Healthy Living

St. John's Wort for Depression Treatment

St. John's Wort for Depression Treatment

Key Takeaways

  • The name St. John's wort is a reference to St. John the Baptist.
  • St. John's wort has been used as medicine for thousands of years.
  • St. John's wort is a favored medication in treating depression of all types.

St. John's wort, also called Perforate St. John's wart, is an exceptional medicine that comes from a plant with nice and colorful flowers. The plant is called Hypericum perforatum, and is one of the most useful green plants known. It originated in Europe but has been growing in many countries across the world. According to the medical science study that defines St. John's wort, it is a highly effective medication and has thus been accepted as an effective treatment for all types of depression.

St. John's Wort is considered a highly favorable medication to use in treating depression of all types. This is backed by a number of studies relating to depression conducted by research institutes, which experimented with various medicines useful in handling depression and nervousness, testing St. John's wort in various forms of depression from mild to moderate as well as various levels of anxiety.

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. 

According to College of Pharmacy and China Medical School, Taiwan and stated in the November 2012 issue of the International Journal of Clinical Practice, the herb is highly useful, but, as with some other herbal medications, may dangerously clash 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, or mention being on St. John's wort when a doctor prescribes a new drug.  

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

Evidence of efficacy

After reviewing 29 different studies done in a variety of countries and involving almost 5,500 patients mostly with mild to moderately severe depression, the Cochrane Review published in 2008 stated the following:

  • The St. John's wort extracts tested 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 have 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 this 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 "St. John's" wort?

The "St. John" in the plant's name is a reference to St. John the Baptist. St. John the Baptist day is on 24th of June, when the plant is in full bloom. It is also around this time that red spots start appearing in the leaves of the plant. These spots are often imagined as the blood of John the Baptist, who was beheaded.

St. John's wort has become part of modern medicine in the last 100 years, but it has been used in antiquity for treating wounds as well as psychological ailments. In medieval times, the medication was used in getting rid of negative feelings, "driving out the inner devil", so they said of it in those times. Paracelcus in 1525 wrote about it and recommended the useful herb for hallucinations and for treating wounds.

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

In most countries, St. John's wort is available in drugstores over the counter, without need for a prescription. However, in some 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 too. When purchased from herbalists, the fluid extract is the most common form. The herb is also sold in teabags or as a component of herbal teas.

What is St. John's wort useful for (and not)?  

St. John's wort has been studied for use in treating various ailments. It is definitely of use in some cases and remains promising 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: 

Depressive disorder

St. John's wort has been used effectively and studied for long time in cases of depression. It has become increasingly popular in the U.S. as well in this regard, although one large study sponsored by the National Center for Complementary and Alternative Medicine (NCCAM) found the herb only as effective as a placebo in major depression of moderate severity. 

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

ADHD (attention deficit hyperactivity disorder)

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

Anxiety disorder

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

Making children smile

The medicine has become known as a most effective solution for depression. It is all over in many countries, and is useful even in treating children. It is said that the herb can make children smile.

Nerve pain

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

Obsessive  compulsive disease  

The many benefits offered by the 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.

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 has been known to have anti-viral properties at high doses, it is advised against for patients with the human immunodeficiency virus (HIV) taking indinavir, a protease inhibitor used to treat HIV infection. This is because St. John's wort can cause a dangerous reduction of indinavir levels in the blood. 

St John's wort dosages in trials

For depression:

For adults (18 years and above) with mild to moderate depression, 20 to 1,800 milligrams of St. John's wort has been taken orally once to three times for 4-52 weeks. For cases of severe depression, 900 to 1,800 milligrams have been taken orally, daily for 8-12 weeks.

In children (under 18 years old), 150 to 1,800 milligrams were taken by mouth, one to three times daily for up to eight weeks.

For anxiety: 
In clinical trials, adults have taken 900 milligrams have been taken orally, twice daily for several weeks.

Most of the studies show that the medicine St.John’s wort works well up to 12 weeks. It gives highly effective results.

The possible side effects of St. John's wort are the following:

  • It makes a person nervous and worried
  • Drowsiness after taking the medicine
  • Feeling thirsty
  • A strong headache
  • Restlessness
  • A sense of excitement
  • Sexual inactivity
  • Skin sensitivity
  • Stomachache
  • Feeling weak

Most patients experience only minor side effects, but 3% of patients suffer major ones. 

Patients taking St. John's wort are advised to avoid the following medications, or forego St. John's wort meanwhile, as a combination of both could either result in complications or reduce the effects of the medicine completely:

  • Digoxin, used for various heart conditions
  • Oral contraceptives 
  • Anti-HIV drugs
  • Medicine that has Theophylline
  • Warfarin, a coagulant
  • SSRI antidepressants (selective serotonin reuptake inhibitors)
  • Triptan drugs used for migraine, such as sumatriptan

Additional considerations:

  • Pregnant or breastfeeding mothers - Currently, experts do not know whether it is safe for pregnant or breastfeeding mothers to take St. John's wort.
  • Most herbal medicines are all right, but not while taking prescription medications, unless first cleared with a qualified doctor.

Facts relating to St Johns wart

St. John’s wort is a strong antiviral drug. It promotes healing and repairs wounds within a short span of time. For this application, St. John's wort is used topically.

The herb is does not always act immediately; its efficacy depends on the severity of the disease.  It sometime takes weeks or months before the drug acts and eliminates the disease.

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 disease.

A normal dose ranges from 300 mg to 1200 mg per day. The drug is given in doses of 300 mg or 600 mg, once or twice daily, depending on severity of disease.

According to a study done from the year 2000 to 2013, there were about 84 adverse reactions involving St. John’s wort. The total number of reports available for Prozac, meanwhile, is about 450. But the reporting of such adverse events is voluntary and, according to the researchers, adverse events are under-reported.

St. John's wort, which has long existed and been used in certain parts of the world, has slowly become part of ours because of its powers to naturally and effectively work against a highly sensitive disease afflicting many patients around the world. This medicine offered by the earth itself is a a boon to millions of people around the world and has changed the lives of many who know the burden and stigma of depression, anxiety, and other related disorders.