Warning:  For occasional use only.  Do not exceed recommended dose except on the advice of a health professional.  Do not take St. John's wort if pregnant or while nursing except on the advice of a health professional.  St. John's wort side effects include photosensitivity with prolonged exposure to sunlight. There may be a higher incidence of cataracts in those who use this herb regularly and are exposed to sunlight. Take frequent breaks from use and, if you still need a mood lifter, consider 5htp or sam-e natural mood lifters.

St. Johns wort supplement facts
St. John's Wort - 300 mg
    (Hypericum perforatum) extract, Hypericin (0.3%) - 900 mcg, and Hyperforin (3%)  -  9 mg

Benefits
Depression -- St. John's wort is helpful in the treatment of mild to moderate depression with fewer side effects than conventional pharmaceutical antidepressants. The effect of the herb may be noticed the first day, but often it takes a few days or weeks for the full benefits of St. John's wort to occur. Some studies indicate that St. John's wort may be as good an antidepressant as some of the SSRIs such as Prozac and Zoloft.
   If your doctor approves, you can take one capsule of St. John's wort in the morning and half a capsule of a 50 mg 5-HTP in the afternoon or evening. Some people find the low dose combination of 5 HTP and St. John's wort to be helpful.

Timing of clinical improvement and symptom resolution in the treatment of major depressive disorder. A replication of findings with the use of a double-blind, placebo-controlled trial of Hypericum perforatum versus fluoxetine.
Neuropsychobiology. 2007;56(2-3):132-7. Papakostas GI, Crawford CM, Scalia MJ, Fava M. Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, Mass. 02114, USA.
Thirty-nine outpatients with depression who responded following a 12-week, double-blind study comparing St. John's wort, fluoxetine or placebo were included in the analysis. In the present work, earlier as well as early clinical improvement during treatment is predictive of greater symptom resolution at endpoint among responders. This was replicated among patients who received active treatment (either St. John's wort or fluoxetine) but not placebo.

PMS -- St. John's wort has been found to be partially helpful in treating PMS.

The Efficacy of Hypericum perforatum for the Treatment of Premenstrual Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial.
CNS Drugs. 2010 Mar 1; Canning S, Waterman M, Orsi N, Ayres J, Simpson N, Dye L. Institute of Psychological Sciences, University of Leeds, Leeds, UK.
Premenstrual syndrome (PMS) is a common condition. Some of the most widely prescribed medications are selective serotonin reuptake inhibitors (SSRIs), based on the hypothesized role of serotonin in the production of PMS symptoms. PMS sufferers, especially those experiencing mild to moderate symptoms, are often reluctant to take this form of medication and instead buy over-the-counter preparations to treat their symptoms, for which the evidence base with regard to efficacy is limited. St John's wort influences the serotonergic system. As such, this widely available herbal remedy deserves attention as a PMS treatment. 36 women aged 18-45 years with regular menstrual cycles (25-35 days), who were prospectively diagnosed with mild PMS. Women who remained eligible after three screening cycles (n = 36) underwent a two-cycle placebo run-in phase. They were then randomly assigned to receive Hypericum perforatum tablets 900 mg/day (standardized to 0.18% hypericin; 3.38% hyperforin) or identical placebo tablets for two menstrual cycles. After a placebo-treated washout cycle, the women crossed over to receive placebo or Hypericum perforatum for two additional cycles. Symptoms were rated daily throughout the trial using the Daily Symptom Report. Secondary outcome measures were the State Anxiety Inventory, Beck Depression Inventory, Aggression Questionnaire and Barratt Impulsiveness Scale. Plasma hormone (follicle-stimulating hormone [FSH], luteinizing hormone [LH], estradiol, progesterone, prolactin and testosterone) and cytokine (interleukin [IL]-1beta, IL-6, IL-8, interferon [IFN]-gamma and tumour necrosis factor [TNF]-alpha) levels were measured in the follicular and luteal phases during Hypericum perforatum and placebo treatment. Hypericum perforatum was statistically superior to placebo in improving physical and behavioural symptoms of PMS). There were no significant effects of Hypericum perforatum compared with placebo treatment for mood- and pain-related PMS symptoms. Plasma hormone (FSH, LH, estradiol, progesterone, prolactin and testosterone) and cytokine (IL-1beta, IL-6, IL-8, IFNgamma and TNFalpha) levels, and weekly reports of anxiety, depression, aggression and impulsivity, also did not differ significantly during the Hypericum perforatum and placebo cycles. Daily treatment with Hypericum perforatum was more effective than placebo treatment for the most common physical and behavioural symptoms associated with PMS. As proinflammatory cytokine levels did not differ significantly between Hypericum perforatum and placebo treatment, these beneficial effects are unlikely to be produced through this mechanism of action alone. Further work is needed to determine whether pain- and mood-related PMS symptoms benefit from longer treatment duration.

