Is St. John's Wort effective in treating depression?

Dr. Sarah N. Mourra, MD

St. John's wort is effective in treating symptoms of depression. However, despite its efficacy for depression, St. John’s wort can interfere with the metabolism of a multitude of medications that older adults with dementia may already be taking. It may either decrease or increase levels based on the way it inhibits the liver enzymes that are in charge of metabolizing, or getting rid of, other medications. It can lower levels of digoxin. It can also decrease the level of warfarin, which people take for clotting disorders, putting them at risk for developing another clot. It can decrease levels of human immunodeficiency virus (HIV) medications such as protease inhibitors, which can be very significant.

Debra Fulghum Bruce PhD
Healthcare Specialist

St. John’s wort (Hypericum perforatum) is used by millions to ease mild to moderate depression. In Germany, more than 20 million individuals use St. John’s wort.

Recently, German researchers have found that St. John’s wort was as effective as such SSRIs as Prozac (fluoxetine) but without any serious side effects. In one study published in the journal International Clinical Psychopharmacology, volunteers who took either St. John’s wort or the antidepressant fluoxetine were evaluated by psychiatrists for symptoms of depression. After 6 weeks of treatment, researchers concluded that those individuals who took St. John’s wort reported fewer and less serious side effects. For instance, just a few participants in the St. John’s wort group reported mild gastrointestinal complaints. Yet those volunteers who took fluoxetine reported far more serious symptoms, such as dizziness, tiredness, anxiety and erectile dysfunction. The researchers concluded that St. John’s wort clearly is superior as the medication of choice for mild to moderate depression in both effectiveness and safety, when compared to fluoxetine.

In 23 randomized controlled human trials, St. John's wort, or hypericum, seems to relieve depressive symptoms more effectively than placebos and with efficacy similar to certain standard antidepressant medications.

A recent study has confirmed this conclusion. In patients with moderate depression, St. John's wort worked better than placebo and at least as well as imipramine, a standard antidepressant medication.

St. John's wort might be beneficial in more severe forms of depression. The usefulness of hypericum compared to standard drug therapy in the treatment of more severe depression, as determined through structured diagnostic interviews and severity criteria, is still uncertain.

However, one study found similar effects of hypericum and one standard anti-depressant medication, imipramine, during a 6-week treatment period in patients with severe clinical depression.

For diagnosed major depression or less severe depressive symptoms, the effectiveness of hypericum in comparison to newer-generation antidepressant medications (selective serotonin or norepinephrine reuptake inhibitors) has not been studied.

With such an awful name, it can be a surprise to find St. John's wort is actually a flower (hypericum perforatum) filled with, some say, mood-altering chemicals. Some studies have shown it to be effective in relieving mild to moderate depression. Others have shown no difference between St. John's wort and placebo. Where St. John's wort has been used on patients with severe depression, researchers find no improvement in symptoms.

Despite these disappointing findings, doctors in some European countries still prescribe St. John's wort for depression. For those studies which report positive results, researchers theorize that St. John's wort may block nerve cells in the brain from reabsorbing the neurotransmitter serotonin, making it more available. Serotonin and other neurotransmitters affect and regulate mood. With the jury out, go to the National Institute of Mental Health's most recent analysis of St. John's wort so that you can decide for yourself.

Stacy Wiegman, PharmD
Pharmacy Specialist

St. John's wort is likely to be effective in treating mild to moderate depression. It has been shown to improve mood and to reduce anxiety, insomnia and physical symptoms related to depression. Guidelines from the American College of Physicians-American Society of Internal Medicine call it an option for short-term treatment of mild depression, but note that evidence is limited and products are not regulated.

On the other hand, St. John's wort can interact with a long list of drugs. And since there's no evidence that it's more effective than conventional antidepressants or tolerated significantly better, it may not be your best choice, especially if you take other medications. Some evidence suggests that St. John's wort may be less effective in treating severe depression than it is for milder cases.

Like 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.

If you are currently taking St. John’s wort and want to stop taking it, talk about this with your doctor or therapist. If this supplement is helping to relieve your symptoms of depression, your symptoms may come back when you stop. It is best not to stop abruptly but rather to taper off your dose. Your therapist or doctor can help you monitor your symptoms.

Anxiety and depression are serious disorders that can affect a person’s daily activity. There are many antidepressants and anti-anxiety medications that can be used to treat these conditions. In terms of herbal supplements, St. John’s wort has been used for depression. However, there may be a lot of drug interaction with this medication and it is best to see a doctor before taking any herbal medication for these problems.

The 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.

Dr. John Preston, PsyD
Psychology Specialist

Most mental health experts agree that St. John's Wort (SJW) a treat some cases of mild to moderate depression. A meta-analysis is a statistical way of looking at very large numbers of studies to see what over-all findings are seen. The Cochrane database is one such source that is highly respected. They have done a meta-analysis and it shows that SJW can treat more severe depression if taken in higher doses. Most of the studies are done in Europe where this medication is used more widely. For instance, it is the top selling antidepressant in Germany.

To treat depression successfully the dose required is much higher than is generally used in the USA. The typical therapeutic dose is 1800 mg a day. This must be taken in 3 divided doses, because taken all at once and it can cause stomach upset, nausea and sometimes vomiting. The benefits of SJW are the following: few side effects (may cause stomach upset), inexpensive (about $1.00 a day), and for some people the fact that it is a "natural" product is appealing (although natural does not always mean safe). SJW is very well tolerated and safe if taken by people who are otherwise in good health and are not taking other prescription drugs. Here are the two significant problems with SJW: First, it has a significant impact on liver enzymes and the impact of this is that it can result in serious drug-drug interactions. Anyone considering taking SJW and taking any prescription drug should ALWAYS talk with their pharmacist to see if SJW might interfere with other medications. Secondly, and very importantly, SJW (and this is true for any antidepressant) can cause serious problems if taken by a person who has bipolar disorder (BD). In BD all antidepressants can cause a shift from depression into mania and this can lead to a catastrophe. This is especially important to consider because most people who buy and then use SJW are not being evaluated and followed by a physician or other mental health expert. To be cautious anyone who is suffering with depression and considers taking SJW...please first consult a professional at least for an evaluation.

Over the counter products such as SJW are often downplayed in the USA due to the huge influence of pharmaceutical companies. In other countries such "natural" products have been studied and are widely used to treat depression.

Continue Learning about St. John's Wort

St. John's Wort

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.

Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.