October 27th, 2009 
Nyomi Graef 
Did you know that St John’s wort is one of the most popular natural antidepressants in the United States and Canada?
St John’s wort is a flowering plant that has been used to treat depression for centuries. Today it’s available from health food stores, pharmacies and even some supermarkets. It is generally safe and has few side effects.
What is St John’s wort?
What is St John’s wort used for?
What evidence is there that St John’s wort works for depression?
How does St John’s wort work?
How long does St John’s wort take to work?
How is St John’s wort taken?
Is St John’s wort addictive?
What are the side effects of St John’s wort?
Who should not take, or be cautious about taking, St John’s wort?
What is St John’s wort?
St John’s wort (Hypericum perforatum) is a yellow-flowering plant native to Europe, Asia and North Africa. Wikipedia says it has been introduced to many temperate areas of the world, and grows wild in many meadows.
What is St John’s wort used for?
St John’s wort has been used for centuries to heal wounds and treat nerve pain, and mental health problems, such as depression.
St John’s wort has also been used as, for example, a sedative (calm and promote sleep), and a treatment for malaria, menopausal changes, burns and insect bites.
Today St John’s wort is mainly used to treat depression, anxiety, mood swings, nervous unrest, restlessness and sleep problems.
Wikipedia says that in some countries, such as Germany, the plant is often prescribed for mild depression, especially in children, adolescents, and where cost is a concern.
What evidence is there that St John’s wort works for depression?
St John’s wort has been studied a lot in Europe over the last two decades, with more recent research in the United States, according to the Mayo Clinic.
In 2008 the NHS reported on a review of 29 studies with nearly 5,500 people. Participants took either St John’s wort, a placebo or standard antidepressants. A placebo is a “dummy” pill designed to have no effect. The results found that St John’s wort was just as good at easing depression as drugs like Prozac, but St John’s wort had fewer side effects. The Daily Mail said this was the most thorough study of St John’s wort to date. The results apply mainly to people with mild-to-moderate depression. According to the NHS: “The authors say that for severe major depression, the evidence is ‘still insufficient to draw conclusions.’”
The Black Dog Institute says recent clinical trials found St John’s wort was better than a placebo, or just as good as standard antidepressants, such as Prozac, Tofranil and Zoloft.
The Mayo Clinic claims many studies report St John’s wort to be better than a placebo and just as good as tricyclic antidepressant drugs in the short-term treatment of mild-to-moderate major depression (one to three months).
How does St John’s wort work?
St John’s wort contains chemicals that can, for example,:
- improve mood, so help treat sadness, depression, anxiety, stress, restlessness and mood swings
- kill viruses
- help heal wounds
- ease inflammation
- sedate people (calm and promote sleep)
The herb works in various ways; one is that it affects neurotransmitters. Neurotransmitters are chemicals in our bodies that affect many areas of our lives, such as sleep, mood and sense of pain.
According to the Black Dog Institute, St John’s wort is believed to be a reuptake inhibitor of the neurotransmitters serotonin, dopamine and noradrenalin. This is similar to how SSRI antidepressants work.
How long does St John’s wort take to work?
Author Jean Carper says depression may ease a few days after starting St John’s wort, but the full effects may take six weeks. She also says that, according to Dr. Rosenthal, most people see some improvement in depression after three weeks of taking 900 milligrams of the herb daily. Medical herbalist Kate Fraser recommends taking St John’s wort for at least six weeks, because problems take time to overcome.
How is St John’s wort taken?
The flowering tops, and other parts, of the plant are used to make teas, and tablets, capsules, oils, ointments and liquids (tinctures) containing extracts of the plant.
Is St John’s wort addictive?
The good news is that it’s not addictive. When you decide to stop taking it, it’s best to gradually reduce the dose. If you stop taking it suddenly you may feel unwell.
If you stop taking St John’s wort, your original symptoms may return. The UK’s NHS recommends taking St John’s wort for at least six months after you have fully recovered from your symptoms.
