St. John's wort (Hypericum perforatum) also known as Tipton's Weed, Chase-devil, or Klamath weed, is an herb, its flowers and leaves are used to make medicine. It is a shrubby plant with clusters of yellow flowers that have oval, elongated petals. Scientists believe it is native to Europe, parts of Asia and Africa, and the western United States.
It has a history of being used as a medicine dating back to ancient Greece, where it was used for a range of illnesses, including various "nervous disorders." St. John's wort also has antibacterial and antiviral properties. Because of its anti-inflammatory properties, it has been applied to the skin to help heal wounds and burns. St. John's wort is one of the most commonly purchased herbal products in the United States.
St. John's wort is native to Europe but is commonly found in the US and Canada in the dry ground of roadsides, meadows, and woods. Although not native to Australia and long considered a weed, St. John's wort is now grown there as a crop. Today, Australia produces 20 percent of the world's supply.
The use of St. John's wort dates back to the ancient Greeks. Hippocrates recorded the medical use of St. John's wort flowers. St. John's wort was given its name because it blooms about June 24th, the birthday of John the Baptist. "Wort" is an old English word for plant.
St. John's wort is most commonly used for depression and conditions that sometimes go along with depression such as anxiety, tiredness, loss of appetite and trouble sleeping. There is some strong scientific evidence that it is effective for mild to moderate depression, and has fewer side effects than most other prescription antidepressants. But it interacts with a number of medications, so it should be taken only under the guidance of a health care provider.
You shouldn't try to treat severe depression -- where you may not be able to function day to day, or have thoughts of harming yourself or others -- with herbs. Always see a doctor if your depression is making it hard for you to function (See "Precautions" section).
Other uses include heart palpitations,
moodiness and other symptoms of menopause, attention
deficit-hyperactivity disorder (ADHD), obsessive-compulsive disorder
(OCD), and seasonal affective disorder (SAD).
St. John's wort
has been tried for exhaustion, stop-smoking help, fibromyalgia,
chronic fatigue syndrome (CFS), migraine and other types of
headaches, muscle pain, nerve pain, and irritable bowel syndrome. It
is also used for cancer, HIV/AIDS, and hepatitis C.
An oil can
be made from St. John's wort. Some people apply this oil to their
skin to treat bruises and scrapes, inflammation and muscle pain,
first degree burns, wounds, bug bites, hemorrhoids, and nerve pain.
But applying St. John's wort directly to the skin is risky. It can
cause serious sensitivity to sunlight.
The active ingredients
in St. John's wort can be deactivated by light. That's why you will
find many products packaged in amber containers. The amber helps, but
it doesn't offer total protection against the adverse effects of
light.
St. John's wort has long been used medicinally as an anti-inflammatory for strains, sprains, and contusions. St. John's wort also has been used to treat muscular spasms, cramps, and tension that results in muscular spasms.
The plant, especially its tiny yellow flowers, is high in hypericin and other flavonoid compounds. If you crush a flower bud between your fingers, you will release a burgundy red juice -- evidence of the flavonoid hypericin. St. John's wort oils and tinctures should display this beautiful red coloring, which indicates the presence of the desired flavonoids.
Bioflavonoids, in general, serve to reduce vascular fragility and inflammation. Since flavonoids improve venous-wall integrity, St. John's wort is useful in treating swollen veins. St. John's wort preparations may be ingested for internal bruising and inflammation or following a traumatic injury to the external muscles and skin.
The oil is also useful when applied to wounds and bruises or rubbed onto strains, sprains, or varicose veins. Topical application is useful to treat hemorrhoids and aching, swollen veins that can occur during pregnancy.
Taking St. John's wort extracts improves mood, and decreases anxiety and insomnia related to depression. It seems to be about as effective in treating depression as many prescription drugs. In many studies it seems to work as well as selective serotonin reuptake inhibitors (SSRIs), a popular type of antidepressant that doctors often prescribe first to treat depression. They include fluoxetine (Prozac), citalopram (Celexa), and sertraline (Zoloft). In fact, clinical guidelines from the American College of Physicians-American Society of Internal Medicine suggest that St. John's wort can be considered an option along with antidepressant medications for short-term treatment of mild depression. However, since St. John's wort does not appear to be more effective or significantly better tolerated than antidepressant medications, and since St. John's wort causes many drug interactions, the guidelines suggest it might not be an appropriate choice for many people, particularly those who take other medications. St. John's wort might not be as effective for more severe cases of depression.
