Research Database –
International Updates

Herbal Medicine

Issue 69

HARNACK and colleagues, Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis 55454, USA, harnack@epivax.epi.umn.edu, documented the usage of herbal products among adults in a large metropolitan area (Minneapolis/St. Paul).
Methods: 752 people aged 18+ years residing in the Minneapolis/St. Paul, Minnesota, metropolitan area were randomly selected from Minnesota Department of Public Safety Driver and Vehicle Service Division data tapes. Surveys were mailed to eligible participants (n=580) between June and August 1999, to determine the use of any herb; and the use, rationale for use, perceived efficacy and source of product information of 13 specific herbs.
Results: 376 of the 580 subjects (65%) returned completed surveys. 230 (61.2%) reported having used a herb during the past 12 months. Prevalence of use of specific herbs ranged from 30.9% for ginseng to 3.0% for milk thistle. The most common reasons for using a herb varied with the type of herb; for 5 herbs, the most common reason for use was ‘to promote general health/wellbeing’. For 11 of the 13 specific herbs, less than 60% of those who used the herb rated it as ‘effective’ or ‘very effective’. Among subjects taking 9 of the 13 specific herbs, the main sources of product information were family, friends and written materials.
Conclusion: Herbs are frequently used to treat or prevent a range of health problems, and people who use herbal products appear to rely mainly on family and friends for information.
Harnack LJ et al. Prevalence of use of herbal products by adults in the Minneapolis/St Paul, Minn, Metropolitan area. Mayo Clinic Proceedings 76 (7): 688-94. Jul 2001.

JOSHI and KAUL, University of Georgia, Institute for Natural Products Research, Athens, GA 30605, USA, bsjoshi@prodigy.net, reviewed (315 references) and critically appraised the increasing global usage of herbal medicine.
Background: Alternative therapies have grown in global popularity during recent decades. Herbal medicines present a major concern in countries where allopathic medicine prevails. Sales of such have increased exponentially. Concerns in the health care professions, particularly in the USA, include lack of quality control; commercial profiteering and exploitation, leading to adulterations; lack of proper knowledge about the herbs and their constituents with regard to drug-drug interactions and other adverse side effects; and inappropriate usage of herbal products.
Discussion: The authors state that they provide an incisive description of the known chemical, pharmacological, clinical and toxicological profiles of four of the most widely used herbal products.
Joshi BS, Kaul PN. Alternative medicine: herbal drugs and their critical appraisal – Part I. Progress in Drug Research 56: 1-76. 2001.

OKYAR and colleagues, Department of Pharmacology, Faculty of Pharmacy, University of Istanbul, 34452 Universite, Istanbul, Turkey, investigated the effects of Aloe vera leaves on blood glucose levels in rat models of diabetes.
Background: Aloe species have been used traditionally in many parts of the world for their various medicinal properties. (Aloe vera (L.) Burm. fil. (= A. barbadensis Miller) (Liliaceae) is native to N. America and is also cultivated in Turkey.) Controversial reports produced over the past 15 years have claimed hypoglycaemic activity of Aloe species. Controversy [ie. variations in findings] may have resulted from the use of different parts of the plant and/or models of diabetes.
Methods: Separate experiments were performed in three different groups of rats: non-diabetic (ND) rats; type I (IDDM) diabetic rats; and type II (NIDDM) diabetic rats.
Results: In ND rats, Aloe vera leaf pulp and gel extracts did not lower blood sugar levels. In IDDM and NIDDM rats, A. vera leaf pulp extract showed hypoglycaemic activity. In NIDDM rats, the effectiveness of A. vera leaf pulp extract was greater than that seen with glibenclamide. Conversely, A. vera leaf gel extract showed hyperglycaemic activity in NIDDM rats.
Conclusion: Aloe vera leaf pulp extract devoid of gel could be useful in the treatment of non-insulin-dependent (type II) diabetes. Okyar A et al. Effects of Aloe vera leaves on blood glucose level in type I and type II diabetic rat models. Phytotherapy Research 15 (2): 157-61. Mar 2001.

