Taking St John’s Wort For Depression Carries Risks: Study
St. John’s wort is a popular herbal therapy for depression, but a new Australian study highlights the fact that “natural” does not always equal “safe.”
Using reports filed with Australia’s drug safety agency, the researchers found that adverse reactions to St. John’s wort were similar to those reported for the antidepressant fluoxetinebetter known by the brand name Prozac.
Those side effects included anxiety, panic attacks, dizziness, nausea and spikes in blood pressure, the researchers reported in the July issue of Clinical and Experimental Pharmacology and Physiology.
“It’s concerning to see such severe adverse reactions in our population, when people believe they are doing something proactive for their health with little risk,” lead researcher Claire Hoban, of the University of Adelaide, said in a university news release.
Research has shown that St. John’s wort can help ease mild to moderate depression. But the fact that it works also means there is a risk of side effects, said Dr. Samar McCutcheon, a psychiatrist at Ohio State University Wexner Medical Center in Columbus.
“Even if the bottle says ‘natural’ or ‘herbal,’ it still has ingredients that are active in your body,” said McCutcheon, who was not involved in the study.
It has long been recognized that St. John’s wort can have significant side effects and interact with certain medications, McCutcheon pointed out.
“Unfortunately,” he said, “this type of information doesn’t have to be printed on product labels.”
How Does St John’s Wort Work
If you plan to take St. John’s wort, there are a few things you should know about how it can interact with your other medications as well as its potential side effects.
St. John’s wort is an herbal supplement marketed as a natural remedy for depression, anxiety, and other mood disorders. Proponents of St. John’s wort believe the herb can increase the amount of serotonin in the brain. Serotonin is a neurotransmitter that may be deficient in some people with depression.
How Do I Take St John’s Wort
St. John’s wort is most often taken in liquid or capsules. The dried herb may also be used as a tea.
The most common dose used in studies has been 300 milligrams, three times a day as a standardized extract. Preparations in the U.S. have varied amounts in them. So be careful to note how much you’re getting.
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St Johns Wort Serotonin And Depression
A friend of a friend committed suicide this past month, and I knew and liked him. Im sad about this, and so Im prompted to write this article today on the worlds most beloved plant-derived antidepressant.
As you can see, St. Johns wort is a beautiful plant with yellow flowers, and it grows wild in many parts of the world. Ironically, its name doesnt quite have the same beautiful effect who wants to touch something thats called a wort lol? Actually, its just the old English word for plant, so its not as bad as it sounds. Its botanical name is Hypericum perforatum.
Extracts from this little plant have been used for centuries as an herbal remedy for all sorts of medical problems. As a dietary supplement, St. Johns wort is probably best known for its positive impact on mild depression and overall mood.
How does St. Johns wort affect mood?
Although research is ongoing, a large part of the magic lies on its impact on those tiny chemicals which hold the keys to brain function and mood: Neurotransmitters! For a long time, hypericin was thought to help with the blues, however scientists are noting that another compound in the plant called hyperforin plays an even bigger role. There are thousands of biologically active components to the plant so Im sure time and research will reveal other compounds in addition to these.
Neurotransmitters are simply small molecules used by neurons to communicate with each other. Five of the major ones include:
Serotonin and mood
How Does St Johns Wort Work
The plant is known to have active chemical component hypericin while others include hyperforin and flavonoids.
How St. Johns work for the treatment of anxiety and depression is not precisely known, but it most likely works as a selective serotonin reuptake inhibitor like fluoxetine, or Prozac which helps to increase the secretion of the chemical in the brain such as dopamine, serotonin, and norepinephrine.
These are neurotransmitters that help to elevate mood. Previously it was believed that hypericin is only responsible for it, but now studies suggest that other chemicals may also play a role in decreasing depression and improve mood.
Not all the research studies, however, agree with the effectiveness of St. Johns wort for anxiety and depression.
