Many people look to St. John’s Wort as an over-the counter treatment for anxiety and depression. St. John’s Wort has been used for medicinal purposes for thousands of years, dating back to ancient Greece.  It represents one of the most commonly used natural supplements sold in the United States today and can be used to treat a variety of conditions.
What is St. John’s Wort?
St. John’s Wort is a plant that can be found in Europe, the Western United States, parts of Asia, and parts of Africa. The plant is shrub-like with yellow flowers. It is named after John the Baptist as it comes into full bloom around June 24th which is often celebrated as his birthday.
Both the leaves and flowers of St. John’s Wort contain the medicinal components of hypericin and pseudophypericin. Research suggests that these active components are responsible for the healing, anti-depressive, and anti-inflammatory properties of St. John’s Wort. The leaves and flowers are broken down and converted into multiple different forms, which can vary quite a bit from supplement to supplement. There are multiple different forms of St. John’s Wort including capsules, teas, tablets, and topical lotions.
What does St. John’s Wort treat?
St. John’s Wort has been used for years to treat a host of medical conditions including depression, symptoms related to menopause, and to heal wounds. Some research suggests utility in treating other conditions as well.
Depression
There is plenty of research [Gaster B, Holroyd J. St. John’s wort for depression. Arch Intern Med. 2000;160:152-156.] to support the use of St. John’s Wort for the treatment of mild-to-moderate depression. It is not indicated for the treatment of severe depression. While researchers are not entirely sure about how the supplement works, they believe that acts similar to selective serotonin reuptake inhibitors (SSRIs) in that it stimulates the creation of neurotransmitters like serotonin (mostly) and possibly dopamine norepinephrine.
Several studies [Kasper S, Anghelescu IG, Szegedi A, Dienel A, Kieser M. Superior efficacy of St John’s Wort extract WS 5570 compared to placebo in patients with major depression: a randomized, double-blind, placebo-controlled, multi-center trial. BMC Med. 2006 Jun 23;4:14.]  that compare depression treatment with SSRIs like Prozac (fluoxetine) and Zoloft (sertraline) with St. John’s Wort have found the supplement to be equally as effective as the pharmaceutical drugs.  Other studies found St. John’s Wort to be as effective as the placebo (similar to some of the controversy surrounding SSRI drug efficacy). The Natural Medicines Comprehensive Database [http://www.nlm.nih.gov/medlineplus/druginfo/natural/329.html] classifies St. John’s Wort as being likely effective for the treatment of mild to moderate depression.
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Other Possible Indications
St. John’s Wort has demonstrated promise in the treatment of pre-menstrual syndrome [Stevinson C, Ernst E. A pilot study of Hypericum perforatum for the treatment of premenstrual syndrome. British Journal of Obstetrics and Gynaecology. 2000;107:870-876.]. It can help to alleviate the physical and emotional symptoms of PMS.
St. John’s Wort has been seen to have anti-inflammatory and antibacterial properties. Research [Schempp CM, Winghofer B, Ludtke R, Simon-Haarhaus B, Shopp E, Simon JC. Topical application of St John’s wort (Hypericum perforatum L) and of its metabolite hyperforin inhibits the allostimulatory capacity of epidermal cells. Br J Derm. 2000;142:979-984.] has suggested it to be effective in treating skin wounds and irritations.
St. John’s Wort may also be indicated for the treatment of seasonal affective disorder and somatization disorder. Research is still being completed to determine the effectiveness of St. John’s Wart in treating the following disorders; anxiety, glioma, OCD, smoking cessation, migraines, nerve pain, fibromyalgia, muscle pain and cancer. [http://www.nlm.nih.gov/medlineplus/druginfo/natural/329.html]
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Dosage Instructions
The recommended dosage of St. John’s Wort for adults is dry herb (either capsules or tablets) 300mg one tablet three times daily with meals, though starting doses are often much lower and gradually increased. There are liquid supplements and teas on the market, these are not typically standard dosages and should be initiated with the aid of a doctor. St. John’s Wort should not be stopped suddenly and should gradually tapered down.
Cautions
The biggest concern with taking St. John’s Wort is the interactions between it and other medications and herbs, as it has complex breakdown pathways in the liver. It has interactions with a large number of common medications. The most common interaction is decreased effectiveness of the other medications due to faster liver metabolism of them. St. John’s Wort can decrease the effectiveness of antidepressants, allergy and antihistamine medications, blood thinners, digoxin, birth control, sedatives, some medications for blood pressure and high cholesterol, and others. St. John’s Wort may not be indicated for patients who take a lot of prescription medications.
St. John’s Wort may cause fertility problems in individuals trying to conceive and should not be taken by individuals with known fertility problems. It has also not been approved for use in pregnancy or lactation. Like other treatments for depression, it can also be dangerous to use in patients with a history or risk of bipolar disorder.
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Talk to your doctor.
Keep in mind that St. John’s Wort may be indicated for the treatment of mild to moderate depression. It is not indicated for individuals with severe depression or depression that occurs in bipolar disorder. As with any treatment, guidance from a professional is necessary.
