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Herbal Treatment for Depression: St. John's Wort
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Herbal Treatments for Depression: St. John's Wort
Parts used and where grown
John's wort is found in Europe and the United States. It is especially
abundant in northern California and southern Oregon. The above-ground
(aerial) parts of the plant are gathered during the flowering season.
Historical or traditional use (may or may not be supported by scientific studies)
In ancient Greece, St. John's wort was used to treat many ailments,
including sciatica and poisonous reptile bites. In Europe, St. John's
wort was used by herbalists for the topical treatment of wounds and
burns. It is also a folk remedy for kidney and lung ailments as well as
constituents in St. John's wort include hypericin and other
dianthrones, flavonoids, xanthones, and hyperforin. While it was
previously thought the antidepressant actions of St. John's wort were
due to hypericin and the inhibition of the enzyme monoamine oxidase,
current research has challenged this belief, focusing on other
constituents, such as hyperforin, and flavonoids. Test tube studies
suggest that St. John's wort extracts may exert their antidepressant
actions by inhibiting the reuptake of the neurotransmitters serotonin,
norepinephrine, and dopamine. This action is possibly due to the
constituent hyperforin. St. John's wort is able to act as an
antidepressant, by making more of these neurotransmitters available to
How much is usually taken?
standard recommendation for mild to moderate depression is 500-1,050 mg
of St. John's wort extract per day. Results may be noted as early as
two weeks. Length of use should be discussed with a healthcare
professional. For more severe depression, higher intakes may be used,
under the supervision of a healthcare professional.
Are there any side effects or interactions?
St. John's wort has a low incidence of side effects compared to
prescription antidepressants. An adverse events profile of St. John's
wort found that, of 14 controlled clinical trials, seven reported no
adverse reactions, two had no information, and five reported a total of
seven mild reactions. Adverse effects reported included stomach upset,
fatigue, itching, sleep disturbance, and skin rash. The rate of adverse
reactions was always similar to that of the placebo. Additionally, in
seven trials comparing St. John's wort with other antidepressants, the
adverse reaction rate for St. John's wort was consistently lower than
that of the antidepressant drugs with which it was compared.
St. John's wort can make the skin more sensitive to sunlight.
Therefore, fair-skinned people should be alert for any rashes or burns
following exposure to the sun. Three cases of severe blistering and
burns were reported in people taking St. John's wort internally or
applying it topically and then being exposed to sunlight. There is a
case report of a woman experiencing neuropathy (nerve injury and pain)
in sun-exposed skin areas after taking 500 mg of whole St. John's wort
for four weeks. Although St. John's wort has photosensitizing
properties, the severity of this reaction is not typical for people
taking the herb.
People with a history of manic-depressive illness (bipolar disorder)
or a less severe condition known as hypomania, should avoid use of St.
John's wort as it may trigger a manic episode.
There is a single case report in which ingestion of St. John's wort
appeared to cause high blood pressure in a 56-year-old man. The blood
pressure returned to normal when the herb was discontinued.
Are there any drug interactions?
Certain medicines may interact with St. John's wort.
Caution: It is likely that there are many drug interactions with St.
John's wort that have not yet been identified. St. John's wort
stimulates a drug-metabolizing enzyme (cytochrome P450 3A4) that
metabolizes at least 50% of the drugs on the market. Consequently, St.
John's wort could potentially interfere with a large number of
medications. Individuals taking any medication should, therefore,
consult with a physician before taking St. John's wort.