But these studies have also been weighed against the studies that show its efficacy similar to that of drugs like Prozac, Celexa, paroxetine , and Zoloft.
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How Does St Johns Wort Feel
If you have had problems with using SSRI prescription antidepressants, St. Johns wort extract may be a good option for you.
St. Johns wort does not produce the same side effects as pharmaceutical antidepressants. Sex drive is not affected. No withdrawal symptoms when you stop taking St. Johns wort.
Users of St. Johns wort extract say it often works sooner than expected, and gets better over time.
St. Johns wort extract helps provide better focus, and fewer Obsessive-Compulsive Disorder symptoms. Users report an end to procrastination, less irritation, and better mood.
St. Johns wort extract takes the edge off situations that would normally stress you. Feelings of anxiety are less or non-existent.
Women going through menopause report feeling more emotionally stable when using St. Johns wort extract. Mood swings are no longer an issue.
If you deal with PTSD you may find that St. Johns wort extract will put a stop to the rage. And long-term depression could be a distant memory.
If you are sure your depression is caused by a serotonin imbalance, you should feel the mood-lifting effects of St. Johns wort.
But neuroscience is a complicated subject. And everyones body and wiring are different. St. Johns wort does not work for all types of depression or anxiety.
If your depression is caused by a hormone imbalance, a depleted microbiome, an issue with dopamine levels or other neuroreceptor issue, you may not experience the benefit of St. Johns wort.
How Does St John’s Wort React With Other Medications
St Johns wort can indeed interfere with medication which means its not for everyone. This plant helps to support your liver and can make it work more efficiently, in fact it can clear medication out of the body quite quickly. This is why we dont recommend it for people on long-term medication like warfarin, the contraceptive pill, immunosuppressive drugs, and cardiovascular or chemo drugs.You want those pharmaceuticals to stay in your system to help with the conditions they were prescribed for. In saying that, St Johns wort teas and oils do not interact with medication and are safe to take. Unfortunately, if you are on long-term medication, high dose St Johns wort for depression is not for you.
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St John’s Wort Versus Placebo
Studies of St. John’s wort use a set of questions called the Hamilton Depression Index . This scale rates the extent of depression, with higher numbers indicating more serious symptoms.
Double-blind, placebo-controlled trials involving a total of more than 1,500 participants with major depression of mild to moderate severity have generally found that use of St. John’s wort can significantly reduce HAM-D scores as compared to placebo. In addition, continued treatment with St. Johns Wort over 6 months may be effective at preventing a relapse of moderate depression in patients who recover from an initial acute episode.
For example, in a 6-week trial, 375 individuals with average 17-item HAM-D scores of about 22 were given either St. John’s wort or placebo. Individuals taking St. John’s wort showed significantly greater improvement than those taking placebo.
St Johns Wort Recommended Dosage
St. Johns wort is available from local health food and vitamin stores and online. St. Johns wort comes in capsule, tablet and powder form. Its also available as tinctures, teas and oil-based lotions.
Most St. Johns wort supplements are standardized to contain 3% hypericin. But the most recent clinical studies show that hyperforin is the constituent in St. Johns wort that has the most antidepressant action.
Researchers say that the benefits of St. Johns wort are only applicable to standardized extracts such as LI 160, WS 5570/2, and ZE 117.
Check the labels and look for:
- Perika® which is WS 5570 extract
- Kira® which is LI 160 extract
- New Chapter SC27 who produce their own extract
There are reports and some clinical data which suggest that the photosensitivity caused by hypericin can cause cataracts and blindness. All the more reason to play it safe, and go with a high quality St. Johns wort extract containing hyperforin.