St. John's wort contains several chemicals, including hypericin, hyperforin, and flavonoids. Researchers aren't exactly sure how St. John's wort works. Some have suggested that the herb acts similar to an SSRI, making more of the brain chemicals serotonin, dopamine, and norepinephrine available. These neurotransmitters help improve one's mood. Scientists thought that hypericin was responsible, but now they believe that other chemicals in St. John's wort may help.
St. John's wort has also shown promise in treating the following conditions, a few of which are related to depression.
Premenstrual syndrome (PMS). An early study suggests that St. John's wort may help relieve physical and emotional symptoms of PMS in some women by even as much as 50% in some women., including cramps, irritability, food cravings, and breast tenderness.
Menopause: Two studies suggest that St. John's wort, combined with black cohosh, helps improve mood and anxiety during menopause.
Seasonal affective disorder (SAD). Used alone, St. John's wort has improved mood in people with SAD, a type of depression that occurs during the winter months because of lack of sunlight. SAD is usually treated with light therapy, and there is some evidence that using St. John's wort together with phototherapy works even better.
Eczema, wounds, minor burns, hemorrhoids. St. John's wort has antibacterial properties and may also help fight inflammation. Applied topically (to the skin), it may relieve symptoms associated with minor wounds and skin irritation.
Obsessive compulsive disorder, social phobia (OCD). One early open-label study found that taking St. John's wort 450 mg two times a day for 12 weeks improved OCD symptoms. But two other studies found that St. John's wort didn't help OCD.
The conversion of mental experiences or states into bodily symptoms (somatization disorder). Treatment with St. John's wort seems to reduce symptoms after 6 weeks of treatment.
Wound healing. Some research shows that applying a specific St. John's wort ointment (Gol-Daru Company) three times daily for 16 days improves wound healing and reduces scar formation after a cesarean section.
Cancer. The National Cancer Institute has conducted several studies showing that St. John's wort has potential as a cancer-fighting drug. One study showed that mice injected with the feline leukemia virus were able to fight off the infection after just a single dose of St. John's wort.
Attention deficit-hyperactivity disorder (ADHD).
Hepatitis C virus (HCV) infection.
HIV/AIDS.
Irritable bowel syndrome (IBS).
Pain conditions related to diabetes (polyneuropathy).
Stomach upset.
Bruises.
Skin conditions.
Migraine headache.
Nerve pain.
Sciatica.
Excitability.
Fibromyalgia.
Chronic fatigue syndrome (CFS).
Muscle pain.
Weight loss.
Smoking cessation.
Other conditions.
More evidence is needed to rate St. John's wort for these uses.
St. John's wort can be obtained in many forms: capsules, tablets, tinctures, teas, and oil-based skin lotions. Chopped or powdered forms of the dried herb are also available. Most products are standardized to contain 0.3% hypericin.
Pediatric
Most studies on St. John's wort have been conducted in adults. However, one study (more than 100 children under age 12) indicated that St. John's wort may be a safe and effective way of treating mild-to-moderate symptoms of depression in children. Never give your child St. John' s wort without medical supervision. Children being treated with St. John's wort should be carefully monitored for side effects, such as allergic reactions or upset stomach. You should not try to treat depression in a child without a doctor's help, because depression can be a serious illness.
Adult
Dry herb (in capsules or tablets): The usual dose for mild depression and mood disorders is 300 mg (standardized to 0.3% hypericin extract), 3 times per day, with meals. St. John's wort is available in time-release capsules.
St. John's Wort is also available as a liquid extract or a tea. Ask your doctor to help you find the right dose.
It may take 3 - 4 weeks to feel any effects from St. John's wort.
Don't stop taking St. John's wort all at once, because that may cause unpleasant side effects. Gradually lower the dose before stopping.
St. John's wort is LIKELY SAFE
for most people when taken by mouth short-term. It can cause some
side effects such as trouble sleeping, vivid dreams, restlessness,
anxiety, irritability, stomach upset, fatigue, dry mouth, headache,
hives or other skin rashes, diarrhea,
tingling and feelings of dizziness or mental
confusion. Take St John's wort in the morning or lower the
dose if it seems to be causing sleep problems.
St. John's wort
seems to be safe when used in children under 12 years of age for up
to 6 weeks.
However, St. John's wort is POSSIBLY UNSAFE
when taken by mouth in large doses. It can also make
the skin overly sensitive to sunlight, called photodermatitis. If you
have light skin and are taking St. John's wort, wear long sleeves and
a hat when in the sun, and use a sunscreen with at least SPF 15 or
higher. Avoid sunlamps, tanning booths, and tanning beds.
Not
enough is known about the safety of St. John's wort when it is
applied to the skin. To be safe, don't use it topically.
St.
