Barnes J, Anderson L A, Phillipson J D
Centre for Pharmacognosy & Phytotherapy, School of Pharmacy, University of London.
J Pharm Pharmacol. 2001 May;53(5):583-600. doi: 10.1211/0022357011775910.
The chemical composition of St. John's wort has been well-studied. Documented pharmacological activities, including antidepressant, antiviral, and antibacterial effects, provide supporting evidence for several of the traditional uses stated for St John's wort. Many pharmacological activities appear to be attributable to hypericin and to the flavonoid constituents; hypericin is also reported to be responsible for the photosensitive reactions that have been documented for St. John's wort. With regard to the antidepressant effects of St John's wort, hyperforin, rather than hypericin as originally thought, has emerged as one of the major constituents responsible for antidepressant activity. Further research is required to determine which other constituents contribute to the antidepressant effect. Evidence from randomised controlled trials has confirmed the efficacy of St John's wort extracts over placebo in the treatment of mild-to-moderately severe depression. Other randomised controlled studies have provided some evidence that St John's wort extracts are as effective as some standard antidepressants in mild-to-moderate depression. There is still a need for further trials to assess the efficacy of St John's wort extracts, compared with that of standard antidepressants, particularly newer antidepressant agents, such as the selective serotonin reuptake inhibitors (recent comparative studies with fluoxetine and sertraline have been conducted). Also, there is a need for further studies in well-defined groups of patients, in different types of depression, and conducted over longer periods in order to determine long-term safety. St John's wort does appear to have a more favourable short-term safety profile than do standard antidepressants, a factor that is likely to be important in patients continuing to take medication. Concerns have been raised over interactions between St John's wort and certain prescribed medicines (including warfarin, ciclosporin, theophylline, digoxin, HIV protease inhibitors, anticonvulsants, selective serotonin reuptake inhibitors, triptans, oral contraceptives); advice is that patients taking these medicines should stop taking St John's wort, generally after seeking professional advice as dose adjustment of conventional treatment may be necessary.
贯叶连翘的化学成分已得到充分研究。其已记录的药理活性，包括抗抑郁、抗病毒和抗菌作用，为贯叶连翘的几种传统用途提供了支持证据。许多药理活性似乎归因于金丝桃素和黄酮类成分；据报道，金丝桃素也是贯叶连翘所记录的光敏反应的原因。关于贯叶连翘的抗抑郁作用，金丝桃素而非最初认为的金丝桃素，已成为负责抗抑郁活性的主要成分之一。需要进一步研究以确定其他哪些成分对抗抑郁作用有贡献。随机对照试验的证据证实，贯叶连翘提取物在治疗轻度至中度重度抑郁症方面优于安慰剂。其他随机对照研究提供了一些证据，表明贯叶连翘提取物在轻度至中度抑郁症中与一些标准抗抑郁药一样有效。仍需要进一步试验来评估贯叶连翘提取物与标准抗抑郁药，特别是新型抗抑郁药，如选择性5-羟色胺再摄取抑制剂（最近已进行了与氟西汀和舍曲林的比较研究）相比的疗效。此外，需要在明确界定的患者群体、不同类型的抑郁症中进行进一步研究，并进行更长时间的研究，以确定长期安全性。贯叶连翘的短期安全性似乎确实比标准抗抑郁药更有利，这一因素在持续服药的患者中可能很重要。人们对贯叶连翘与某些处方药（包括华法林、环孢素、茶碱、地高辛、HIV蛋白酶抑制剂、抗惊厥药、选择性5-羟色胺再摄取抑制剂、曲普坦类、口服避孕药）之间的相互作用表示关注；建议服用这些药物的患者通常在寻求专业建议后停止服用贯叶连翘，因为可能需要调整传统治疗的剂量。