BURITS and colleagues, Institute of Pharmacognosy, Karl-Franzens-University of Graz, Universitaetsplatz 4/1, A-8010, Graz, Austria, examined the possible antioxidant (free radical scavenging) activities of three essential oils (Artemisia afra Jacq., Artemisia abyssinica Schultz-Bip. and Juniperus procera Hoechst ex Endl.).
Methods: First, a thin-layer chromatography (TLC) screening method was used to rapidly evaluate the possible antioxidant properties of the oils. The diphenylpicrylhydrazyl assay was used to check the oils’ abilities to act as non-specific donors of hydrogen atoms or electrons. All three oils showed positive results and were examined further. The deoxyribose degradation assay assessed hydroxyl radical scavenging properties. The in vitro assay for non-enzymatic lipid peroxidation in liposomes further evaluated antioxidant potential.
Results: Oils of A. afra and J. procera were effective hydroxyl radical scavenging agents; oils from A. abyssinica showed a paradoxical effect. Oils of A. afra and J. procera also showed antioxidant potential in liposomes; it was not possible to measure the effect of A. abyssinica oil in this system, because certain compounds (eg. alk-2-enals) interfered with the assay. The compounds contributing to the radical scavenging activities of A. afra and J. procera were identified and then assessed for their effects in the various test systems. GC-MS (gas chromatography-mass spectrometry) was also used to study the qualitative and quantitative compositions of the essential oils.
Burits M et al. The antioxidant activity of the essential oils of Artemisia afra, Artemisia abyssinica and Juniperus procera. Phytotherapy Research 15 (2): 103-8. Mar 2001.

Issue 68

SCHNITZLER and colleagues, Department of Virology, Hygiene Institute, University of Heidelberg, Germany, examined the antiviral effects of Australian tea tree oil (TTO) and eucalyptus oil (EUO) against herpes simplex virus (HSV) in vitro.
Methods: A standard neutral red dye uptake assay was used to evaluate cytotoxicity of TTO and EUO on RC-37 cells in vitro. A plaque reduction assay was used to test antiviral activity of TTO and EUO in RC-37 cells infected with either HSV type 1 (HSV-1) or HSV type 2 (HSV-2) in vitro. Virucidal activities of TTO and EUO were also assessed in viral suspension tests. To determine the mode(s) of antiviral action of TTO and EUO: either RC-37 cells were pretreated with TTO or EUO before infection, or viruses were incubated with TTO or EUO before infection, during adsorption or after penetration into EC-37 cells.
Results: Cytotoxicity of TTO and EUO on RC-37 cells was moderate and approached 50% (TC50) at concentrations of 0.006% and 0.03% respectively. The IC50 (50% inhibitory concentration) of TTO for HSV-1 and HSV-2 plaque formation was 0.0009% and 0.0008% respectively. The IC50 of EUO for HSV-1 and HSV-2 was 0.009% and 0.008% respectively. Non- cytotoxic concentrations of TTO significantly reduced HSV-1 and HSV-2 plaque formation by 98.2% and 93.0% respectively. Non-cytotoxic concentrations of EUO reduced HSV-1 and HSV-2 virus titres by 57.9% and 75.4% respectively (non-significant). When HSV was pretreated with TTO or EUO prior to adsorption into EC-37 cells, plaque formation was clearly reduced.
Discussion: Both TTO and EUO were able to exert a direct antiviral effect on HSV in vitro. The active antiherpes components of TTO and EUO are not yet known. However, these essential oils offer promise as possible antiviral agents for recurrent herpes infection.
Schnitzler P et al. Antiviral activity of Australian tea tree oil and eucalyptus oil against herpes simplex virus in cell culture. Die Pharmazie 56 (4): 343-7. Apr 2001.

Comments: These very promising results show that tea tree and eucalyptus oils are effective against herpes simplex virus in vitro. Further research will establish whether these results can be replicated in vivo.