What are the side effects of St John’s wort?
Generally St John’s wort is safe and has only a few side effects.
ABC Health and Wellbeing says the most common side effects of St John’s wort include:
- stomach upset
- sensitivity to sunlight
- agitation
- skin reactions
The National Institutes of Health in USA says that, in some people, St John’s wort can cause:
- dry mouth
- dizziness
- fatigue
- headaches
- sexual dysfunction
Who should not take, or be cautious about taking, St John’s wort?
Talk to a relevant health professional before taking St John’s wort.
The herb can reduce the effectiveness of birth control pills and some other medications.
St John’s wort can cause serious side effects when taken with some other supplements and medications. These include:
- antidepressants
- blood thinning drugs, such as Warfarin
- drugs for irregular heartbeats
- HIV medication
- drugs to treat cancer
- immunosuppressants
- triptan migraine drugs
If you take St John’s wort and are about to have surgery, stop taking the plant at least 10 days beforehand.
Drink no, or little, alcohol while taking St John’s wort. Alcohol can interact with the herb to make you feel dizzy or confused. The UK’s NHS recommends that you avoid alcohol until you are used to taking St John’s wort. Once you are used to it you may be able to drink very small amounts. If you mix alcohol with antidepressants you may become very drowsy. Drinking alcohol can also worsen depression and anxiety.
You might feel dizzy at first when taking St John’s wort. Until this wears off, or you know how St John’s wort affects you, do not drive or use machinery. You should be careful as St John’s wort might affect your reaction times.
written by Nyomi Graef
updated 13 October, 2012
References:
Bratman, S, 1998, The Alternative Medicine Ratings Guide, Rocklin, USA: Prima Publishing
Carper, J, 2000, Your Miracle Brain, New York, USA: HarperCollins
Carter, H, 2008, St John’s Wort, ABC Health & Wellbeing,
http://www.abc.net.au/health/healthyliving/naturalhealth/guide/stories/2008/05/20/2230384.htm#.UE896FH_kTA
Fraser, K, 1995, Positive Health with Herbs: The Complete Guide to Herbal Medicine, Mona Vale, Australia: All Type and Art
Somerville, R, (Ed.), 1997, The Alternative Advisor, Virginia, USA: Time-Life Books
St John’s wort, 2009, Wikipedia,
http://en.wikipedia.org/wiki/St_John’27s_Wort
St John’s wort, 2008, NHS,
http://www.nhs.uk/medicine-guides/pages/MedicineOverview.aspx?medicine=St.%20Johns%20wort
St John’s wort, 2005, National Center for Complementary and Alternative Medicine, National Institutes of Health,
http://nccam.nih.gov/health/stjohnswort/ataglance.htm
St John’s wort as a depression treatment [pdf], 2009, Black Dog Institute,
http://www.blackdoginstitute.org.au/docs/StJohnswort.pdf
St. John’s wort for depression, 2008, NHS,
http://www.nhs.uk/news/2008/10October/Pages/StJohn%27swortanddepression.aspx
St. John’s wort (Hypericum perforatum L.), 2009, Mayo Clinic,
http://www.mayoclinic.com/health/st-johns-wort/NS_patient-stjohnswort
Posted in 
Tags: 
Gday great blog, plenty of original content, will be back in a while to see more.
Great post. I feel it sums up how many of us feel about this.
I have been taking st john wort for the last six month. i believe it works. i feel better.
I got constipated when I was taking st johns wort. Nice post!
is it safe to take while breastfeeding?
Hi Lisa,
In regards to your question about whether St John’s wort is safe to take while breastfeeding, according to WebMD:
“Nursing infants of mothers who take St. John’s wort can experience colic, drowsiness, and listlessness. Until more is known, don’t use St. John’s wort if you are pregnant or breast-feeding.”
Visit http://www.webmd.com/vitamins-supplements/ingredientmono-329-ST%20JOHN%27S%20WORT.aspx?activeIngredientId=329&activeIngredientName=ST%20JOHN%27S%20WORT and click on “Side Effects”.