John's wort interacts with many drugs (see the section below). Let
your healthcare provider know if you want to take St. John's wort.
Your healthcare provider will want to review your medications to see
if there could be any problems.
Pregnancy and breast-feeding:
St. John's wort is POSSIBLY UNSAFE when taken during
pregnancy. There is some evidence that it can cause birth defects in
unborn rats. No one yet knows whether it has the same effect in
unborn humans. Nursing infants of mothers who take St. John's wort
can experience colic, drowsiness, and listlessness. Until more is
known, don't use St. John's wort if you are pregnant or
breast-feeding.
Infertility: There are some concerns
that St. John's wort might interfere with conceiving a child. If you
are trying to conceive, don't use St. John's wort, especially if you
have known fertility problems.
Attention
deficit-hyperactivity disorder (ADHD): There is some concern that
St. John's wort might worsen symptoms of ADHD, especially in people
taking the medication methylphenidate for ADHD. Until more is known,
don't use St. John's wort if you are taking methylphenidate.
Bipolar
disorder: People with bipolar disorder cycle between depression
and mania, a state marked by excessive physical activity and
impulsive behavior. St. John's wort can bring on mania in these
individuals and can also speed up the cycling between depression and
mania.
Major depression: In people with major
depression, St. John's wort might bring on mania, a state marked by
excessive physical activity and impulsive behavior.
Schizophrenia:
St. John's wort might bring on psychosis in some people with
schizophrenia.
Alzheimer's disease: There is concern
that St. John's wort might contribute to dementia in people with
Alzheimer's disease.
Anesthesia and surgery: Use of
anesthesia in people who have used St. John's wort for six months may
lead to serious heart complications during surgery. Stop using St.
John's wort at least two weeks before a scheduled surgery. Make
sure your doctor and surgeon know you are taking St. John's wort.
St. John's wort interacts with a large number of medications. In most cases, St. John's wort makes the medication less effective. In other cases, however, St. John's wort may make the effects of a medication stronger.
If you are being treated with any medications, you should not use St. John's wort without first talking to your doctor. St. John's wort may interact with these medications:
Antidepressants -- St. John's wort may interact with medications used to treat depression or other mood disorders, including tricyclic antidepressants, SSRIs, and monoamine oxidase inhibitors (MAOIs). Taking St. John's wort with these medications tends to increase side effects, and could lead to a dangerous condition called serotonin syndrome. Do not take St. John's wort with other antidepressants, including:
SSRIs: Citalopram (Celexa), escitalopram (Lexapro), fluvoxamine (Luvox), paroxetine (Paxil), fluoxetine (Prozac), sertraline (Zoloft)
Tricyclics: Amitriptyline (Elavil), nortryptyline (Pamelor), imipramine (Tofranil)
MAOIs: Phenelzine, (Nardil), tranylcypromine (Parnate)
Nefazodone (Serzone)
Allergy drugs (antihistamines) -- St. John's wort may reduce levels of these drugs in the body, making them less effective:
Loratadine (Claritin)
Cetirizine (Zyrtec)
Fexofenadine (Allegra)
Clopidogrel (Plavix) -- Theoretically, taking St. John's wort along with clopidogrel may increase the risk of bleeding.
Dextromethorphan (cough medicine) -- Taking St. John's wort at the same time as dextromethorphan, a cough suppressant found in many over-the-counter cough and cold medicines, can increase the risk of side effects, including serotonin syndrome.
Digoxin -- St. John's wort may lower levels of the medication and make it less effective. Do not take St. John's wort if you take digoxin.
Drugs that suppress the immune system -- St. John's wort can reduce the effectiveness of these medications, which are taken after organ transplant or to control autoimmune diseases. There have been many reports of cyclosporin blood levels dropping in those with a heart or kidney transplant, even leading to rejection of the transplanted organ.
Adalimumab (Humira)
Azathioprine (Imuran)
Cyclosporine
Etanercept (Enbrel)
Methotrexate
Mycophenolate mofetil (CellCept)
Tacrolimus (Prograf)
Drugs to fight HIV -- St. John's wort appears to interact with at least two kinds of medications used to treat HIV and AIDS: protease inhibitors and non-nucleoside reverse transcriptase inhibitors. The Food and Drug Administration recommends that St. John's wort not be used with any type of antiretroviral medication used to treat HIV or AIDS.
Aminolevulinic acid -- a medication that makes your skin more sensitive to sunlight. St. John's wort also increases skin sensitivity to light. Together the two may have a dangerous impact on skin sensitivity to the sun.
Reserpine -- Based on animal studies, St. John's wort may interfere with reserpine's ability to treat high blood pressure.