GOVINDAN and GOVINDAN, Department of Chemistry, Fitchburg State College, Fitchburg, MA 01420, USA, mgovindan@fsc.edu, evaluated the usefulness of thin-layer chromatography (TLC) as a method of determining the quality of the herbal product goldenseal (Hydrastis canadensis).
Background: Goldenseal is one of the top five herbal supplements in the international market.
Methods: 10 goldenseal samples were analysed by TLC using two solvent systems and spray reagents.
Results: Five samples contained both hydrastine and berberine, four contained berberine only, and one did not contain either of these alkaloids. The TLC results were confirmed by high-pressure liquid chromatography (HPLC).
Conclusion: TLC is a convenient method of determining the quality and possible adulteration of goldenseal products.
Govindan M, Govindan G. A convenient method for the determination of the quality of goldenseal. Fitoterapia 71 (3): 232-5. Jun 2000.

Issue 67

The perennial shrub, PETASIDES HYBRIDUS, has been used medicinally for centuries. In this monograph the history of its use is traced, and the plant is described in its appearance and its common names (butterbur in English). Currently the plant is used primary for the prophylactic treatment of migraines, and as an anti-spasmodic agent for chronic cough and asthma. It has also successfully been used in the prevention of gastric ulcers, and in the treatment of irritable bladder and urinary tract spasms.
Monograph. Petasides hybridus. Alternative Medicine Review 6 (2): 207-9. Apr 2001.

CHING, Deakin University, Burwood, studied the application of aromatherapy, and specifically lavender, in acute pain relief.
Background: Postoperative pain management is a poorly explored field in terms of alternative medicine. However all therapeutic interventions should be considered that nurses can apply to their practice.
Methods: The potential use of aromatherapy in postoperative pain management is critically examined. The concept of aromatherapy is explored in terms of its effects on pain pathways, methods of administration, and therapeutic effects.
Results: There are gaps in the knowledge of the clinical applications of aromatherapy in relation to issues of dosage, methods of administration, and therapeutic effects. The small number of studies of aromatherapy in acute care settings makes it difficult to generalise findings.
Conclusions: In order to achieve best practice, further research is necessary into the uses of aromatherapy in the management of acute postoperative pain.
Ching M. Contemporary therapy: aromatherapy in the management of acute pain? Contemporary Nurse 8 (4): 146-51. Dec 1999.

MACKAY, Thorne Research, 4616 SE 30th, Portland, OR 97202, USA, mackaynd@earthlink.net, has reviewed (70 references) treatment options for haemorrhoids and varicose veins.
Background: Loss of vascular integrity is associated with the pathogenesis of both haemorrhoids and varicose veins. Traditional treatments are often costly and uncomfortable, leading patients to postpone evaluation until aggressive intervention is necessary. More conservative treatment options are diet and lifestyle changes, mechanical compression stockings, topical agents for haemorrhoids, and hydrotherapy.
Methods: 70 references for the use of herbal dietary supplements were reviewed.
Results: Several botanical extracts have been shown to improve blood circulation and vascular tone, and to strengthen the connective tissue surrounding blood vessels.
Conclusions: Dietary supplementation with Aesculus hippocastanum, Ruscus asculeatus, Centella asiatica, Hamamelis virginiana, and bioflavonoids may prevent painful, time-consuming and expensive complications of varicose veins and haemorrhoids.
Mackay D. Hemorrhoids and varicose veins: a review of treatment options. Alternative Medicine Review 6 (2): 126-40. Apr 2001.

Issue 66

MAHADY, Program for Collaborative Research in the Pharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, IL 60612, USA reviews (15 references, and discusses the increasing global importance of herbal medicine and the consequent urgent need for accurate scientific assessment of the quality, safety and efficacy of herbal products.
Discussion: Over the past decade, herbal medicines have increased
dramatically in global importance, with both medical and economic
implications. In developing countries, up to 80% of indigenous populations depend on traditional systems of medicine and medicinal plants for their
primary healthcare. In the EC, herbal medicines form an important share of the pharmaceutical market, annual sales being around US$7 billion. In the USA, sales of herbal products soared from US$200 million in 1988 to US$3.3 billion in 1997. There are serious concerns about the quality, safety and efficacy of herbal products. In 1995, the Traditional Medicine Program of the WHO began reviewing the world’s extensive scientific literature on commonly used herbal medicines and publishing this information in monographs – technical reviews of the quality, safety and efficacy of the herbal medicines. The monographs are intended primarily to aid harmonization of the proper use of herbal medicines throughout the world.
Mahady GB. Global harmonization of herbal health claims. The Journal of Nutrition 131 (3s): 1120S-3S. Mar 2001.