On the other hand, researchers of a study of breastfeeding mothers taking St John’s wort concluded: “These results add to the evidence of the relative safety of St. John’s wort while breast-feeding found in previous observational studies.”
This study was published in the Journal of Clinical Psychiatry in 2006. Read more at http://www.ncbi.nlm.nih.gov/pubmed/16566628.
The BabyCenter says: “It is safest not to take St John’s wort while you are breastfeeding, because we do not know enough about its effects.”
Read more at http://www.babycenter.com.au/pregnancy/antenatalhealth/physicalhealth/stjohnswort/#6.
So, personally, I’d err on the side of caution and go with WebMD and BabyCenter’s advice and avoid taking St John’s wort while breastfeeding.
Thanks for commenting and all the best.
Kind regards,
Nyomi
Dear Nyomi,
I’ve been suffering from anxiety and depression symptoms since 16 months ago, but I told my doctor that I’m not going to take any anti depression Medications. Without consulting her I decided to start taking st. John’s wort, one capsule 300 mg a day. This is the 4th day that I’ve been taking it. Is there any thing that I need to know from your personal experience?
Thank you,
Shay
Hi Shay,
I’m sorry to hear you have anxiety and depression. I hope you feel better soon.
Here are some tips about St John’s wort (SJW):
* It’s best to take SJW while under the care of a relevant health professional.
* Make sure that SJW doesn’t badly interact with any other medications and/or supplements you’re taking, if you are taking any of these. You don’t want to have any bad reactions.
* Ensure SJW doesn’t worsen any health problems that you already have, should you have any such problems.
* Be aware of any side effects you might get from SJW. See a relevant health professional if any are serious, too annoying and/or worsen over time etc.
I hope this helps.
All the best and thanks for commenting.
Best wishes,
Nyomi
Can SJW be combined with 5-HTP? Do they do the same thing or compliment each other?
Hi Robin,
Thanks for your comment. According to Dr. Michael Murray: “5-HTP should not be used in combination with antidepressant drugs unless under the supervision of a physician. It can be used in combination with St. John’s wort extract.” Read more at http://doctormurray.com/health-conditions/depression/.
Both 5-HTP and St John’s wort (SJW) affect neurotransmitters. Dr. Murray explains SJW and 5-HTP in more detail in the above web page. Scroll down to the information under “5-Hydroxytryptophan” and “St. John’s wort extract”, in bold, to read more. Also visit my blog post about 5-HTP at http://extrahappiness.com.au/happiness/?p=2071.
All the best
Kind regards,
Nyomi
Hello,
Thank you very much for the time you’ve put into this post.
For the last year and a half I have been suffering moderate to sever anxiety. I have been prescribed celexa and ativan and have taken it for about 8 months but currently been drug free for about six months after noticing how much I was loosing while not even gaining full relief from my anxiety. I was curious to know from your experience if sjw is effective for anxiety? Is it safe to be trying different herbs that interact with my brain? Can this cause serotonin syndrome?
Thanks
Corey
Hi Corey,
I am sorry to hear that you have anxiety. Having had it in the past, I understand that it’s not pleasant.
Be careful taking a number of herbs/other supplements/medication at the same time. Some can combine to cause health problems – including serotonin syndrome – and/or worsen health problems already present. Talk to a relevant health professional to see which supplements suit you.
The Mayo Clinic lists drugs and supplements that may be linked to serotonin syndrome. Towards the bottom of the list is: “Herbal supplements, including St. John’s wort and ginseng”. Read more at: http://www.mayoclinic.com/health/serotonin-syndrome/DS00860/DSECTION=causes.
Some research says St John’s wort (SJW) doesn’t work for anxiety. For example, read this Daily Mail article: http://www.dailymail.co.uk/health/article-1318410/Bad-news-St-Johns-wort-wont-cure-anxiety-Good-news-passion-flower-will.html. This article says passion flower is, however, good for anxiety.