Recommended doses for St. Johns wort extract:
- St. Johns wort for anxiety: 900 mg twice daily
- St. Johns wort for mild to moderate depression: 300 mg 3-times daily
- St. Johns wort for severe depression: 900 1800 mg daily
- St. Johns wort for OCD: 450 1800 mg daily for 12 weeks
- St. Johns wort for PMS: 300 900 mg daily for 2 menstrual cycles
- St. Johns wort for irritable bowel syndrome: 450 mg twice daily for 12 weeks
- St. Johns wort for nerve pain: three 900 mcg hypericin tablets for 2 treatment periods of 5 weeks each
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Which St Johns Wort Supplements Are Best
St. Johns wort is an herbal supplement known to treat mild depression and anxiety. Its scientific name is Hypericum perforatum, and it dates back to ancient Greece, where it was revered as an herb with mystical qualities. The leaves and flowers of St. Johns wort contain antioxidants, anti-inflammatory and antibacterial compounds. People rely on its natural mood-boosting properties as a natural alternative to antidepressants.
If youre looking for the best of the best, Natures Way St. Johns Wort contains 450 milligrams per serving to support a positive mood.
Unpacking The Different Forms Of St Johns Wort And Their Impact On Mental Health
Finally, it is important to examine the different forms of St Johns wort and their impact on mental health. For example, tablets and capsules are the most common forms of St Johns wort and are generally considered to be the most effective. Tinctures and teas may also be effective, but they tend to take longer to take effect. Additionally, some forms of St Johns wort may interact with certain medications, so it is important to speak to a doctor before taking any form of the supplement.
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Is There An Over The Counter Medicine For Anxiety
There are no over the counter medications for anxiety since any medication that affects the brain needs to be carefully monitored, and because the medication is not the only treatment a person should take. Luckily, there are many natural treatments and exercises that can help with anxiety in its place.
What Is St Johns Wort Used For
Scientists havent proven any potential St. Johns wort benefits. People take St. Johns wort most often to relieve symptoms of mild to moderate depression. But studies on the use of St. Johns wort for depression have been mixed.
Past studies had shown that people with symptoms of mild depression could benefit from the herb. But newer studies havent proven the effectiveness of St. Johns wort in treating mild to moderate depression. And no studies have shown that St. Johns wort is effective in treating severe depression.
The effectiveness of the herb in treating other conditions hasnt been studied at length. Theres not enough evidence to know if it works for these conditions. But other possible St. Johns wort uses may include:
- Relief of menopausal symptoms, such as hot flashes.
- Treatment of insomnia, when you take St. Johns wort before bed.
- Assistance with wound healing, when you apply lotion directly onto your skin .
- Management of nerve pain , when you apply St. Johns wort oil directly to your skin.
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How Much St Johns Wort Should I Take
Preparations in the U.S. have different amounts of the active ingredient. So, if you decide to take St. Johns wort, be careful to note how much you’re getting in your tablets. The most common dosage of St. Johns wort is 300 to 400 milligrams taken three times a day with meals. Beyond tablets, people also use:
- Tinctures, teas or liquid extracts.
- Ointments or gels.
- Oils and lotion.
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Al-Akoum, M., Maunsell, E., Verreault, R., Provencher, L., Otis, H., and Dodin, S. Effects of Hypericum perforatum on hot flashes and quality of life in perimenopausal women: a randomized pilot trial. Menopause. 2009 16:307-314. View abstract.
Andreescu, C., Mulsant, B. H., and Emanuel, J. E. Complementary and alternative medicine in the treatment of bipolar disordera review of the evidence. J.Affect.Disord. 2008 110:16-26. View abstract.
Bancirova, M. and Lasovsky, J. The photodynamic effect: the comparison of chemiexcitation by luminol and phthalhydrazide. Luminescence. 2011 26:410-415. View abstract.
Barbenel, D. M., Yusufi, B., OShea, D., and Bench, C. J. Mania in a patient receiving testosterone replacement postorchidectomy taking St Johns wort and sertraline. J Psychopharmacol 2000 14:84-86. View abstract.
Berlanda, J., Kiesslich, T., Engelhardt, V., Krammer, B., and Plaetzer, K. Comparative in vitro study on the characteristics of different photosensitizers employed in PDT. J.Photochem.Photobiol.B 9-2-2010 100:173-180. View abstract.