Issue 64

BECKMAN, SOMMI and SWITZER, Department of Psychiatry, School of Pharmacy, University of Missouri-Kansas City, and Western Missouri Mental Health Center, Missouri 64108-2792, USA conducted a telephone survey of people who had taken St John’s wort.
Background: Use of St John’s wort is largely unsupervised and unexplored, despite limited available information on its pharmacology, efficacy and side effects.
Methods: The investigators carried out a telephone survey of 43 individuals who had taken St John’s wort to obtain information on demographics, psychiatric and medical conditions, dosage, duration of use, reason for use, side effects, concomitant drugs, professional consultation, effectiveness, relapse and withdrawal effects.
Results: The majority of subjects reported taking St John’s wort for depression. 74% did not seek medical advice. The mean dosage used was 475.6±360 mg/day (range 300-1200 mg/day). The mean duration of dosing was 7.3±10.1 weeks (range 1 day-5 years). 84% (n=36) reported an improvement. Of these, 50% (n=18) had a psychiatric diagnosis. 47% (n=20) reported side effects, leading to discontinuation of use in 5 (12%) and 1 emergency room visit. 2 subjects reported symptoms of serotonin syndrome. 3 reported food-drug interactions. 13 subjects experienced withdrawal symptoms on stopping St John’s wort. 2 had a depressive relapse.
Conclusion: There is a need for greater consumer and provider awareness of the potential risks of St John’s wort in the self-care of depression and related conditions.
Beckman SE, Sommi RW and Switzer J. Consumer use of St John’s wort: a survey on effectiveness, safety, and tolerability. Pharmacotherapy 20 (5): 568-74. May 2000.

BINNS and colleagues, Ottawa-Carleton Institute of Biology, University of Ottawa, Canada evaluated the phototoxic antimicrobial (antifungal) activity of Echinacea extracts.
Background: Extracts of Echinacea have previously been reported to contain acetylenic isobutylamides and polyacetylenes. This study aimed to confirm the presence of these compounds and demonstrate that such plant extracts have phototoxic antifungal activity.
Methods: HPLC (high-pressure liquid chromatography) was used to confirm the presence of polyacetylenes and alkylamides in different organs in Echinacea purpurea. The abilities of hexane extr acts of Echinacea to inhibit growth of different yeast strains, under near UV irradiation (phototoxicity) or without irradiation, were investigated.
Results: Hexane extracts inhibited the growth of the following yeast strains to varying degrees: Saccharomyces cerevisiae, Candida shehata, C. kefyr, C. albicans, C. steatulytica and C. tropicalis. Inhibition was greater under near UV irradiation (phototoxicity) compared with no irradiation (conventional antifungal activity). Two representative pure compounds, undeca-2E,4Z-diene-8,10-diynoic acid isobutylamide and dodeca-2E,4E,8Z,10E/Z-tetraenoic acid isobutylamide, were isolated from Echinacea root extracts and compared in a disk assay (5 ug/disk) with the highly conjugated trideca-1-ene-3,5,7,9,10-pentayne (previously isolated in this laboratory and found here in E. purpurea). Of the three compounds, only the pure trideca-1-ene-3,5,7,9,10-pentayne demonstrated significant phototoxicity.
Conclusion: The study demonstrated that extracts of Echinacea had
phototoxic activity against a range of fungi, including clinically relevant pathogenic fungi. Phototoxic activity of Echinacea extracts was related to the presence of polyacetylenes and alkylamides. Specifically, the phototoxic activity of Echinacea species was attributed primarily to the ketoalkenes and ketoalkynes abundantly present in its roots.
Binns SE et al. Light-mediated antifungal activity of Echinacea extracts. Planta Medica 66 (3): 241-4. Apr 2000.
Comments: The above study demonstrates the wide-ranging anti-fungal activity of Echinacea, particularly against Candida strains, one of the gold standards used in herbal medicine to fight infection.

