Healthy Living

St. John's Wort for Depression Treatment

St. John's Wort for Depression Treatment

The scientific name of St. John’s wort is Hypericum perforatum, which is a powerful medicinal herb that has anti-inflammatory properties. This herb has been long been used due to its health benefits, especially in relieving depression. Ancient Greek physicians believed that this herb possessed a mystical quality along with protective properties. During the ancient times, Greeks used this herb for the treatment of various mental issues such as mood disorders. The plant is believed to be native in parts of Africa, Asia, Europe, and the American West. 

St. John’s wort is a natural and effective treatment for the symptoms of anxiety, depression, appetite loss, sleep problems, and fatigue. This herb is also used for the treatment of menopause symptoms, moodiness, heart palpitations, ADHD symptoms, and seasonal affective disorder (SAD).

Hypericin: The Active Component in St. John's Wort

According to experts, the active chemical in St. John's wort is hypericin, although the plant offers a variety of components that may work synergistically with hypericin to produce a higher efficacy. 

The College of Pharmacy in China Medical University, Taiwan stated in the November 2012 issue of the International Journal of Clinical Practice that the herb is highly useful, but similar to other herbal medications, it may dangerously interact with prescription drugs and cause severe adverse reactions. It is, therefore, important to consult a doctor when one plans to take St. John's wort while on a prescription drug. When a doctor prescribes a new drug, patients must also inform their doctor that they are currently taking St. John's wort to avoid having unnecessary drug interactions. 

St. John's wort can be used in various levels of health, although there are possible side effects and risks associated with it. Among these side effects are photosensitivity (sensitivity to the sun and other sources of light), an upset stomach, and certain allergic reactions. 

Evidence for Its Efficacy

In 2008, the Cochrane Library published the following findings after reviewing 29 separate studies done in different countries. It involved almost 5,500 patients who had mild to moderately severe depression. 

  • The tested St. John's wort extracts were more effective than placebos.
  • They were as effective as standard prescription antidepressants.
  • They had fewer side effects than standard prescription antidepressants. 

It noted, however, that there were more favorable results in the studies done in countries that had a long tradition of St. John's wort's use in folk medicine, and where St. John's wort is commonly prescribed by modern-day doctors. While these results may be due to the participation of patients with varying types of depression, it is also quite possible that some of the smaller studies were overly optimistic toward St. John's wort, given the long-established experience with it.

Why is it called "St. John's" wort?

The St. John in the plant's name is a reference to St. John the Baptist. The plant got its name since it blooms at the time of John the Baptist's birthday, which is around June 24. It is also around this time that red spots start to appear in the leaves of the plant. These spots are often imagined as the blood of John the Baptist, who was beheaded. Moreover, wort is an old English word, which means plant.

St. John's wort has become a part of modern medicine in the last 100 years, but it has been also used in antiquity for treating wounds as well as psychological ailments. In medieval times, this herb was used to get rid of negative feelings, which were referred to as driving out the inner devil in those times. Paracelsus, a Swiss alchemist and physician in 1525, wrote about St. John's wort and recommended its use for hallucinations and treating wounds.

Between 1959 and 1971, St. John's wort was widely popular in many European countries, especially in Germany. German general practitioners or primary care physicians today commonly prescribe this herbal remedy to patients of different age groups.

In most countries, St. John's wort is available as an over-the-counter supplement without the need for a prescription. However, in other countries such as Ireland, a prescription is required by drugstores to purchase the medicine. The herbs are usually available in the form of tablets, which is the form most people prefer to take, but the herb is available in various other forms as well. When purchased from herbalists, the fluid extract is the most common form. The herb is also sold in tea bags or as a component of herbal teas.

Uses of St. John's Wort

St. John's wort has been studied for its use in treating various ailments. It is definitely of use in some cases and remains a promising remedy in others, but there are also conditions for which it presents no therapeutic value or is even advised against. Some of the disorders and ailments for which the use of St. John's wort has been studied are listed below: 

1. Depressive Disorder

St. John's wort has been effectively used and studied for a long time in cases of depression. It has also become increasingly popular in the US. One large study sponsored by the National Center for Complementary and Alternative Medicine (NCCAM) found the herb as effective as a placebo in major depression of moderate severity. 

Comparing St. John's wort with selective serotonin reuptake inhibitors (SSRIs) such as Prozac (fluoxetine) or Zoloft (sertraline), St. John's wort has been very effective in relieving severe depression with limited side effects.

