A.Vogel Anti-Stress Sedative for relief of restlessness and nervousness Helps to treat symptoms of sleep disorders. Organic cultivation certified by Bio Suisse Sugar-, gluten- and lactose-free Composition Each tablet contains: Medicinal ingredient: Dry extract of organically grown* fresh flowers and aerial parts of St. John’s Wort (Hypericum perforatum L) ...40.24 – 73.22 mg. Each tablet is standardized to 0.33 mg of hypericin. Non-medicinal ingredients: Microcrystalline cellulose, corn starch, soy polysaccharides, hydrogenated cottonseed oil. * Certified by Bio Suisse Dosage Adults: Take 1 tablet, 3 times daily with water, 30 minutes before meals.Duration of use: May be used for up to 6 weeks. Historical overview St. Johns Wort was traditionally used to drive evil spirits away and to ward off witchcraft. It was sometimes called fuga demonium (that which makes the demon flee). Its French name, millepertuis (mille = thousand; pertuis = hole), comes from its perforated aspect, which is due to the sun transparency of the numerous vacuoles (containing a red pigment, hypericin) covering its petals and leaves. According to some authors, its name comes from a tradition of suspending a bouquet of St. Johns Wort in the house, the day before Midsummers day (in French: la St-Jean-Baptiste = St. John the Baptist), to ward off witches. Other authors attribute its name to the beginning of its flowering season, at Midsummers day. Actions and pharmacology Numerous studies confirm St. Johns Worts antidepressant effect. Its active ingredients are mainly hyperforin, hypericin and pseudohypericin. Hyperforin seems to be the most active molecule for the relief of depression and mood disorders: it inhibits serotonin reuptake (the same as antidepressant medications like Zoloft®). However, St. Johns Wort has a more global action because it also reduces the reuptake of many other neurotransmitters like GABA, L glutamate, norepinephrin and dopamin. It also has an inhibiting effect on serotonin-specific receptors: 5 HT3, 5 HT4 and, to a lesser degree, 5 HT2. These effects increase the neurotransmitters bioavailability and promote mood-improvement.(1) A few studies have also noted an in vitro activity against some viruses (herpes, polio, hepatitis C, retrovirus, cytomegalovirus, etc.) and bacteria (some gram-negative and gram-positive bacteria). The clinical significance of this is yet to be demonstrated.(1) The German Commission E acknowledges its benefits in cases of: psycho-vegetative disturbances, depressive moods, anxiety and nervous unrest.(2) Scientific studies St. Johns Wort is one of the most studied medicinal herbs. A brief survey of scientific literature reveals more than 400 references on St. Johns Wort, 48 of which are clinical studies with 32 being randomized, double blind and placebo-controlled. (PubMed - Medline, June 2001) Numerous clinical studies confirm its efficacy for the treatment of light to moderate depression. A recent study on 240 patients suffering from light to moderate depression compared St. Johns Wort with a well-known antidepressant, Fluoxetine (Prozac®). The researchers concluded: « (…) Hypericum and Fluoxetine are equipotent with respect to all main parameters used to investigate antidepressants in this population. Although hypericum may be superior in improving the responder rate, the main difference between the two treatments is safety. Hypericum was superior to Fluoxetine in overall incidence of side-effects, number of patients with side-effects (Fluoxetine 23% side-effects vs Hypericum 8%) and the type of side-effect reported (more severe with Fluoxetine). »(3) Another study, published in the prestigious British Medical Journal, compares St. Johns Wort with another antidepressant, Imipramine. 263 patients suffering from moderate depression (according to Hamiltons scale) were given a placebo, St. Johns Wort, or Imipramine. The authors concluded: « (…) hypericum extract was more effective than the placebo and at least as effective as 100 mg of Imipramine daily in the treatment of moderate depression. Treatment with hypericum extract is safe and improves quality of life. »(4) A study on Hyperiforce was published in the Swiss Journal for Global Medicine. This 6 weeks, randomized, double blind study, was conducted on 348 patients suffering from light to moderate depression. The response to treatment was good: according to Hamiltons scale, the researchers noted a 50% improvement in the condition of patients.(5) Precautions, contraindications and interactions Avoid prolonged exposure to sunlight, ultraviolet (UV) light or UV therapy.Consult a healthcare practitioner if you experience sleep disturbances or if you are taking conventional medication such as contraceptives, HIV-1 protease inhibitors, non-nucleoside reverse transcriptase inhibitors, immunosuppressants, anticoagulants, digoxin, theophylline, serotonergic antidepressants, migraine therapies, SSRIs and/or antiepilepsy drugs. Do not use if you are pregnant or nursing.Avoid taking in case of known allergy to any of the ingredients in the product. Consult a healthcare practitioner if symptoms persist. Do not use if safety seal is broken. Keep out of reach of children. References 1-Natural Medicines Comprehensive Database 2001. Pharmacist's Letter 3120 W. March Lane, PO Box 8190, Stockton, CA 95208. 2-The Complete German Commission E Monographs, Therapeutic Guide to Herbal Medicines. Blumenthal M et al. 1998. American Botanical Council, 6200 Manor Rd, Austin, Texas, 78723. 3-Schrader E. Equivalence of St John's wort extract (Ze 117) and fluoxetine: a randomized, controlled study in mild-moderate depression. Int Clin Psychopharmacol 2000 Mar;15(2):61-8 4-Philipp M, Kohnen R, Hiller KO. Hypericum extract versus imipramine or placebo in patients with moderate depression: randomised multicentre study of treatment for eight weeks. BMJ 1999 Dec 11;319(7224):1534-8 5-Lenoir S, Degenring FH, Sller R. Comprimés Hyperiforce® pour le traitement de dépressions légères à modérées. Schweiz Zschr GanzheitsMedizin 1997;9(5):226-232. 6-Obach RS. Inhibition of human cytochrome P450 enzymes by constituents of St. Johns Wort, an herbal preparation used in the treatment of depression. J Pharmacol Exp Ther 2000;294:88-95. 7-Gurley BJ, Gardner SF, Hubbard MA. Clinical assessment of potential cytochrome P450-mediated herb-drug interactions. AAPS Annual Meeting & Exposition, Oct. 29 - Nov. 2, 2000, Indianapolis, IN:poster (presentation number 3460). 8-Durr D, Stieger B, Kullak-Ublick GA, et al St John's Wort induces intestinal P-glycoprotein/MDR1 and intestinal and hepatic CYP3A4. Clin Pharmacol Ther 2000;68:598-604.