ABE and SAITO, Laboratory of Chemical Pharmacology, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo 113-0033, Japan reviewed recent evidence of the effects of saffron (Crocus sativus L.) extract on learning and memory in animals.
Discussion: Saffron is used in folk medicine for various purposes. Modern pharmacology has shown saffron extracts to have antitumour effects, radical scavenger (antioxidant) properties and hypolipaemic effects. Crocetin is the constituent of saffron extract mainly responsible for these effects. Recent studies have shown that saffron extract also affects learning and memory in animals.
Results: Saffron extract improved ethanol-induced impairments in learning behaviours in mice. In electrophysiological studies, saffron extract prevented ethanol-induced inhibition of hippocampal long-term potentiation, a process that may underlie learning and memory. These effects are attributed to the saffron constituent crocin (crocetin di-gentiobiose ester) but not crocetin.
Conclusion: Saffron extract, or its active constituents crocetin and crocin, may be useful in the treatment of neurodegenerative disorders
accompanying memory impairment.
Abe K, Saito H. Effects of saffron extract and its constituent crocin on learning behaviour and long-term potentiation. Phytotherapy Research 14 (3): 149-52. May 2000.

SAEKI, Department of Anatomy and Physiology, Nagano College of Nursing, Japan investigated the effect of a foot bath with or without lavender essential oil on the autonomic nervous system.
Methods: In this randomized, controlled, cross-over study, young women sat with their feet soaking in hot water, with or without lavender essential oil, for 10 minutes. An electrocardiogram (ECG), finger tip blood flow and respiratory rate were recorded. Spectral analysis of heart rate variability was used to evaluate autonomic function.
Results: Foot bathing (with or without lavender essential oil) caused a significant increase in finger tip blood flow, but no changes in heart or respiratory rates, and a significant increase in parasympathetic nerve activity (as evaluated by spectral analysis). The foot bath with lavender essential oil caused delayed changes in the balance of autonomic activity in the direction associated with relaxation.
Conclusion: A hot foot bath and lavender essential oil appear to be associated with small but significant changes in autonomic activity.
Saeki Y. The effect of foot-bath with or without the essential oil of lavender on the autonomic nervous system: a randomized trial. Complementary Therapies in Medicine 8 (1): 2-7. Mar 2000.

SCHEMPP and colleagues, Department of Dermatology, Photodermatology Unit, University Medical Center, Haupstr. 7, D-79104 Freiburg, Germany investigated immunomodulatory properties of St John’s wort (Hypericum perforatum) ointment, and the Hypericum metabolite hyperforin, in vitro and in vivo, and compared the effects with the immunosuppressive effects of solar-simulated radiation (SSR).
Background: St John’s wort is a traditional herbal medicine used for the topical treatment of superficial wounds, burns and dermatitis. The characteristic metabolites of St John’s wort are the photodynamic active plant pigment hypericin and the phloroglucin-derivative hyperforin.
Methods: The researchers compared the alloantigen-presenting function of human epidermal cells (EC) exposed to Hypericum ointment or SSR in vivo in a mixed EC lymphocyte reaction (MECLR). Purified hyperforin was also tested in vivo and in vitro in an MECLR, to assess whether it contributed to the effect of the Hypericum ointment. The effects of hyperforin on the proliferation of peripheral blood mononuclear cells (PBMC) in vitro were also assessed.
Results: Hypericum ointment or SSR resulted in significant suppression of the MECLR (p0.001) compared to untreated skin, and the effects of Hypericum ointment and SSR were similar. Combined Hypericum ointment plus SSR was not significantly different from either treatment alone. EC isolated from skin treated with the hyperforin-containing ointment showed a reduced capacity to stimulate proliferation of allogeneic T cells (p0.001). Similarly, EC incubated in vitro with hyperforin showed reduced ability to stimulate alloreactive T cell proliferation (p0.001). Hyperforin dose-dependently inhibited the proliferation of PBMC, as determined by Trypan blue staining.
Conclusion: Hypericum extract and its metabolite hyperforin have an inhibitory effect on the MECLR and on the proliferation of T lymphocytes. These results may provide a rationale for the traditional use of Hypericum extracts to treat inflammatory skin disorders.
Schempp CM et al. Topical application of St John’s wort (Hypericum perforatum L.) and of its metabolite hyperforin inhibits the allostimulatory capacity of epidermal cells. The British Journal of Dermatology 142 (5): 979-84. May 2000.