The Efficacy of Hypericum perforatum (St John's Wort) for the Treatment of Premenstrual Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial.
CNS Drugs. 2010 Mar 1; Canning S, Waterman M, Orsi N, Ayres J, Simpson N, Dye L. Institute of Psychological Sciences, University of Leeds, Leeds, UK.
Premenstrual syndrome (PMS) is a common condition. Some of the most widely prescribed medications are selective serotonin reuptake inhibitors (SSRIs), based on the hypothesized role of serotonin in the production of PMS symptoms. PMS sufferers, especially those experiencing mild to moderate symptoms, are often reluctant to take this form of medication and instead buy over-the-counter preparations to treat their symptoms, for which the evidence base with regard to efficacy is limited. St John's wort influences the serotonergic system. As such, this widely available herbal remedy deserves attention as a PMS treatment. To investigate the effectiveness of Hypericum perforatum on symptoms of PMS. This randomized, double-blind, placebo-controlled, crossover study was conducted between November 2005 and June 2007. Institute of Psychological Sciences, University of Leeds, Leeds, UK. 36 women aged 18-45 years with regular menstrual cycles (25-35 days), who were prospectively diagnosed with mild PMS. Women who remained eligible after three screening cycles (n = 36) underwent a two-cycle placebo run-in phase. They were then randomly assigned to receive Hypericum perforatum tablets 900 mg/day (standardized to 0.18% hypericin; 3.3% hyperforin) or identical placebo tablets for two menstrual cycles. After a placebo-treated washout cycle, the women crossed over to receive placebo or Hypericum perforatum for two additional cycles. Hypericum perforatum was statistically superior to placebo in improving physical and behavioural symptoms of PMS. There were no significant effects of Hypericum perforatum compared with placebo treatment for mood- and pain-related PMS symptoms. Plasma hormone (FSH, LH, estradiol, progesterone, prolactin and testosterone) and cytokine (IL-1beta, IL-6, IL-8, IFNgamma and TNFalpha) levels, and weekly reports of anxiety, depression, aggression and impulsivity, also did not differ significantly during the Hypericum perforatum and placebo cycles. Daily treatment with Hypericum perforatum was more effective than placebo treatment for the most common physical and behavioural symptoms associated with PMS. As proinflammatory cytokine levels did not differ significantly between Hypericum perforatum and placebo treatment, these beneficial effects are unlikely to be produced through this mechanism of action alone.

Weight loss -- St. john's wort may be helpful in appetite control when combined with other natural supplements. A more effective herbal combination for appetite suppression is Diet Rx.

Somatoform disorders (see study below).

Side effects, risk, caution, danger, adverse events
The most common St. John's wort side effect is insomnia, which is likely to be worse on higher doses. Headaches and irritability or anxiety have also been reported. Sensitivity to light is another St. John's wort side effect. St. John's wort side effects could also include retinal harm if this herb is taken and the eyes are exposed to strong sunlight. Those who are predisposed to macular degeneration or have macular degeneration may with to either avoid the use of St. John's wort or to avoid sunlight when taking this herbal extract.

Q. I read the information on your site about St. John's wort, and I didn't find any suggestions in case of side effects like anxiety, insomnia and irritability when someone takes St. John's wort occur. Do the side effects disappear in time? Or should St. John's wort must be taken with another supplement to counteract the side effects?
   A. It is best to reduce the dosage rather than to take something else to counteract the St. John's wort side effects.