Others, however, claim SJW does work for anxiety. Walter E. Mueller wrote St. John’s Wort and its Active Principles in Depression and Anxiety. Read this at: http://link.springer.com/book/10.1007/b137619/page/1.
Check-out my blog posts on this website tagged in Anxiety: http://extrahappiness.com.au/happiness/?tag=anxiety. I have written a blog post about passion flower at http://extrahappiness.com.au/happiness/?p=2103.
I hope you feel better soon.
Thanks for your comment and questions.
Best wishes,
Nyomi
Hello!
I have a variety of physical problems that doctos have been unable to diagnose. I have made four attempts at using an ssri but have been unable to tolerate the side effects. I am on my 7th day of taking SJW 600mg/day with just mild headaches and dizziness. I feel much better in many ways already!
My only concern is that Ive read that SJW can be a MOAI inhibitor and that I should be on a Tyramine free diet.
Is this a realistic or valid concern?
Chris
Hi,
My husband lost his father 4 months ago to an illness. Since then he has been removed, anxious, pessimistic, and generally not enjoying anything in his life anymore. He is very resistant to seeing a doctor or admitting he has any sort of depression or anxiety. I would like to help suggest he take something natural like St. John’s wort just to see if it helps. He is not currently on any other medications. Would this be safe and effective for him? What would his side effects be?
Thank you.
Hi Chris,
I’m glad you’re feeling better on St John’s wort (SJW). Visit other health professionals besides doctors, such as qualified naturopaths, to find the cause of your problems, if you feel the need.
Your concern about whether you should be on a tyramine-free diet when taking SJW, because SJW can be a MAOI inhibiter, is valid.
About.com says SJW is a MAOI. The website lists foods high in tyramine that people should avoid eating while taking SJW. Visit http://atheism.about.com/library/glossary/paranormal/bldef_stjohnswort.htm to read more.
The Tang Center claims that, in regards to SJW,: “Initially, monoamine oxidase (MAO) inhibition was considered a possible mechanism of action. Later studies have shown, however, that the inhibition of MAO by St. John’s wort is clinically insignificant. Adverse events that would be expected with MAO inhibition have not been reported with St. John’s wort.” Read more at: http://tangcenter.uchicago.edu/herbal_resources/stjohnswort.shtml
Pathmed.com says: “Although St. John’s wort contains chemicals that bind MAOI in test tubes, the action of St. John’s wort is not thought to be due to MAOI activity. However, because St. John’s wort may have serotonin reuptake inhibiting action (similar to the action of drugs such as fluoxetine [Prozac®]), it is best to avoid using of St. John’s wort with MAOI drugs.” Read more at: http://www.pathmed.com/faq/?p=376
So to be on the safe side, it’s probably best to avoid eating too many foods high in tyramine while taking SJW.
Get well soon Chris.
Thanks for your comment.
Best wishes,
Nyomi
Hi Brandy,
My deepest sympathies on the loss of your father-in-law recently. This must be a very tough time for you and your family. I hope your husband’s health improves soon.
Sorry Brandy, but because I am not a qualified medical doctor or naturopath, for example, I am unable to prescribe health treatments for your husband. My website is not intended to diagnose health problems nor prescribe medication.
I recommend that your husband sees one or more relevant health professionals for his symptoms soon. I understand that he’s resisting seeing a doctor, but if I were you, I would kindly persist, or get one of his friends, or another family member, besides yourself, to try to talk him into seeing a doctor/other relevant health professional, if you haven’t already done so. Together your husband and the health professional(s) can discuss, for example, your husband’s symptoms, and any supplements etc that he is taking/has previously taken – something that I am unable to do.
St. John’s wort (SJW) may or may not be suitable for your husband; I am unsure because I do not know your husband’s health history, any reactions he’s had to other supplements etc. Generally, however, SJW is a safe herb with few side effects, as I’ve mentioned in the above blog post.