CHAN and TOMLINSON, Division of Cardiovascular Medicine, Taipei Medical College, Taipei Wan Fang Hospital, Taiwan examined the antioxidant effects of trilinolein, a triacylglycerol isolated from the Chinese herb sanchi (Panax pseudoginseng) and commonly used in traditional Chinese medicine.
Background: Oxygen-derived free radicals (OFR) cause lipid peroxidation, which is thought to contribute to the process of atherosclerosis and the myocardial damage that occurs with ischaemia and reperfusion. Antioxidants could potentially ameliorate such harmful effects.
Discussion: Many plant products have been shown to have antioxidant effects. Trilinolein, a triacylglycerol isolated from Panax pseudoginseng, has pharmacological effects including antioxidant activity. This property may explain the perceived benefits of the herb in treating circulatory
disorders gained over the centuries.
Chan P, Tomlinson B. Antioxidant effects of Chinese traditional medicine: focus on trilinolein isolated from the Chinese herb sanchi (Panax pseudoginseng). Journal of Clinical Pharmacology 40 (5): 457-61. May 2000.

Issue 63

MILLER and colleagues, Department of Pediatrics and Center for Cardiovascular Sciences, Albany Medical College, New York 12208, USA, millermj@mail.amc.edu carried out studies to evaluate, in an animal model and in vitro, the possible uses of Sangre de grado, an Amazonian herbal medicine, in gastrointestinal disorders.
Background: Sangre de grado is an Amazonian herbal medicine used to aid the healing of gastric ulcers and to treat gastritis, diarrhoea, skin wounds and insect stings.
Methods: The researchers induced gastric ulcers in rats. The rats were then given drinking water containing sangre de grado in a dilution of 1:1,000 or 1:10,000 for 7 days post-operatively. In a further study, the in vitro effects of sangre de grado on the secretory responses of guinea pig ileum to capsaicin, electrical field stimulation and the neurokinin-1 (NK-1) agonist (Sar(9), Met(0(2))(11))substance P were examined in Ussing chambers.
Results: In the rat gastric ulcer model, sangre de grado treatment facilitated ulcer healing, as shown by reduced myeloperoxidase activity, reduced ulcer size and reduced bacterial content of the ulcer. Ulcer induction caused upregulation of the expression of pro-inflammatory genes, tumour necrosis factor-alpha, inducible nitric oxide synthase (iNOS), interleukin (IL)-1-beta, IL-6 and cyclooxygenase-2. These effects were reduced by sangre de grado treatment, particularly iNOS and IL-6. In guinea pig ileum, sangre de grado reduced the secretory response to capsaicin, but not to electrical field stimulation or to the NK-1 agonist.
Conclusion: Sangre de grado is a potent, cost-effective treatment for gastrointestinal ulcers and distress, acting via antimicrobial, anti-inflammatory and sensory afferent dependent mechanisms.
Miller MJ et al. Treatment of gastric ulcers and diarrhea with the Amazonian herbal medicine sangre de grado. American Journal of Physiology. Gastrointestinal and Liver Physiology 279 (1): G192-200. Jul 2000.

TSEN and colleagues, Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA 02115, USA quantified the use of herbal remedies and vitamins in the pre-surgical population of a large tertiary care centre.
Background: There has been a dramatic increase in the use of complementary and alternative medicines, which has implications for anaesthesiologists regarding possible drug interactions, side effects and medical liability.
Methods: Over an 11-week period, all patients presenting for evaluation in the pre-operative clinic were asked to complete a 1-page questionnaire regarding use of prescription and non-prescription medications, herbal remedies and vitamins.
Results: 22% of pre-surgical patients reported using herbal remedies and 51% used vitamins. Women and patients aged 40-60 years were more likely to use herbal medicines than men or other age groups respectively. Use of over-the-counter medicines was strongly associated with use of herbal preparations. The most commonly used herbal preparations (from highest to lowest) were: echinacea, gingko biloba, St. John’s wort, garlic and ginseng.
Conclusion: Use of complementary/alternative medicines is common in the pre-operative period.
Tsen LC et al. Alternative medicine use in presurgical patients. Anesthesiology 93 (1): 148-51. Jul 2000.

