Supplement with St. John’s Wort

Herb St John's wort

St. John’s Wort (Hypericum perforatum) has been used for centuries in medicine for various mental health purposes and is widely prescribed for depression treatment in Europe.  St. John’s Wort is a flowering plant/shrub and medicine derived from it may have serious side effects or may affect effectiveness  of other medications you may be using at the same time. The popular herbal remedy consists of using its flowers to make teas, pills and liquid extracts to ease depression symptoms.  It does not require a prescription and may be bought in a health food store or your local pharmacy. Before starting a treatment with St. John’s Wort, check with your doctor first if this is the right supplement for you. While St. John’s Wort may elevate mood in individuals that suffer from mild to moderate depression, it is not to be used for treatment of individuals with severe depression.

While the evidence is not definitive, St. John’s Wort may help with certain type of depression.  Its effect on your mind can have similar effect to the standard prescription antidepressants as it increases serotonin in the brain. If combined with antidepressant drugs it may lead to a potentially life-threatening increase of serotonin or it can lead to a psychosis, although rarely.

In North America, St. John’s Wort is not considered a proven therapy for depression. In Europe it is widely prescribed for depression treatments. Do not use St. John’s Wort unless you consulted with your medical doctor first as inadequately treated depression can escalate in symptoms and become severe enough to result in suicide. Consult a healthcare provider if you or someone you know may be depressed.  If you are using other supplements to treat your depression, consult with your doctor first as they need to have a full picture of what you do to manage your health.

While depression can be treated successfully with conventional medicine, including antidepressant and certain types of psychotherapy, many people opt to try herbal supplements and vitamins first in hope to find a relief to their symptoms.  This herb is not fast acting and it may take weeks or months before you notice any effect, same as with conventional antidepressant medicine. St. John’s Wort can have serious side effect, please read below.

Side Effects and Cautions

It is known to affect body’s ability to break down certain drugs and can cause serious side effects.Combining St. John’s Wort and some antidepressant  (SSRIs – selective serotonin reuptake inhibitors) and MAO (monoamine oxidase) inhibitors may lead to increased blood pressure that could induce a potentially life threatening increase of serotonin levels in the brain which can create a condition called serotonin syndrome. Symptoms can vary from mild such as diarrhea to serious such as dangerous confusion, drop in body temperature to death.

  • Psychosis can happen rarely but is a possible side effect of taking St. John’s wort, particularly if taken by people who are at risk of bipolar disorder or other mental health disorders.
  • Taking St. John’s wort can lower effectiveness and weaken many prescription drugs such as:
    • Birth control pills
    • Some HIV drugs including indinavir
    • Some cancer medication including irinotecan
    • Antidepressants
    • Cyclosporine (medicine that prevents body from rejecting transplanted organs)
    • Digoxin, medication for heart condition
    • Warfarin, a blood thinner and certain other medications that have similar use.
    • Pregnant or breastfeeding women should avoid St. John’s Wort as they have not been tested enough to ensure safety to the mother and/or the fetus/baby.
    • Do not give to children

People sensitive to sunlight should avoid St. John’s Wort as the plant can intensify the effect

  • Other minor side effects are usually uncommon and minor and may include sensitivity to sunlight and cause upset stomach. Be aware of the fact that St. John’s Wort is a stimulant as well so it may increase anxiety in some people.

When compared to placebo, 29 studies in 2009 systematic review  found that St. John’s Wort may be better than placebo (which is an inactive substance that appears to be identical to the study substance),  and equally effective as standard prescription antidepressants  used in treatment of major depression of mild to moderate severity. On the plus side, St. John’s Wort appeared to have fewer and less serious side effects than standard antidepressants.

St. John’s Wort has strong antiviral active ingredients and may promote repairing and healing of wounds and other minor injuries.

Dosing of St. John’s Wort varies due non-standardized manufacturing.  Dosage can vary from 300 to 1200 mg a day and it may be taken in divided doses such as 300 mg three times a day or 600 mg twice a day.  When buying St. John’s Wort you need to look for tablets or capsules that are standardized to 0.3 percent Hypericin and 3 percent Hyperforin.  Recent published clinical studies have shown that Hyperforin is the main active ingredient in St. John’s Wort that appears to affect various neurotransmitters in a similar way as some antidepressants (i.e. Prozac or other SSRIs)  to ease depression symptoms.  Be aware that some brands are standardized to 0.3% hypericin but may contain little or no Hyperforin. Ensure that your supplement of St. John’s Wort is packaged in a bottle that blocks out light, such as a dark/amber bottle as St. John’s Wort degrades with exposure to sunlight. Avoid white plastic bottles as they can let in damaging amounts of light. Ensure that you store it properly in a cool environment as excessive heat can degrade hyperforin and reduce efficacy of St. John’s Wort.

If you are thinking of using St. John’s Wort in treatment of your depression, keep in mind that it can cause medical problems if not used in correct dosages or in large amounts and it may interfere with medications you already take. If unsure, discuss it with your medical provider or pharmacist and let them know of other supplements you use so they could have a full picture of your health and medicine you use.

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