Hypericum for fatigue — a pilot study

doi:10.1016/S0944-7113(98)80040-8

Phytomedicine

Volume 5, Issue 6, December 1998, Pages 443-447

https://doi.org/10.1016/S0944-7113(98)80040-8 Get rights and content

Summary

Fatigue is a common reason for consulting a doctor but there is no definitive treatment. Hypericum perforatum has been shown to reduce symptoms of fatigue in depressed patients. It therefore may have potential value as a remedy for fatigue of unexplained origin. This pilot study aimed to investigate the effect of Hypericum on fatigue in a small group of patients in order to formulate a hypothesis upon which a randomized controlled trial could be subsequently based. The study protocol followed an uncontrolled, open design. Twenty patients consulting their doctors complaining of fatigue were treated with Hypericum extract (3×1 tablet daily) for six weeks. Compared to baseline values, perceived fatigue was significantly lower after 2 weeks of treatment and reduced significantly further after 6 weeks. Symptoms of depression and anxiety were also reduced. Baseline scores suggested that nearly half the sample may have been depressed at the start of the trial which was possibly related to fatigue. These results suggest there is scope for conducting a randomized placebo-controlled trial to investigate the specific effect of Hypericum on fatigue and that the study design must take account of the role of depression in fatigue.

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Effects of Hypericum perforatum and paroxetine on rat performance in the elevated T-maze
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Hypericum perforatum extract exhibits an antidepressant effect and since several antidepressant drugs are also effective on generalised anxiety disorder (GAD) and panic disorders (PD), H. perforatum may possess some anxiolytic/antipanic effect. Thus, the aim of the present study was to evaluate the putative antipanic/anxiolytic effect of standardised H. perforatum extract (LI 160) on rats tested in the elevated T-maze, an animal model of innate (panic) and learned (generalised) anxiety, at doses that exhibit antidepressant-like activity. H. perforatum (150, 300 and 500 mg/kg, administered orally 24, 18 and 1 h before the test) decreased the immobility time in the forced swim test. Rats were treated orally with H. perforatum (150 or 300 mg/kg) or paroxetine (5 mg/kg) 24, 18, and 1 h before being tested in the elevated T-maze (subacute treatment). Immediately after this test, the animals were submitted to the open field to evaluate locomotor activity. Paroxetine was used as a positive control, since it was clinically effective in GAD and PD. Other groups of animals were submitted to the same drug treatment for 7 days (subchronic treatment). Paroxetine (5 mg/kg) impaired inhibitory avoidance after subacute treatment, while subchronic administration increased one-way escape latency. Subacute treatment with H. perforatum (300 mg/kg) exerts a partial anxiolytic-like effect in the inhibitory avoidance task. Repeated administration of H. perforatum (300 mg/kg) induced an anxiolytic effect (decreased inhibitory avoidance) and an antipanic effect (increased one-way escape). No effect on locomotor activity was found with any treatment. Thus, the results suggest that H. perforatum extract could exert an anxiolytic and antipanic effect.
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Citation Excerpt :
SJW had fewer side effects (28%) than fluoxetine (72%).43 Some studies have suggested that SJW may be particularly helpful for patients with somatic symptoms, especially fatigue.44,45 Martinez et al found that 20 patients with seasonal affective disorder were as responsive to hypericum (900 mg) as to light therapy after 35 days.46
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Effects of Hypericum perforatum and paroxetine in the mouse defense test battery
2003, Pharmacology Biochemistry and Behavior
Citation Excerpt :
Some studies have shown that H. perforatum also may exert an anxiolytic effect. In clinical studies, H. perforatum extract exerted a beneficial effect on patients with obsessive–compulsive disorder in an open study (Taylor and Kobak, 2000) and reduced anxiety and depression scores in the Hospital Anxiety and Depression Scale in patients with fatigue of unexplained origin (Stevinson et al., 1998). Moreover, there is a case report showing that H. perforatum treatment reduced the number of panic attacks in a patient with a possible panic disorder (PD) diagnosis (Yager et al., 1999), and three case reports suggest an anxiolytic effect of the extract (Davison and Connor, 2001).
Since (a) Hypericum perforatum shows anxiolytic-like effect in some animal models, (b) antidepressant drugs (AD) have been used as the main drug treatment for panic disorder (PD), (c) AD are also effective in generalized anxiety disorder (GAD), and (d) H. perforatum exhibits antidepressant activity, it was hypothesized that H. perforatum might possess an antipanic-like and/or anxiolytic-like effect. Previous studies with the mouse defense test battery (MDTB) have suggested that this model may be useful for the investigation of anxiolytic-like and antipanic-like compounds. Thus, the aim of the present study was to evaluate the effect of H. perforatum extract in the MDTB. The effect of acute, subchronic (7 days), and chronic (21 days) H. perforatum (150 and 300 mg/kg) extract administration was evaluated in mice submitted to the MDTB. Paroxetine (5 mg/kg), a selective serotonin re-uptake inhibitor with anxiolytic and antipanic effect, was used as a positive control. The results showed that 21 days of repeated administration of H. perforatum 300 mg/kg and paroxetine 5 mg/kg reduced flight reactions (number of avoidances, avoidance distance, and overall flight speed) to the presence of the predator. While the effect of paroxetine confirms that MDTB is useful for the detection of antipanic-like drugs, the effect of H. perforatum suggests a putative antipanic-like effect for this extract. Moreover, after 21 days of repeated administration, paroxetine increased the number of approaches/withdrawals and reduced the number of upright postures, suggesting a partial anxiolytic-like effect, while H. perforatum only reduced the number of upright postures. The present results suggest anxiolytic-like and antipanic-like effects of H. perforatum extract. However, it should be emphasized that the risk assessment (the main index of anxiety) was not affected by the extract, while the attack reactions were only weakly modified.
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2001, Complementary Therapies in Medicine
Clinical research into the effectiveness of any therapy usually progresses in a series of steps that are aimed at providing evidence that will lead to improved patient care. One important early step is the uncontrolled trial. Uncontrolled trials serve several crucial purposes, including establishing firmly that there is a clinical effect worth investigating, identifying the most suitable patients and the most appropriate treatments, and providing information on how large the effect might be. They can be conducted relatively easily by practitioners in the course of their normal work, and are an excellent first step for anyone interested in clinical research. Such studies are not only satisfying, but develop skills in searching the literature and writing protocols, and promote rigorous thinking and attention to detail. The ultimate purpose of uncontrolled trials is to facilitate subsequent definitive studies that will help define the place of CAM in health care.
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2022, Iranian Journal of Basic Medical Sciences

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^†: Address C. Stevinson, Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter, 25 Victoria Park Road, Exeter, EX2 4NT, UK. Tel: +44 (0) 1392 424839, Fax: +44 (0) 1392 424989

^*: Clare Stevinson is supported by a grant from Lichtwer Pharma UK Ltd, Regency House, Mere Park, Dedmore Road, Marlow, Bucks. SL7 1JF, UK

View full text

Hypericum for fatigue — a pilot study

Summary

Phytomedicine

Measuring disease: a review of disease specific quality of life measurement scales

Development of a fatigue scale

J. Psychosom. Res.

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

Br. Med. J.