BRENNER and colleagues, St. John’s Episcopal Hospital, Far Rockaway, New York 11691, USA compared hypericum (St. John’s wort) to the serotonin reuptake inhibitor (SSRI) sertraline for the treatment of depression.
Background: Hypericum has been shown to be as efficacious and well tolerated as standard antidepressants in treating [mild-to-moderate] depression, but has not been compared with SSRIs.
Methods: 19 female and 11 male outpatients of a community hospital, mean age 45.5 years, with mild-to-moderate depression were randomised in a double-blind manner to receive 600 mg/day of a standardised extract of hypericum (LI 160) or 50 mg/day sertraline for 1 week, followed by 900 mg/day hypericum or 75 mg/day sertraline respectively for 6 weeks. Severity of depression symptoms was assessed on the Hamilton Rating Scale for Depression (HAM-D) and the Clinical Global Impression (CGI) scale.
Results: Symptom severity was significantly reduced in both treatment groups (p<0.01). A clinical response (defined as a 50% reduction in HAM-D scores) was seen in 47% of patients who received hypericum and 40% of those who received sertraline; the difference between the two groups was not statistically significant. Both hypericum and sertraline were well tolerated. A post-hoc power analysis indicated that the failure to detect a statistically significant difference between the two treatments was primarily due to a lack of clinical differences rather than the small patient sample size.
Conclusion: Hypericum extract LI 160 was at least as effective as the SSRI sertraline in the treatment of mild-to-moderate depression in this small group of outpatients.
Brenner R et al. Comparison of an extract of hypericum (LI 160) and sertraline in the treatment of depression: a double-blind, randomized pilot study. Clinical Therapeutics 22 (4): 411-9. Apr 2000.

MAY and colleagues, Microbiology Department, St. Thomas’ Hospital, London SE1 7EH, UK investigated the kill rate and kill time of tea tree oil against several multidrug-resistant microorganisms and other sensitive microorganisms.
Background: Tea tree oil is an effective topical antimicrobial agent against a wide range of organisms and may have important clinical applications both in the hospital and in the community.
Methods: Methods based on the time-kill approach were used to determine the kill rates/times of two chemically different tea tree oils against several multidrug-resistant organisms including: methicillin-resistant Staphylococcus aureus (MRSA), glycopeptide-resistant enterococci, aminoglycoside-resistant klebsiellae, Pseudomonas aeruginosa and Stenotrophomonas maltophilia. The kill rates/times of the oils against other sensitive microorganisms were also determined. The two oils consisted of: a) a standard oil; and b) Clone 88, extracted from a tree that has been selected and bred for increased activity and decreased skin irritation.
Results: The findings confirmed that the cloned oil had increased antimicrobial activity compared with the standard oil. Most of the findings indicated that the susceptibility pattern and Gram reaction of a microorganism did not influence its kill rate. Both tea tree oils achieved rapid kill times (less than 60 minutes) with most of the organisms examined; however, the kill time for MRSA was longer than for other organisms.
May J et al. Time-kill studies of tea tree oils on clinical isolates. The Journal of Antimicrobial Chemotherapy 45 (5): 639-43. May 2000.
Comments: With the lethal rise in MRSA infections in many hospital wards, I would hope that clinicians would pay particular attention to research results of this nature. Essential oils were once used as disinfectants during World War I in France, when there was a scarcity of other disinfecting chemicals. If antibiotic resistant microorganisms persist in outwitting the microbiologists, using other herbal or essential oil remedies will be instrumental in saving many thousands of lives. (See also the article Tea Tree Oil by Cynthia Olsen.)

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