St. John's wort can interact with a wide variety of medications, so have a conversation with your doctor and pharmacist about any other medications you are taking. Be sure to mention if you are currently taking birth control pills, prescription antidepressants, heart medications such as digoxin, anticoagulants like warfarin, HIV medications such as protease inhibitors or seizure medications such as phenytoin or phenobarbital. Taking St. John's wort while you are also taking a prescription antidepressant may increase your risk of a condition called serotonin syndrome, which can be very serious.
St. John's Wort
St. John’s Wort, a yellow flowering plant, is a popular herbal treatment for depression. This natural remedy has been known to treat symptoms of depression for centuries. St. John’s Wort supplement is available in pill or liquid. As with any alternative medicines please consult your health provider for treatment, correct dosage, benefits and risk factors.
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Stacy Wiegman, PharmD , Pharmacy, answeredLike a prescription antidepressant, St. John's wort will not relieve depression symptoms immediately. It is not well understood how St. John's wort works, but it appears to affect a number of brain neurotransmitters such as serotonin. In one study of more than 3,000 patients who were given an extract of St. John's wort three times a day, about 30 percent felt an improvement in depression after four weeks. -
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Dr. Tieraona Low Dog, MD , General Practice, answeredSt. John's wort has been shown to interact with many prescription medications, but less so with other supplements. In this video, integrative medicine specialist Tieraona Low Dog, MD, explains the guidelines to keep in mind about St. John's wort.
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Debra Fulghum Bruce PhD , Healthcare, answeredSee All 2 AnswersSt. John’s wort (Hypericum perforatum), the popular herbal remedy used to lift symptoms of depression, is taken by more than 20 million Germans on a daily basis and has become quite popular in the United States. This herbal supplement is taken internally to relieve depression without the side effects of prescription antidepressants. In a study published in the British Journal of Obstetrics and Gynaecology, researchers report that St. John’s wort may help women with PMS (premenstrual syndrome) by easing nervous tension, anxiety, and insomnia.
In a four-month study, 19 women with PMS kept track of their daily symptoms and took psychological tests to rate their emotions and physical state. During months three and four, women were given 300 milligrams of hypericin, the active ingredient in St. John’s wort, and continued to chart their symptoms. Treatment with St. John's wort for two menstrual cycles resulted in significant improvements in PMS symptoms, with greatly reduced symptoms, such as nervous tension, insomnia, crying and depression.
St. John’s Wort is available as capsules, tincture, extract, oil, and dried leaves and flowers. St. John’s Wort can cause sensitive skin in sunlight. Moreover, because this herb can interact with prescription medications, talk to your doctor before self-medicating. (Caution: Since the mechanism of action of St John wort is uncertain, using it with antidepressants such as monoamine oxidase inhibitors and selective serotonin reuptake inhibitors is not advised. Pregnant women are advised not to take St. Johns wort.) -
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Discovery Health answeredSee All 2 AnswersSt. John's wort is an herbal remedy that is sometimes used to treat depression. Many of the psychotropic drugs used to treat depression have side effects which can be severe, and some hope that a natural medicine will cause fewer problems.
Depression is treated in a number of ways, often by the use of anti-depressant drugs, for example Prozac, Paxil, Elavil and Nardil. These can cause side effects such as sleeplessness, headaches, gastrointestinal disturbances and sexual problems. The British Medical Journal reported in 1994 that St. John's wort was about as effective as standard anti-depressants, and worked better than placebos in treating mild to moderate depression.
The active therapeutic ingredients in St. John's wort include hypericin, pseudohypericin and xanthones, and it is believed that other components may support the action of these compounds. Extract preparations of St John's Wort are standardized to 0.3 percent hypericin, so the typical adult dose of 300 milligrams taken three times a day means 2.7 milligrams of hypericin a day.
It is presumed that hypericin helps to affect mood by elevating the biochemicals dopamine and seratonin in the brain. It also reduces adrenal activity, which is increased in depression. However St. John's wort has side effects as well. Light-sensitivity, dry mouth, stomach irritations, dizziness and tiredness can occur.
