If 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.
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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Dr. Tieraona Low Dog, MD , General Practice, answered
St. 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 AnswersThe active ingredient in St. Johns Wort, hypericin, appears to affect various neurotransmitters, including serotonin, epinephrine, and dopamine. These are the same chemicals affected by the prescription drug Prozac. St. John’s Wort may also help to improve sleep because hypericum extract increases the brain's output of melatonin at night. Melatonin is a hormone produced by the body that influences the circadian rhythm and sleep. -
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HealthyWomen answeredSee All 5 AnswersThe herb St. John's wort may help depression in some people. Studies have found it effective for mild to moderate depression. However, you should not use St. John's wort without a doctor's supervision, due to interactions this supplement has with various medications. St. John's wort acts like an antidepressant, so it should not be taken with other antidepressants. It also interferes with oral contraceptives, immunosuppressants, HIV medications and oral anticoagulants, among other drugs.
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Stacy Wiegman, PharmD , Pharmacy, answeredSee All 3 AnswersSt. John's wort may cause a number of side effects. It can make it hard to get to sleep and may lead to undesirably vivid dreams when you do. It can influence your mood, making you restless, anxious, agitated and irritable. It can cause gastrointestinal problems, upsetting your stomach or giving you diarrhea. Fatigue, dry mouth, dizziness, headache, skin rash, low blood sugar and tingling sensations are other possible side effects of St. John's wort.
You may be able to relieve sleep problems by taking St. John's wort in the morning and/or taking less of it. Overall, in clinical trials, St. John's wort caused about the same number of side effects as a placebo (a sugar pill containing no active ingredients) and fewer than conventional antidepressants.
Taking St. John's wort by mouth or applying it to your skin can make you very sensitive to the sun, possibly resulting in an extreme reaction sometimes called sun poisoning. -
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Stacy Wiegman, PharmD , Pharmacy, answeredMany oral supplements of St. John's wort are actually extracts. These are formulations containing the herb's active ingredients -- including hypericin and/or hyperforin -- in concentrated form.
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Stacy Wiegman, PharmD , Pharmacy, answeredThe best way to take St. John's Wort depends on the reason it is being used. For example, an oral form, such as a pill, would be typically used for treatment of mild or moderate depression and should be taken with a full glass of water. A topical form would treat a burn on the skin. Standardized forms of an herbal supplement such as St. John's Wort can provide a more reliable dose, but since the U.S. Food and Drug Administration (FDA) does not require standardization of herbal products, not every St. John's Wort product may contain the same degree of active ingredients. Become informed about the contents of the product you choose, and use it as directed on its package or as stipulated by your health care professional.
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Stacy Wiegman, PharmD , Pharmacy, answeredUsing St. John's Wort in various cultural and traditional environments may be different from approaches accepted by present day Western medicine. When you are determining whether to use any herbal supplement, such as St. John's Wort, discussion about it with your doctor is recommended because of its possible serious interactions with prescription medicines you are taking and health issues you may have. In addition, you may benefit from a discussion with a practitioner specifically trained in herbal supplements.
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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.