Sedatives -- St. John's wort can increase the effect of drugs that have a sedating effect, including:
Anticonvulsants, such as phenytoin (Dilantin) and valproic acid (Depakote)
Barbiturates
Benzodiazepines, such as diazepam (Valium)
Drugs to treat insomnia, such as zolpidem (Ambien), zaleplon (Sonata), eszopiclone (Lunesta), and ramelteon (Rozerem)
Tricyclic antidepressants, such as amitriptyline (Elavil)
Alcohol
Alprazolam (Xanax) -- St. John's wort may speed up the breakdown of Xanax in the body, making it less effective.
Theophylline -- St. John's wort can lower levels of this medication in the blood. Theophylline is used to open the airways in people with asthma, emphysema, or chronic bronchitis.
Triptans (used to treat migraines) -- St. John's wort can increase the risk of side effects, including serotonin syndrome, when taken with these medications:
Naratriptan (Amerge)
Rizatriptan (Maxalt)
Sumatriptan (Imitrex)
Zolmitriptan (Zomig)
Warfarin (Coumadin) -- St. John's wort reduces the effectiveness of warfarin, an anticoagulant (blood-thinner).
Other drugs -- Because St. John's wort is broken down by certain liver enzymes, it may interact with other drugs that are broken down by the same enzymes. Those drugs may include:
Antifungal drugs, such as ketoconazole (Nizoral), itraconazole (Sporanox), fluconazole (Diflucan)
Statins (drugs taken to lower cholesterol), including atorvastatin (Lipitor), lovastatin (Mevacor), and simvastatin (Zocor)
Imatinib (Gleevac) -- St. John's wort may make Gleevac less effective.
Irinotecan (Camptosar) -- St. John's wort may speed up the rate that Camptosar is broken down by the body, making it less effective.
Some calcium channel blockers (taken to lower blood pressure)
Any medication broken down by the liver
There are no known interactions with herbs and supplements.
There are no known interactions with foods.
The following doses have been studied
in scientific research:
BY MOUTH:
For mild to moderate depression:
When using St. John's wort extract standardized to 0.3% hypericin content: 300 mg three times daily.
When using a St. John's wort extract standardized to 0.2% hypericin: 250 mg twice daily.
When using a St. John's wort extract standardized to 5% hyperforin: 300 mg three times daily.
For children under 12 years of age with depression: St. John's wort extract standardized to 0.3% hypericin 300 mg daily.
For premenstrual syndrome (PMS): St. John's wort extract standardized to 0.3% hypericin dosed at 300 mg once daily.
For body symptoms associated with depression: 300 mg three times daily of the standardized hypericin extract has been used.
For somatization disorder: a specific extract (LI 160, Lichtwer Pharma) 600 mg/day has been used.
Do not suddenly stop taking St. John's wort. This might cause unpleasant side effects. If you decide to stop taking St. John's wort, reduce the dose slowly over time.
Here are some relevant reviews on some of the health benefits of using St. John's Wort:
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42 of 42 people found the following review helpful:
5.0 out of 5 stars Accept no substitutes, July 23, 2006
By
Kristen
I'd read some wonderful things about the effectiveness of St. John's wort for treating mild to moderate depression and anxiety. However, I was unimpressed when I tried other products. I then came across an article discussing how any company can grind up St. John's wort, put it in a bottle, and market it, but very few brands have been standardized and used in clinical trials. This is one of those brands, and the results I've gotten from it are superb. I have used this product exclusively for about three years, and I truly believe this product has allowed me to cope and to thrive despite my tendencies towards anxiety and mild depression. Highly recommended.
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20 of 21 people found the following review helpful:
5.0 out of 5 stars Very Effective, February 24, 2007
By
K. Rose "CyberShopper" (California)
This was my first time using St. John's Wort. I wanted to get a reputable product so that my experience with it would accurately gauge it's efficacy. The first few days I felt significantly more mentally energized. I also felt more susceptible to anxiety, which I was able to suppress with some simple relaxation techniques. After about a week I became more comfortable with being "up" and the potential for anxiety decreased. After 2 weeks of use I feel much more positive about things and have a relaxed, energized feeling. Be aware that you will become slightly more sensitive to sunlight and should avoid certain foods like yogurt and bananas. [This] definitely works for me and is well worth the money.
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4 of 4 people found the following review helpful:
5.0 out of 5 stars Wow...., April 18, 2008
By
H. Elnomany "musical polymath" (Bklyn, NY, USA)
At first, I didn't know what was wrong with me..... I asked questions around online, and i found out i had clinical depression. Someone recommended Saint John's Wart to me, and I ordered it online. I made sure it didn't conflict with any of my medications, and soon i was taking it. I didn't remember the last time i felt like that.. It worked very well with me. For a while, i thought i was allergic to it, but then i found out i was allergic to tomatoes..... So I'm all good!!!