Q. I took St. John's wort to help with menopause related depression. I took a German preparation which was a single 900 mg tablet in the morning for a week. I was waking frequently in the night, but knew that insomnia was a potential side effect. My blood pressure rose to 180 / 100. I think this could be a side effect of St. John's wort extract. I stopped taking the St. John's wort and feel quite a bit better. I realize there are lots of studies to show that St. John's wort does not affect blood pressure. Unfortunately the studies clearly do not cover rare cases like myself.
   A. St. John's wort extract taken daily at 900 mg is quite a high dosage. We suggest 300 mg of St. John's wort extract taken in the morning, and even to reduce the frequency to every other day once the benefits begin. Insomnia is a side effect of St. John's wort on high dosages.

Additional nutrients involved in mood support
5-HTP sometimes has an effect within hours and is best suited for those whose low mood is related to serotonin deficiency. Sam-e is a powerful nutrient that starts working within hours but should not be used by those who have a tendency for depression associated with anxiety. B vitamins have a mild influence on depression. The combination of 5 HTP St. John's wort may help some people. If you plan to take St. John's wort and 5HTP together, use low dosages. These supplements should not be mixed together with pharmaceutical medicines prescribed for depression such as Prozac, Paxil, Zoloft, and other SSRI drugs unless done so or supervised by a health care provider experience with these combinations.

St. John's wort and 5HTP for depression treatment
Q. I have depression and have been taking St. John wort off and on for several months and although I feel better when I take it regularly my depression continues. I just read from a site that a 5HTP supplement sometimes works in a few hours and some of it's benefits and side affects interest me. Should I consider switching from St. John wort to 5HTP or could they both be taken together, every other day of course? Also, if changing is encouraged, should I start taking 5HTP the very next day (I will take a dose of St. John wort before lying down and another tomorrow if I remember) or should I be off St. John wort for a few days before taking 5HTP? And, since 5HTP can reduce sexual drive, when I begin to date again can Passion Rx restore my sexual drive; or will I need to take it whenever I desire to be sexual?
   A. It is often best to learn how each supplement works by itself before combining. When combined, both the St. John's wort dosage and the 5HTP dosage should be kept low in order to avoid potential side effects. Passion Rx can restore sexual drive and can be used as needed, it normally takes a few days for it to be most effective. Passion Rx should not be taken the same day as 5HTP or St. John's wort. As to the specifics on how to switch, that is the role of your health care provider since each person may have a different response and it is not possible for us to know how you will respond to the switch. We wish you well. 5HTP is available over the counter.

St. John's Wort and long term use
There is always a concern when taking a particular herb for prolonged periods. Thus far, it does not seem that St. John's wort has any significant side effects (particularly compared to standard pharmaceutical antidepressants). However, I often recommend taking breaks from a supplement every few weeks. It also depends on dosage. If a person is only taking one pill a day, they can continue taking this much longer that someone taking three pills a day.
   One study indicates St. John's wort does not influence heart rate variability.

Caution and danger, safety
Reduce exposure to sunlight when you take St. John's wort. One study has indicated that in the presence of light, hypericin (a component of St. John's wort) can induce changes in lens protein that could lead to the formation of cataracts. Appropriate precautions should be taken to protect the eye from intense sunlight while taking St. John's wort.
   St. John’s wort may interfere with oral contraceptives. St John's wort is an inducer of cytochrome P450 (CYP) 3A enzymes and may reduce the efficacy of oral contraceptives.
   St. John's wort interacts with many medicines, including antidepressants, so caution is advised when combining this herb with other medicines. Combining St. John's wort with SSRIs or other pharmaceutical antidepressants should only be done under medical supervision since their effects are additive and it is possible that the combination could cause serotonin syndrome.
   St. John's wort may increase metabolism of certain drugs such as indinavir used in treating HIV. The mechanism is likely due to st. john's wort inducing the production of cytochrome P450 3A, an enzyme that breaks down certain drugs, but the specifics of this interaction are not yet clear. St. John's wort may also interfere with the metabolism of Camptosar, a medicine used to treat some kinds of cancer.
   Certain formulations of St. John's wort seem to reduce levels of digoxin, a drug that helps the heart to pump in people who have heart failure. If the digoxin level falls too low, the drug may not provide a beneficial effect. St. John's formulations rich in chemicals called hypericin and hyperforin seemed to reduce blood-stream levels of digoxin. There were no interactions, however, when volunteers took "traditionally used" St. John's wort preparations. The hypericin and hyperforin-rich formulations produce their effect by turning on enzymes that break down digoxin.

