St. John’s Wort for Depression

Introduction

St. John’s Wort, also known as Hypericum perforatum, is a wild plant that is found native to Europe, western Asia, and northern Africa.¹ The plant has flowers and buds that are taken and dried to create capsules, tea, oils and liquid extracts. Thousands of Americans use St. John’s Wort every day. In fact, it is the most commonly purchase over-the-counter natural product that is available in stores. St. John’s Wort is a very popular natural product that has been investigated for many years. Throughout the years, it has been determined that St. John’s Wort has antidepressant properties.¹ St. John’s Wort has also shown to have potential therapeutic benefits in aiding insomnia and anxiety.¹

In the United States today, St. John’s Wort is approved as a dietary supplement by the Food and Drug Administration (FDA), however, it is not approved as a prescription medication to treat depression.²

How Does St. John’s Wort Work?

To date, it is not entirely understood how St. John’s Wort works within the body. However, there are some theories as to how it may help individuals that have depression. St. John’s Wort contains active ingredients including hypericin, hyperforin and adhyperforin, which are believed to be responsible for the anti-depressive features of the natural product.³ These natural ingredients have a correlation with an increase in the amount of chemical messengers within the brain.³ This includes increased amounts of serotonin, dopamine and noradrenaline.³ All of these chemical messengers are associated with an improvement in mood stability and feelings of happiness. Therefore, by this mechanism it is possible that St. John’s Wort can influence an improvement in symptoms of depression. Nonetheless, more data is necessary to establish the entire validity of these theories.

St. John’s Wort and Depression

Many studies have compared St. John’s Wort with current prescription anti-depressant medications to determine the effectiveness and safety of the natural product. A majority of these studies have found a positive relationship between the use of St. John’s Wort and the potential for anti-depressive benefits.

A 2016 in-depth review of 35 studies reviewed the use of St. John’s Wort in the treatment of depression.⁴ This review determined various outcomes. Firstly, the use of St. John’s Wort was associated with reduced symptoms of mild and moderate depression.⁴ Secondly, the use of St. John’s Wort when compared to prescription anti-depressant medications showed a similar reduction in symptoms of depression.⁴ These findings suggest that St. John’s Wort may be just as effective as prescription anti-depressant medications, however, more data is required to conclusively indicate that this is a true statement. Lastly, it was found that St. John’s Wort had fewer side effects when compared to prescription anti-depressant medications as well.⁴

Another study review looked at 27 studies which compared St. John’s Wort to prescription anti-depressant medications.⁵ This review showed that there was a similar effect of St. John’s Wort on improvement in symptoms of mild and moderate depression when compared to prescription anti-depressant medications.⁵ Findings also showed that more patients discontinued the use of their prescription anti-depressant medications.⁵ This finding is suggestive of the possibility that St. John’s Wort is perhaps better tolerated and has less adverse events when compared to prescription therapies.

There are hundreds of additional studies that have shown the effectiveness of St. John’s Wort in patients that have depression. Overall, these investigative studies positively correlate the effectiveness of utilizing St. John’s Wort when treating mild and moderate depression.

How Do You Take St. John’s Wort?

St. John’s Wort comes in a variety of formulations as mentioned above. It is available in capsules, tablets, teas, oils and liquid extracts. As discussed, this is not approved as a drug by the FDA, but rather as a supplement. Therefore, the concentrations and strength of the product is not regulated and can vary greatly. This makes it difficult to determine how much of a dose to start with. Always use a smaller dose and increase gradually to see a therapeutic benefit. However, before starting the use of this product, consult with a healthcare provider to ensure this is an appropriate option for you.

Safety of St. John’s Wort

St. John’s Wort has shown in various investigative studies that it have anti-depressive properties. As a natural product, this may seem like a wonderful option to try for individuals that do not think their current prescription therapy is working, or even in individuals that do not want to take prescription medications at all. However, St. John’s Wort may not be for everyone.

Side Effects

Most individuals do not commonly report side effects while using St. John’s Wort. However, some reported side effects include upset stomach, fatigue and trouble sleeping.⁵ St. John’s Wort has been associated with a sensitivity to the sun which can cause rashes on the skin.⁶ This reaction has been related to higher doses of St. John’s Wort. Therefore, it is important to use proper precautions to ensure that you do not experience the same reaction if you are using higher doses of this product.

Additionally, St. John’s Wort is known to negatively interact with a variety of prescription medications. It can interact with antidepressants, oral birth control pills, blood thinners like warfarin and many more medications. It is important to consult with your doctor prior to starting the use of this product in order to ensure that it will not have a drug-drug interaction or cause harm to your health. 

References:

1. Oliveira AI, Pinho C, Sarmento B, Dias AC. Neuroprotective Activity of Hypericum perforatum and Its Major Components. Front Plant Sci. 2016 Jul 11;7:1004. doi: 10.3389/fpls.2016.01004. PMID: 27462333; PMCID: PMC4939296.
2. : 12775192.
3. Apaydin EA, Maher AR, Shanman R, et al. A systematic review of St. John’s wort for major depressive disorder. Syst Rev. 2016;5(1):148. Published 2016 Sep 2. doi:10.1186/s13643-016-0325-2
4. Ng QX, Venkatanarayanan N, Ho CY. Clinical use of Hypericum perforatum (St John’s wort) in depression: A meta-analysis. J Affect Disord. 2017 Mar 1;210:211-221. doi: 10.1016/j.jad.2016.12.048. Epub 2017 Jan 3. PMID: 28064110.
5. Brockmöller J, Reum T, Bauer S, Kerb R, Hübner WD, Roots I. Hypericin and pseudohypericin: pharmacokinetics and effects on photosensitivity in humans. Pharmacopsychiatry. 1997 Sep;30 Suppl 2:94-101. doi: 10.1055/s-2007-979527. PMID: 9342768.