Depression affects more than 300 million people worldwide, including 1 in 10 adults in the United States alone (1, 2).
While many drugs effectively treat depression, some people prefer to use natural or alternative remedies.
St. John’s Wort is a herbal remedy that has been used for centuries to treat depression, among a myriad of other conditions.
What is St. John’s Wort?
St. John’s wort, botanically called Hypericum perforatum, is a wild plant native to Europe and Asia. It has yellow flowers in the shape of a star.
It is traditionally gathered around San Giovanni at the end of June, hence its name.
The flowers and buds of the plant can be dried and made into capsules and teas or pressed to be used in oils and liquid extracts.
It is most often used to treat depression and related conditions such as anxiety, sleep problems and seasonal affective disorder.
Although it is usually taken orally in the form of capsules, tea or a liquid extract, it can also be applied directly to the skin as an oil.
In the United States, it is classified as a dietary supplement by the Food and Drug Administration (FDA) and is not approved as a prescription medication for depression.
However, it is one of the most purchased herbal products in the United States.
Summary: St. John’s wort is a wild plant. Its flowers and buds are commonly used as an alternative treatment for depression and other conditions.
How it works?
Although the effects of St. John’s Wort on your body are not fully understood, it is believed to work the same way as antidepressants.
Research suggests that many active ingredients, including hypericin, hyperforin and adhyperforin, may be responsible for these benefits.
These ingredients appear to increase the levels of chemical messengers in the brain, such as serotonin, dopamine, and norepinephrine. These then act to boost and regulate your mood (3).
Interestingly, St. John’s Wort does not have some of the common side effects of prescription antidepressants, such as loss of libido.
Summary: St. John’s Wort is thought to regulate mood by increasing the levels of many chemical messengers in the brain.
It might be as effective as antidepressants
There is strong evidence to support the use of St. John’s Wort in the treatment of depression.
In 2016, an in-depth review of 35 studies examined these effects.
He discovered that St. John’s Wort (4):
- Reduction in symptoms of mild and moderate depression compared to placebo
- Symptoms reduced to an extent similar to prescription antidepressants
- It seems to have fewer side effects than prescription antidepressants
- Does not seem to reduce sexual desire, a common side effect of antidepressants
However, research on its effects on severe depression was lacking.
Another recent review looked at 27 studies comparing the effects of St. John’s Wort and antidepressants. He has shown that St. John’s Wort has effects similar to antidepressants on mild to moderate depression.
He also found that fewer people stopped taking St. John’s Wort while studying, compared to antidepressants. This could be due to its minor side effects (5).
In addition, in a controlled study, 251 people who took 900 to 1,800 mg of St. John’s Wort for six weeks saw their depression score decrease by 56.6%, compared to a 44.8% decrease in those treated with antidepressants (6).
Finally, another controlled study of 241 people taking St. John’s Wort or an antidepressant found that 68.6% of people had reduced symptoms of St. John’s Wort, compared to 70.4% of people treated with an antidepressant (7).
Summary: Studies show that St. John’s Wort appears to be as effective as antidepressants in treating mild to moderate depression. It also seems to have fewer side effects.
Other potential benefits
St. John’s Wort has also been researched for other conditions, including:
Premenstrual syndrome (PMS): one study found that hypericum supplements reduced the symptoms of PMS. However, a more recent review of the studies did not find it more effective than a placebo (8, 9).
Wound healing: when applied to the skin, it is effective in treating pressure sores, sores, bruises, burns and hemorrhoids (10, 11).
Menopause Symptoms: A small study found a significant reduction in menopause symptoms after taking liquid hypericum extract compared to placebo (12).
Seasonal Affective Disorder (SAD): SAD is a form of depression that occurs during the winter months. There is weak evidence to support the use of hypericum supplements in the treatment of SAD (13).
Cancer: Test tube studies have shown that hypericin in St. John’s Wort can inhibit the growth of cancer cells. However, it is not recommended as a treatment for cancer because of its potential interaction with other anticancer drugs (14, 15).
In addition, some argue that it can be used to treat obsessive-compulsive disorder (OCD) and help people quit smoking.
However, there is currently no evidence to support these claims.