2. ADHD (Attention Deficit Hyperactivity Disorder)

The medicine is not highly useful when used in treating or managing ADHD in children. Its effects were only equivalent to those of a placebo.

3. Anxiety 

There is not much evidence yet in the use of St. John's wort for the treatment of anxiety disorders. In many doctors in Europe, however, St. John’s wort is highly useful and helpful in dealing with anxiety and other psychological-related disorders.

4. Pediatric Use

Studies conducted regarding St. John's Wort are usually done in adults than children. However, one study had indicated the effectiveness and safety the herb's use in children below 12 years old, who experience mild to moderate symptoms of depression. 

However, it is important to note that children should never be given St. John's wort without a doctor's supervision to avoid having side effects, such as an upset stomach or allergic reactions. Depression is a serious mental illness, so avoid treating your child's depression without proper medical assessment by a healthcare provider. 

5. Nerve Pain

Some preliminary studies have demonstrated that St. John's wort is helpful in treating neuropathic pain. However, more research is needed in this area.

6. Obsessive-Compulsive Disorder  

The many benefits offered by this herb in various depression-related disorders are proven, and obsessive-compulsive disorder is one of the disorders, which St. John's wort is helpful in treating.

7. Somatoform Disorders

St. John's wort has been proven to help in improving somatoform disorders, a group of psychiatric disorders that cause significant but unexplained physical symptoms. Among the more commonly known somatoform disorders are body dysmorphic disorder, pain disorder, and hypochondriasis.  

While St. John's wort is known to have antiviral properties at high doses, it is advised against patients with the human immunodeficiency virus (HIV) taking indinavir, which is a protease inhibitor used for the treatment of HIV infection. The reason is that St. John's wort can cause a dangerous reduction of indinavir levels in the blood. 

St. John's Wort Dosages in Trials

For depression

  • Mild to moderate depression: For adults 18 years old and above, 20 mg to 1,800 mg of St. John's wort should be taken orally 1-3 times daily for 4 to 52 weeks.
  • Severe depression: 900 mg to 1,800 mg daily for 8-12 weeks.
  • In children under 18 years old: 150 mg to 1,800 mg should be taken by mouth 1-3 times daily for 4-8 weeks.

For anxiety

In clinical trials, adults have orally taken 900 mg twice daily for several weeks. Most of the studies show that St. John’s wort works well up to 12 weeks. It gives highly effective results.

Side Effects

The possible side effects of St. John's wort may include:

  • Nervousness or anxiety
  • Drowsiness after taking the medicine
  • Feeling thirsty
  • Headache
  • Restlessness
  • A sense of excitement
  • Sexual dysfunction
  • Skin sensitivity
  • Stomachache
  • Feeling weak

Most patients experience only minor side effects, but around 3 percent of patients may suffer major ones. 

Patients taking St. John's wort are advised to avoid certain medications or forego St. John's wort in the meantime. A combination of the following medications could either result in complications or a significant reduction in the effects of the drugs:

  • Digoxin
  • Oral contraceptives 
  • Anti-HIV drugs
  • Medicine that contains theophylline
  • Warfarin
  • Selective serotonin reuptake inhibitors (SSRIs) 
  • Triptans
  • Sumatriptan

Additional Considerations

  • Currently, experts do not know whether it is safe for pregnant and breastfeeding mothers to take St. John's wort.
  • Most herbal medicines are fine, but not while taking prescription medications, unless first cleared by your healthcare provider.

Other St. Johns Wort Facts

  • St. John’s wort is a strong antiviral drug. When topically used, it promotes healing and repairs wounds within a short span of time. 
  • The herb does not always immediately act, and its efficacy depends on the severity of the disease. It sometimes takes weeks or months before the herb acts and gets rid of the illness.
  • The dosage of the drug should be as per the advice of the doctor. The dosages can vary from person-to-person depending on their physical state and type of disease.
  • The usual dose ranges from 300 mg to 1,200 mg per day. The drug is given in doses of 300 mg or 600 mg, once or twice daily, depending on the severity of the disease.

According to a study done between 2000 and 2013, there were about 84 adverse reactions involving St. John’s wort. The total number of reports available for Prozac is about 450. However, such report is voluntary, and according to researchers, adverse effects are underreported.