It is inconclusive whether St. John's wort may help with the treatment of herpes, HIV or leukemia, or if it could help in treating some cancers.
St. John's wort is marketed as a dietary supplement, and so it is not regulated by the U.S. Food and Drug Administration, and taking it should be done under a doctor's supervision.
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Dr. Peter Bongiorno, ND , Naturopathic Medicine, answeredSt. John's wort (Latin name: Hypericum perforatum) is considered a bit of a menace in the conventional world. Because of its ability to change the liver's ability to process medications, it is considered one of the taboo herbs if you are on any other medication.
The truth: By the same mechanism that St. John's wort may negatively change the effect of a medication by possibly increasing or decreasing its level of effect, it could also help. Known for its ability to stave off depression, it is not well known that the psychiatric-geared St. John's wort may be gaining ground in the field of cardiology and may be a good example of an herb that can help a drug actually work better.
St. John's wort is already well-known to work well to beat depression in heart patients, with fewer negative side effects on the heart than traditional antidepressants. For patients with cardiac electrical issues (such as arrhythmias) or in elderly patients with heart problems, high-dose hypericum extract has been found to be safer for the heart than tricyclic antidepressants (such as amitryptiline (Elavil) and imipramine). As a result, some researchers are thinking it makes sense to use St. John's wort as a first-line therapy for cardiac patients with depression.
Two other studies also suggest St. John's wort may even help patients lower the dose of Plavix (an anticlotting drug), and can help in the 20% of patients who are treatment resistant (meaning that for these patients the drug would normally not work). One study using clopidogrel (Plavix) found that for 2 out of 10 patients using this drug, it does not work well, but in these patients, 300 milligrams (mg) of St. John's wort for two weeks boosted the antiplatelet effect by 20%. A past study using 300 mg three times a day of this botanical showed an increased drug effectiveness of 36%.
Although doctors were concerned that the St. John's wort might negatively change the effectiveness of the patients' cholesterol-lowering statin drugs, no negative change in cholesterol was seen.
In conclusion, we are learning that drug interactions are not necessarily a bad thing. When used properly, herbs like St. John's wort may be a great choice for heart patients by helping get a good effect using fewer toxic medications and allowing drugs to work better. -
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Dr. Mehmet Oz, MD , Cardiology (Cardiovascular Disease), answeredSee All 2 AnswersAlthough many studies have focused on St. John's wort as an antidepressant, the supplement interacts with many other medications. For example, enzymes in St. John's wort speed the body's metabolism of substances in birth-control pills, essentially making them useless for about 25 percent of the women who take both birth-control pills and St. John's wort. Other drugs it may weaken include cyclosporines, digoxin, some anti-HIV drugs, some cancer medications, and some blood thinners. It should never be taken with prescrpition antidepressants. Taking SAMe (S-adenosylmethionine) may be a better choice, but it too may cause drug interactions; its effects on other drugs have not been as well studied. Always let your doctor know about any supplements you are taking. -
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Dr. Peter Bongiorno, ND , Naturopathic Medicine, answered
Naturopathic Doctor and Licensed Acupuncturist Dr. Peter Bongiorno discusses what you should know before using St. John's Wort as an herbal remedy. Watch Dr. Peter Bongiorno's video for tips on naturopathic remedies and alternative treatments.
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Dr. Michael T. Murray, ND , Naturopathic Medicine, answeredThe dosage for the SJWE standardized to contain 0.3 percent hypericin and 3 to 5 percent hyperforin is typically 900 mg per day for mild depression and 1,800 mg per day for moderate to severe depression. Initially the dosage was spread out during the day, but recent studies indicate that a single daily dose is preferable.
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Stacy Wiegman, PharmD , Pharmacy, answeredSee All 2 AnswersIf you have bipolar disorder, do not take St. John's wort without talking to your doctor. It may induce mania (excessive physical activity and impulsive behavior), and like other antidepressants, it may also accelerate your usual cycling between depression and mania. There have been cases in which mania developed after two to eight weeks of treatment with St. John's wort. The mania was relieved when the dose of St. John's wort was decreased and the dose of a mood stabilizer (such as lithium) was increased.