I’ve listed a number of possible side effects of SJW in my blog post on the herb. To read these side effects, click on the second last link in the list of links under the introduction of this blog post.
People react differently to different supplements/medication etc, so, again, I can’t say for sure how your husband would react to SJW, and whether or not the herb is safe for him.
Thank you for your comment, Brandy. I hope your husband seeks professional help soon, and his health improves shortly.
Kind Regards,
Nyomi
Hi
I’ve been considering trying SJW. With regards to the recommendations concerning alcohol, I was hoping for some advice. I go out once a week to meet with friends for a drink. I don’t want to give this up, as it’s really the only thing I have to look forward to at the mo, and I was wondering how serious the side effects with SJW and alcohol are? For example, could I just lay off the SJW for that one day a week?
Thanks
Andy
Hi Andy,
Thanks for your comment. Taking SJW and alcohol together can affect different people in different ways. As I wrote in the above blog post: “Drink no, or little, alcohol while taking St John’s wort. Alcohol can interact with the herb to make you feel dizzy or confused. The UK’s NHS recommends that you avoid alcohol until you are used to taking St John’s wort. Once you are used to it you may be able to drink very small amounts. If you mix alcohol with antidepressants you may become very drowsy. Drinking alcohol can also worsen depression and anxiety.”
All the best
Kind regards,
Nyomi
Hopefully this information will be helpful for readers.
2 years ago i married my husband and went from 3 kids to 5 almost overnight. That was stressful enough and jas been quite a journey to get used to. Thankfully i am awesome bbbbnbF under stress but a couple months ago we listed our house for sale and are trying to move into a bigger house. The stress of rennovations and moving was sending me . Over the edge. I had been on zoloft briefly after my second pregnancy and it worked wonders…actially it worked a little too well. With my stress levels i decided to try sjw as a less intense alternative. I have been taking it for almost 3 weeks at 700mg/day herb capsules and while it isnt a total 180 it has definately taken a lot of the tension away and . I am back to my stress butt kicking self and i am greatful but like someone else said it is giving me constipation and some stomach upset. Nothing overwhelming but it is annoying. Im just not sure if its grounds for concern . Or if i should just pickup some stool softeners and call it good? Thanx in advance 🙂
Hi Marissa,
Thanks for your comment and for sharing information about your life. That’s good news that SJW is helping you feel calmer.
I recommend that you speak to a medical doctor or other relevant health professional about whether it’s okay for you to take stool softener along with SJW, and to talk about your side effects. Sorry, but because I don’t know your medical history and I’m not a medical doctor, for example, I’m unable to give you medical advice.
All the best and take care.
Best wishes,
Nyomi
Hi,
I have started taking Kira Low Mood relief 450mg to treat my anxiety and just want to know if it is likely to affect my Irritable Bowel Syndrome? I manage it by having a health lifestyle and eat well etc but I am 3 days in now taking 450mg x2 per day and I am starting to feel a bit constipated. Its nothing overly uncomfortable just wondering if it is likely to get worse before it settles down?
Also I have read online that SJW can stop your menstrual cycle is this true?
Hi Lyn,
Thanks for commenting. Sorry, I am unsure about whether your constipation will worsen before it improves. I suggest that you read the side effects mentioned in the information leaflet in the packet, if you haven’t already done so. It might say something about it in there.
Boots.com says: “You should see a doctor or qualified healthcare practitioner if the symptoms persist while using Kira® LowMood relief or if side effects not mentioned in the patient information leaflet occur.” For more information, visit http://www.boots.com/en/Kira-Low-Mood-St-Johns-Wort-Extract-Tablets-30-x-450-mg_1258503/
To help answer your question about SJW stopping the menstrual cycle, according to the Mayo Clinic: “St. John’s wort may result in altered menstrual flow, bleeding, unwanted pregnancies, and hormone level changes. Use cautiously in women taking contraceptives or other estrogen agents by mouth.” Visit http://www.mayoclinic.org/drugs-supplements/st-johns-wort/safety/hrb-20060053 for more details. There’s also a discussion on Yahoo Answers about this topic, if you’re interested: https://au.answers.yahoo.com/question/index?qid=20120427215731AAj8gHV
Take care and I hope you feel better soon.