Lack of safety and danger info on St. John's wort supplement products
In an analysis of product labels for St. John's wort supplements, hardly any mentioned all of the serious safety issues associated with using this herb. Dr. Kevin A. Clauson of Nova Southeastern University in West Palm Beach, Florida, caution that taking St. John's wort with AIDS medications or with drugs that suppress the immune system, or with oral contraceptives, or the blood-thinning drug warfarin can reduce the effectiveness of these drugs. St. John's wort may not be appropriate for people with bipolar illness or those taking prescription antidepressants. Taking St. John's wort with antidepressant drugs can cause anxiety, restlessness, and increased body temperature.  Dr. Kevin A. Clauson of Nova Southeastern University evaluated labels of 74 St. John's wort supplements to find out whether these cautions were mentioned. None of the products listed all of the potential drug interactions and contraindications. Three mentioned seven of the eight criteria, while four listed no safety information at all. The most common warnings included not to take the drug with antidepressants; phototoxicity, and advice to consult a health care professional before taking the drug. BMC Complementary and Alternative Medicine, online July 17, 2008.

Dosage, how much to take for mood disorders and as a treatment for depression
Since each person is different, the proper dosage of St. John's wort could range from as little as half of a 300 mg capsule to 3 capsules a day. Most people find one capsule of St. John's wort extract at 300 mg a day to be sufficient.

St. John's Wort and depression research
An extract of the herbal remedy St. John's wort is as effective as a commonly prescribed drug for people with moderate-to-severe depression. They compared the st. john's wort extract called WS 5570, which is made by the German company Dr. Willmar Schwabe Pharmaceuticals, and the antidepressant paroxetine sold by GlaxoSmithKline Plc under the brand name Paxil or Seroxat. St. John's wort is also known as hypericum perforatum. "In the treatment of moderate to severe major depression, St. John's wort hypericum extract WS 5570 is at least as effective as paroxetine and is better tolerated," Professor Armin Szegedi of the Charite-Universitatsmedizin, part of the University of Berlin, said in a report published online by the British Medical Journal. In a study funded by the German company, the researchers compared the treatments in 251 patients, between 18 and 70 years of age, for six weeks. Half of the patients taking the st. john's wort extract reported an improvement, compared with one third taking paroxetine. Patients taking the extract also reported fewer side effects, such as stomach disorders, according to the researchers.

Influence of St John's wort on catecholamine turnover and cardiovascular regulation in humans.
Clin Pharmacol Ther. 2004 Nov;76(5):480-9.
St John's wort (Hypericum perforatum) is a popular over-the-counter antidepressant. Its antidepressive effect has been attributed in part to inhibition of monoamine transporters and monoamine oxidase, on the basis of in vitro studies. In a double-blind, randomized, placebo-controlled, crossover study, 16 healthy subjects (11 men and 5 women; mean age, 31 +/- 5 years) ingested either St John's wort (300 mg three times daily) or placebo for 7 days. Imipramine treatment (50 mg three times daily) in 7 subjects served as a positive control. After treatment, physiologic and biochemical tests included cardiovascular reflex testing, graded head-up tilt testing, and plasma catecholamine determinations. St John's wort had no effect on blood pressure, heart rate, heart rate variability, or blood pressure variability, regardless of the test condition. St John's wort had no effect on plasma concentrations of norepinephrine and its main metabolite, dihydroxyphenylglycol, whereas plasma dihydroxyphenylacetic acid (DOPAC; the main metabolite of dopamine) concentrations increased in every subject. In contrast, imipramine increased resting blood pressure and heart rate and elicited a marked orthostatic tachycardia. Our findings challenge the concept that St John's wort elicits a major change in norepinephrine uptake or monoamine oxidase activity in vivo. The consistent increase in plasma DOPAC concentrations might suggest a novel mode of action or an inhibitory effect on dopamine beta-hydroxylase that should be followed up. We propose that a combination of physiologic and biochemical profiling may help better define the mode of action and potential side effects of herbal remedies.