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9 of 9 people found the following review helpful:
5.0 out of 5 stars Excellent, June 08, 2010
By
From California
It took some trial and error to find the right dose but it was worth the effort. While most take 2-3 pills a day I found that taking only a 1/2 tablet every other day is what fits my system. I have been taking it at this dose for about 9 months now and find I sleep better, am less anxious, can think more clearly and am less depressed. Higher doses had side effects like insomnia and increased anxiety, if you get either of these problems try lowering the dosage amount or increasing the time between doses before just giving up. I tried other brands and found them to be quite different in effect. For example, one left me very sensitive to bright light while this one doesn't have that effect at all. If you tried brand x and it didn't work, don't lose hope, just try a different brand.
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The following reviews are taken from WebMD's homepage User Reviews & Ratings Section:
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Reason for taking: Depression
9/19/2011 11:31:17 PM
Reviewer: 25-34 Male (Consumer)
Comment:
I tried this on a whim and was highly highly skeptical that it would have any effect. I took a pill and about 30 minutes later I was mid-sentence talking to my wife when I suddenly laughed. I wasn't even sure why I laughed or what was funny, but it was the only time I'd laughed at anything all day. I remember saying "wow I'm starting to feel weird." It was the feeling of my cloud of depression lifting away. It was like someone just snapped their fingers and my head cleared up, I could think straight, and smile. I was me again. I don't know why I didn't try this stuff sooner.
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Reason for taking: Depression
7/28/2011 7:22:33 PM
Reviewer: trinamatt, 55-64 Female on Treatment for 6 months to less than 1 year (Consumer)
Comment:
It helps to keep me in a positive mood. I can really tell the difference in my mood when I have forgotten to take it. I used to take a prescription for depression but it make me lethargic and lazy. The prescription medication altered my passion for life and my feelings that came from my heart. I felt like I was a walking zombie. St Johns Wort doesn't do that.
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Reason for taking: Depression
11/9/2011 5:05:25 PM
Reviewer: TripEZ's, 35-44 Female on Treatment for less than 1 month (Consumer)
Comment:
I've been taking it for almost a week and, these particular pills are big and round. Kind of hard to swallow. The very first night after taking it,(2), I had very vivid, horrible nightmares. The worst ever! And I kept waking up afterwards. Only to have another terrible one. The oddest feeling I ever had. But I felt very rested in the morning. So I cut back to one, pill a day. If the nightmares continue, I will be forced to stop, because they are unusually realistic and frightening. I will update this a little later.
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Reason for taking: Depression
8/24/2010 9:24:06 PM
Reviewer: vera, 45-54 Female on Treatment for less than 1 month (Consumer)
Comment:
I was on Paxil for 2 years off and on, I ran out of prescription and decided to take sjw instead. Within a few days of taking this I did not feel edgy, my mood was happy, I experienced calmness. I know this is working because if I skip a day I become edgy and anxiety appears. This is the best thing that has ever happened to me. I will not go back to using anti-depressents again. I stopped due to weight gain and worry over liver damage, and other side effects to my body. I would reccommend this to anyone who has suffered thru stress, anxiety, and depression
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Reason for taking: Other
11/29/2007 11:46:38 PM
Reviewer: 25-34 Female on Treatment for 1 to 6 months (Consumer)
Comment:
I decided to try St. John's Wort rather than go to a doctor for anti-depressants, and I have been happy with the results. I saw a significant difference in my mood after only about 1 week. Side effects for me include slight headaches (which stopped after the first two weeks) and light sensitivity (nothing my sunglasses can't handle). Although I've never tried other medications, I did not feel the 'numbness' that I've heard others describe when taking certain prescription meds. In short, I feel like a less irritable, more positive and resilient version of my former self.
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Reason for taking: Depression
1/30/2011 11:44:20 PM
Reviewer: Here now, 45-54 Male on Treatment for less than 1 month (Consumer)
Comment:
I have always been susceptible to anxiety and general malaise or depression. I have found the improvement using St. John's wort to be dramatic. I felt better just by the second day. And by better I mean without any change whatsoever in my physical state. No change in motor functions or perception at all. Just a generally lighter demeanor. Enjoying things and people more and seeing the better rather than the worse of things in general just comes naturally now; which results in a synergy of making all my interactions better. I have no idea if it affects different people in different ways but in my case it has made a major difference. It is economical and readily available from many sources. My experience has been very encouraging.
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