Best wishes,
Nyomi
Can SJW be taken at the same time with Gingko Biloba?
Hi Jerry,
According to the Mayo Clinic, “St. John’s wort may alter the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto.” This information is under the heading ‘Interactions with Herbs and Dietary Supplements’. Read more at http://www.mayoclinic.org/drugs-supplements/st-johns-wort/interactions/hrb-20060053
Thanks for visiting my website.
Kind regards,
Nyomi
Hello,
I have started to take 5htp 8 days ago along with B complex, fish oil and vitamin D3. Today is my second day of including 300 mg of SJW. I found the combination of these supplements as recommendable at Dr. Murray site. I am so resolute in not taking ADs as I tried them 2 years ago, and now I am sure that Zoloft didn’t help at all, since it didn’t work for at least 2 months. I believe that I myself got out of that mood. Actually I visited a doctor and he immediately prescribed me Zoloft. I become certain that as soon as you ask for medical help, you will end up with prescribed AD. I feel terribly sad, crying all the time…I still can go to work, I go to gym on a regular basis as well, which gives me a hope that I still have strength to get out of this mood. But I have a racing mind, and I am feeling so so sad……It has been like this for 2 months and I do not have any visible reason for it. I guess the fact that I’ve been alone, with no partner, in my 40s with not many good friends around me, is one of the reasons I am feeling this way. Of course, so many stressful situations made for all this.
Please, tell me your opinion on this combination and what do you think that 5htp and SJW might start work? And would they at all?
Thank you
Hi Linda,
Thanks for commenting and for your questions. You’re going through a difficult and stressful time. Well done for exercising regularly — it’s great for your mind, body and spirit. And good on you for also researching ways to feel happier. Keep your hopes up, as things can improve. Keep searching as you can find the answers.
Have you heard of Meetup? It’s a website where people can join groups in their local area that they are interested in, to find people with similar pastimes. Millions of people all over the world have joined. There are heaps of different groups, including ones for walkers, adventurers, writers and movie goers. Many groups are free to join. The website address is http://www.meetup.com, if you’re interested.
What social hobbies/pastimes do you enjoy or might interest you? A local directory with clubs (such as sports/recreation/hobby clubs) could be a good place to look to help you find people with similar interests to yourself.
To answer your question about 5-HTP and St. John’s wort (SJW), according to Drugs.com, “Using St. John’s wort together with 5-HTP can increase the risk of a rare but serious condition called the serotonin syndrome.” For more information visit http://www.drugs.com/drug-interactions/5-htp-with-st-john-s-wort-1-10727-2106-0.html
Livestrong says that it might take several weeks for people to notice the full effects of 5-HTP. Read more at http://www.livestrong.com/article/434982-what-is-5-htp-how-long-does-it-take-to-work/. This article also warns about serotonin syndrome (see the information under the heading ‘Precautions’.)
I’ve written information about how long SJW takes to work, in the above article under the heading “How long does St John’s wort take to work?”
I’m unsure how long it might take for a combination of SJW and 5-HTP to work. I recommend that you talk to a relevant health care professional about whether this combination might be suitable for you. Sorry, but because I’m not a medical doctor, I am unable to recommend any particular medication for you.
Here’s a link to blog posts that I’ve written tagged ‘depression’ on Extra Happiness: http://extrahappiness.com.au/happiness/?tag=depression, should you wish to have a look.
All the best for feeling better soon.
Take care Linda,
Nyomi
How long does it take until the calming effect of the St. John’s wort kicks in? i need it badly for an experiment at school!
Thank you for sharing, this is very interesting visit my website SASAQQ
I’ve joined your rss feed and look forward to seeking more of your fantastic post.
Also, I have shared your web site in my social networks!