Patients After Shugan Jieyu Capsule Treatment

Meta-analysis of Shugan Jieyu Capsule for depression in patients with coronary heart disease

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