Mechanism of Action of St John’s Wort in Depression

What is Known?

Abstract

Extracts of Hypericum perforatum L. (St John’s wort) are now successfully competing for status as a standard antidepressant therapy. Because of this, great effort has been devoted to identifying the active antidepressant compounds in the extract. From a phytochemical point of view, St John’s wort is one of the best-investigated medicinal plants. A series of bioactive compounds has been detected in the crude material, namely flavonol derivatives, biflavones, proantho-cyanidines, xanthones, phloroglucinols and naphthodianthrones.

Although St John’s wort has been subjected to extensive scientific studies in the last decade, there are still many open questions about its pharmacology and mechanism of action. Initial biochemical studies reported that St John’s wort is only a weak inhibitor of monoamine oxidase-A and -B activity but that it inhibits the synaptosomal uptake of serotonin, dopamine and noradrenaline (norepinephrine) with approximately equal affinity. However, other in vitro binding assays carried out using St John’s wort extract demonstrated significant affinity for adenosine, GABAa, GABAb and glutamate receptors. In vivo St John’s wort extract leads to a downregulation of β-adrenergic receptors and an upregulation of serotonin 5-HT2 receptors in the rat frontal cortex and causes changes in neurotransmitter concentrations in brain areas that are implicated in depression. In studies using the rat forced swimming test, an animal model of depression, St John’s wort extracts induced a significant reduction of immobility. In other experimental models of depression, including acute and chronic forms of escape deficit induced by Stressors, St John’s wort extract was shown to protect rats from the consequences of unavoidable stress. Recent neuroendocrine studies suggest that St John’s wort is involved in the regulation of genes that control hypothalamic-pituitary-adrenal axis function. With regard to the antidepressant effects of St John’s wort extract, many of the pharmacological activities appear to be attributable to the naphthodianthrone hypericin, the phloroglucinol derivative hyperforin and several flavonoids.

This review integrates new findings of possible mechanisms that may underlie the antidepressant action of St John’s wort and its active constituents with a large body of existing literature.

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Notes

  1. 1.

    The use of tradenames is for product identification purposes only and does not imply endorsement.

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Acknowledgements

The author thanks Dr Miles Herkenham, Professor Dr Adolf Nahrstedt and Professor Dr Hilke Winterhoff for continued enthusiastic support, insightful discussions and thoughtful reading of this manuscript.

No sources of funding were used to assist in the preparation of this manuscript. The author has no conflicts of interest that are directly relevant to the content of this manuscript.

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Correspondence to Dr Veronika Butterweck.

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Butterweck, V. Mechanism of Action of St John’s Wort in Depression. CNS Drugs 17, 539–562 (2003). https://doi.org/10.2165/00023210-200317080-00001

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Keywords

  • Imipramine
  • Forced Swimming Test
  • Hypericin
  • Quercitrin
  • Hyperforin