The herb St. John's Wort, used as an alternative therapy for mild depression, may hinder the effectiveness of a newer type of cancer drugs. Their study of 10 healthy volunteers found that the herbal remedy lowered blood levels of the cancer drug Gleevec (known in some countries as Glivec) by as much as 42 percent. In a cancer patient, the study authors warn, this could mean the difference between success or failure on Gleevec, an oral drug used mainly to treat the blood cancer chronic myeloid leukemia. The findings, published in the journal Pharmacology, add to the list of prescription drugs that don't mix well with St. John's Wort. Past studies have shown that the drug may alter blood levels of some other chemotherapy drugs, as well as certain cardiovascular drugs, HIV medications, antidepressants and birth control pills.

St. John's wort and Prozac, Zoloft, Paxil
Q. Are there interactions between Prozac and St. John's wort extract? Can a person take both the SSRI drug and the herb together?
   A. Unless the dosage of the drug and the herb and very low, we suggest not taking them the same day, they are both potent. It would be best to first learn how each one works by itself for 2 or 3 weeks before combining, and doing so with medical approval. When combined, the dosages would be at least half or a third of the suggested amounts taken alone.

St. John's wort supplement pill emails
Q. Is St. johns wort supplement stronger than kava kava?
   A. They are different. St. John's wort supplement is better suited for depression while kava is helpful for anxiety.

Q. I have experienced the St. John's wort side effect of insomnia even on two capsules a day. Is this common?
   A. Some people who are sensitive to St. John's wort get the insomnia side effect even on one capsule.

Q. Is St. Johns Wort plant as good than antidepressant drugs?
   A. The largest-ever study of St. John’s wort reports that the plant should be given first choice over a commonly-prescribed drug to treat depression. St. John's wort, known in Latin as Hypericum perforatum, has long been used to ease mood swings and anxiety. Documented evidence of its use dates back to ancient Greece. Outpatient clinics in Germany carried out a trial on 324 people suffering from mild to moderate depression, half of whom were given St. John’s wort while the other half were given the anti-depressant imipramine. Both treatments, conducted over six weeks, yielded significant benefits. A mood-measuring scale found that, on average, all the patients' symptoms had dropped below the level of mild depression. However, St. John's wort scored "a significant advantage" in having far fewer side effects than imipramine. Side effects such as dry mouth, sweating and dizziness were reported in 39 percent of patients taking the herb, while the figure was 63 percent among those taking imipramine. As a result, only three percent taking St. John's wort stopped the treatment, compared to 16 percent on imipramine. The extract "is therapeutically equivalent to imipramine in treating mild to moderate depression, but patients tolerate hypericum better," says the authors of the study published in the British Medical Journal. This investigation is the biggest and most exhaustive in nearly two dozen trials that have given St. John's wort the thumb's-up as a treatment for melancholy.
   n view of the mounting evidence that St. John’s wort works as well as traditional antidepressant drugs and has fewer side effects, this herb should be considered first in the treatment of mild to moderate depression. Avoid excessive sun exposure since a rash can occur. Daily doses range from 300 to 900 mg.

Q. Does St. John's wort cause anxiety?
   A. In high doses it is possible the St. John's wort could make cause anxiety, restlessness, and insomnia.

Q. Hello. I came across your website when looking up the possibility of opening up capsules and putting them in food. I have a hard time taking large pills and don't like the idea of taking gelatin since I'm a vegetarian. I picked up some St. John's Wort capsules and was hoping to just open them up and put them in yogurt or juice. Is this ok to do with this herb? I just wanted to make sure before I do it. Also, it says that SJW can actually cause some anxiety. I am actually dealing with anxiety and depression and thought that SJW was supposed to treat anxiety not CAUSE anxiety. Should I worry?
   A. St. John's wort can be taken with juice, we're not sure about yogurt and whether it will slow the absorption or not. Most often herbs work quicker when taken on an empty stomach or little food. High doses of St. John's wort may cause anxiety. restlessness and insomnia. This can happen on 3 capsules or it can even happen on one capsule after several days of use.