Summary: There is evidence that St. John’s Wort can be useful as an alternative treatment for PMS, wound healing and menopausal symptoms.
It may not be for everyone
Although St. John’s Wort seems to be a relatively safe supplement, there are a few things to consider before taking it.
Most people who take St. John’s Wort have no side effects.
However, some people report side effects, including sleep disturbances, stomach pain, irritability, fatigue, and rashes.
However, research shows that it has far fewer side effects than antidepressants (4, 16, 17, 18).
In addition, it is associated with fewer distressing symptoms, such as increased sweating, sexual dysfunction and fatigue (19).
On rare occasions, St. John’s Wort can cause sensitivity to the sun, both for the skin and the eyes. This appears to be linked to high doses (20, 21).
It is important to note that most of the side effects reported are also common symptoms of depression. This is why it helps you to be aware of how you feel before you start taking St. John’s Wort.
Pregnancy and breast feeding
A limited number of observational studies have examined the risk of taking St. John’s Wort during pregnancy.
They found that premature birth rates were not affected. However, one of the studies found a slight increase in the risk of malformations (22, 23).
In addition, there is some evidence to suggest that St. John’s Wort may reduce fertility by inhibiting sperm and preventing fertilization of the eggs (24, 25).
However, midwives often recommend St. John’s Wort for postpartum depression.
Only a limited number of studies have examined its effects on breastfeeding. They show that it can be transferred into breast milk at very low levels, but that it does not seem to cause side effects in breastfed babies (26, 27).
Due to lack of evidence, it is not possible to say with certainty whether St. John’s wort can be used safely during pregnancy or breastfeeding.
The evidence for St. John’s Wort that causes withdrawal symptoms is primarily anecdotal.
Some people report symptoms such as illness, dizziness and anxiety after they stop taking it suddenly.
For safety reasons, it is generally recommended to slowly reduce the dose before stopping the use of St. John’s Wort.
Summary: Some side effects have been reported with the use of St. John’s Wort. However, research constantly shows that it has fewer side effects than standard antidepressants.
It can interact with many common drugs
St. John’s Wort interacts with a large number of commonly prescribed medications.
In most cases, it decreases their effects, but it can also increase them, potentially causing more frequent and more serious side effects.
It is known to interact with the following drugs, among others:
Antidepressants: may increase side effects when taken with certain antidepressants. This can lead to serotonin syndrome, a rare condition in which serotonin levels get too high and, in extreme cases, it can be fatal (28, 29).
Birth control pills: Unexpected bleeding may occur midway through the combined use of birth control pills and St. John’s Wort. It can also decrease the effectiveness of birth control (30, 31).
Warfarin: Warfarin is a blood thinning medication commonly used to prevent heart attacks, strokes, or blood clots. St. John’s Wort has been found to reduce its effectiveness, increasing the risk of blood clots (32).
Anti-cancer drugs: St. John’s Wort has been shown to reduce the effectiveness of certain anti-cancer drugs (33, 34).
Xanax: It has been shown to reduce the effectiveness of Xanax, an anxiety medication (35).
Summary: St. John’s Wort interacts with many common medications. It is important that you talk to your doctor before taking it if you are taking other medicines.
How to take St. John’s Wort
St. John’s Wort comes in many forms, including tablets, capsules, teas, extracts and oils for the skin.
The standard strength is 0.3% hypericin (36).
But since the FDA does not recognize it as a drug, it is not regulated as such and the products can vary considerably in terms of strength.
It is therefore difficult to determine an exact dosage, but most studies on herbs and depression in St John have used a dose of 300 mg three times a day (900 mg per day) (37).
The capsules or tablets seem to allow a more precise dosage. Purchasing from a reliable source can also guarantee accurate dosing.
Summary: A precise dosage can be difficult to determine. The standard dosage is 0.3% hypericin, while the standard dose for depression is 300 mg taken three times a day.
Studies show that St. John’s Wort can be as effective as antidepressants in treating mild to moderate depression and has fewer side effects.
In addition, there is some evidence to support its use for the treatment of PMS, wound healing and symptoms of menopause.
The main concern is its interaction with a large number of common drugs, so it is important to speak to a doctor before taking it.