Bernd A, Ramirez-Bosca A, Kippenberger S, and et al. Phototoxic effects of Hypericum extract in cultures of human keratinocytes compared with those of psoralen. Photochem Photobiol 1999 2:218-221.
Bhattacharya, S. K., Chakrabarti, A., and Chatterjee, S. S. Activity profiles of two hyperforin-containing hypericum extracts in behavioral models. Pharmacopsychiatry 1998 31 Suppl 1:22-29. View abstract.
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Special Precautions & Warnings
Pregnancy and breast-feedingPOSSIBLY UNSAFE
Children: St. John’s work is POSSIBLY SAFE when taken by mouth for up to 8 weeks in children 6-17 years-old.
Alzheimer’s disease: There is concern that St. John’s wort might contribute to dementia in people with Alzheimer’s disease.
Anesthesia: Use of anesthesia in people who have used St. John’s wort for 6 months may lead to serious heart complications during surgery. Stop using St. John’s wort at least 2 weeks before a scheduled surgery.
Attention deficit-hyperactivity disorder : There is some concern that St. John’s wort might worsen symptoms of ADHD, especially in people taking the medication methylphenidate for ADHD. Until more is known, don’t use St. John’s wort if you are taking methylphenidate.
Bipolar disorder: People with bipolar disorder cycle between depression and mania, a state marked by excessive physical activity and impulsive behavior. St. John’s wort can bring on mania in these individuals and can also speed up the cycling between depression and mania.
Depression: In people with major depression, St. John’s wort might bring on mania, a state marked by excessive physical activity and impulsive behavior.
Infertility: There are some concerns that St. John’s wort might interfere with conceiving a child. If you are trying to conceive, don’t use St. John’s wort, especially if you have known fertility problems.
Schizophrenia: St. John’s wort might bring on psychosis in some people with schizophrenia.
Does St Johns Wort Work
Research has found that St John’s wort is useful in the treatment of mild to moderate depression, but not effective in severe depression.
In an analysis of studies comparing St Johns wort with a placebo and standard antidepressants , the authors found that compared with placebo, people taking St Johns wort were more likely to have an improvement in their symptoms. There were no significant differences in depression response rates between St Johns wort and standard antidepressants. The studies also found that patients taking St Johns wort were less likely to drop out of trials due to adverse effects than those taking standard antidepressants.
There are a number of products available on the market containing St John’s wort . When buying St John’s wort you should be careful about the potency and purity of the product. A standardised extract of 0.3% Hypericum is mostly used in clinical trials.
St John’s wort is possibly effective for menopausal symptoms, plaque psoriasis, wound healing and somatisation disorder. Read more about St John’s wort National Institute of Health.
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What Products Does St Johns Wort Contain And What Are The Effects Of These Substances
The entire plant is used therapeutically, particularly for its mood and brain benefits. St. Johns Wort contains red substances, naphthodianthrones, hypericin, and pseudo hypericin.
In addition, the plant contains phloroglucinol derivatives, in particular hyperforin, as well as flavonoids. These derivatives have been the subject of several studies which have confirmed the intuitions of traditional pharmacopeia.
Safer More Effective Alternatives To St Johns Wort
Understandably, you may now be leery of taking a St. Johns wort supplement.
If you are currently taking it with success, then stick with it.
But if you are one of the millions of people for whom St. Johns wort is not a viable option, rest assured that there are many alternatives.
You can also use proven antidepressant activities such as yoga, breathing exercises, neurofeedback, or mindfulness meditation.
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What About St Johns Wort For Anxiety
You may have heard that St. Johns wort can be taken for anxiety, but theres little evidence that it is helpful.
In fact, one of the more common side effects of St. Johns wort is anxiety and, in rare cases, can even bring on panic attacks.
If anxiety is your main concern, its best to avoid St. Johns wort and try one of the many proven supplements for anxiety instead.