Q. Can you tell me is there had been any research done with taking Sam-e and St. Johns wort simultaneously? For example, I take Sam-e in the mornings and sometimes actually crave some tincture of St. Johns wort occasionally on some afternoons.
   A. We are not aware of research done combining the two supplements. Some people may get overly stimulated and have insomnia combining St. John's wort and SAM-e.

Q. have there been any studies done on the combined usage of Ashwagandha and St. John's Wort for improving moderate depression?
   A. We have not seen such studies with this combination.

Q. Since taking St Johns wort, I have been suffering with bladder problems, could this be a side effect?
   A. We have not heard of this potential St. John's wort side effect yet, but many side effects exist from herbs that are not yet known.

Q. Can you please let me know if there is an interaction between 5 HTP or St John’s wort and Lithium. What are your suggestions and which natural medication ( 5 HTP or St John’s wort ) is better for treating Manic Depressive Psychosis.
   A. There can be an interaction between 5HTP and St. John's wort, therefore it is best to learn how each one works by itself before combining, and when combined, half the dosage should be used. This has to be done under medical guidance. We are not aware of any research or reports using St. John's wort and lithium together, unexpected side effects can occur when drugs and potent herbs are combined. It is up to your doctor to learn about these herbs and decide the best treatment option for your depression.

Q. Sometimes I take a St. John's wort pill in the morning and 5-HTP in the afternoon or evening. Is there a danger combining 5-HTP with St. John's wort?
   A. We have not seen any research with the combination of St. John's wort and 5-HTP, however, if the dosage of the St. John's wort is kept to 300 mg and the dosage of 5-HTP is half a 50 mg capsule, there should be no major problems as long as you are healthy and take no other medicines. However, unexpected reactions can happen when potent supplements are mixed.

Q. My 33-year old son is suffering from mild to moderate depression and may also have some mild ADD. Which of these 2 (St. John's or SAM-e) would be most beneficial for him to try? Would you recommend one or the other to be tried first? If so, how long should he wait between if he switches from one to the other?
   A. It is very difficult, in many cases nearly impossible, to predict which natural antidepressant will work in any particular individual. Taking three or four days off before switching is a good idea.

Q. Would you please briefly summarize the science behind your statement so that I can explain it to my doctor who is also a nutrition physician? “Additional nutrients involved in mood support 5-HTP sometimes has an effect within hours and is best suited for those whose low mood is related to serotonin deficiency. SAM-e a powerful nutrient that starts working within hours. B vitamins have a mild influence on depression. The combination of 5 HTP St. John's wort may help some people. If you plant to take St. John's wort and 5HTP together, use low dosages. These supplements should not be mixed together with pharmaceutical medicines prescribed for depression such as Prozac, Paxil, Zoloft, and other SSRI drugs.” What is the science behind why should not use St. John’s Wort and 5HTP together with Paxil?
   A. A high dose of 5-HTP added to SSRI drugs may cause serotonin syndrome since SSRI drugs such as Paxil, Zoloft, Prozac, and others make more serotonin available in the brain and when 5HTP is taken in supplement form, it can increase serotonin levels even further. Experienced doctors may add 5-HTP as a treatment, but at the same time they would need to reduce the dosage of the SSRI to prevent serotonin syndrome.

My son is 13 years old and has autism and problems with insomnia. The doctor recommended St. John's wort supplement. We started one capsule a day. At first he seemed to be improving, getting more sleep and more focused (he is 13 years old). Then last Sunday he started to "trip out". He was constantly moving. We called the doctor and he said to stop the St. John's wort herb. It is now Thursday and he has been very unfocused all week. The teachers say that he is not doing anything at school. Can this amount of the herb cause permanent damage?
    It is unlikely that St. John's wort supplements causes permanent damage, but the effects from certain herbs can last several days. The effects of St. John's wort tend to accumulate over time and the dosage would either need to be reduced or the frequency of use would need to be reduced.

Note: Some people misspell St. John's wort as St. John's wart or St. John's wurt

Succinic acid is a chemical building block used in the manufacture of polymers, resins, food and and pharmaceutical medications.
Symplocos racemosa is used by Ayurvedic doctors for various female disorders.
Synsepalum dulcificum is a fruit  native to West Africa and has been known to Westerners since the 18th century.
Taraxacum officinale is also known as dandelion herb.

This herbal supplement page was last updated in 2010.