St. John’s Wort | NCCIH

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Common Names: St. John’s wort, hypericum, Klamath weed, goatweed

Latin Names: Hypericum perforatum

Background

• St. John’s wort is a plant with yellow flowers that has been used in traditional European medicine as far back as the ancient Greeks. The name St. John’s wort apparently refers to John the Baptist, as the plant blooms around the time of the feast of St. John the Baptist in late June.
• Historically, St. John’s wort has been used for a variety of conditions, including kidney and lung ailments, insomnia, and depression, and to aid wound healing.
• Currently, St. John’s wort is promoted for depression, menopausal symptoms, attention-deficit hyperactivity disorder (ADHD), somatic symptom disorder (a condition in which a person feels extreme, exaggerated anxiety about physical symptoms), obsessive-compulsive disorder, and other conditions. Topical use (applied to the skin) of St. John’s wort is promoted for various skin conditions, including wounds, bruises, and muscle pain.

How Much Do We Know?

• There has been extensive research on the use of St. John’s wort for depression and on its interactions with medications. It has been clearly shown that St. John’s wort can interact in dangerous, sometimes life-threatening ways with a variety of medicines.

What Have We Learned?

• St. John’s wort appears to be more effective than a placebo (an inactive substance) and as effective as standard antidepressant medications for mild and moderate depression. It’s uncertain whether this is true for severe depression and for time periods longer than 12 weeks.
• St. John’s wort has also been studied for conditions other than depression. For some, such as irritable bowel syndrome, chronic hepatitis C virus (HCV) infection, HIV infection, and social anxiety disorder, current evidence suggests that St. John’s wort isn’t helpful.
• St. John’s wort might be helpful for menopausal symptoms, wound healing, and somatic symptom disorder, but there’s not enough evidence to know for certain.
• There’s not enough reliable evidence to know whether St. John’s wort might be beneficial for quitting smoking or improving memory or for many conditions, including anxiety, ADHD, and seasonal affective disorder.

What Do We Know About Safety?

• In research studies, taking St. John’s wort by mouth for up to 12 weeks has seemed to be safe. But because St. John’s wort interacts with many drugs, it might not be safe for many people, especially those who take conventional medicines.
• St. John’s wort can weaken the effects of many medicines, including crucially important medicines such as
  • Antidepressants
  • Birth control pills
  • Cyclosporine, which prevents the body from rejecting transplanted organs
  • Some heart medications, including digoxin and ivabradine
  • Some HIV drugs, including indinavir and nevirapine
  • Some cancer medications, including irinotecan and imatinib
  • Warfarin, an anticoagulant (blood thinner)
  • Certain statins, including simvastatin.
• Taking St. John’s wort with certain antidepressants or other drugs that affect serotonin, a substance produced by nerve cells, may lead to increased serotonin-related side effects, which may be potentially serious.
• St. John’s wort may cause increased sensitivity to sunlight, especially when taken in large doses. Other side effects can include insomnia, anxiety, dry mouth, dizziness, gastrointestinal symptoms, fatigue, headache, or sexual dysfunction.
• There isn’t enough reliable information available to know if St. John’s wort is safe when it’s used topically. It may cause severe skin reactions to sun exposure.
• It may not be safe to use St. John’s wort during pregnancy or while breastfeeding. It has caused birth defects in laboratory animals. Breastfeeding infants of mothers who take St. John’s wort can experience colic, drowsiness, and fussiness.

Keep in Mind

• Depression can be a serious illness. If you or someone in your family may have depression, consult a health care provider.
• Take charge of your health—talk with your health care providers about any complementary health approaches you use. Together, you can make shared, well-informed decisions. Although it is important to tell your health care providers about any complementary health approaches you use, this is especially crucial for St. John’s wort because this herb interacts with so many medicines. Interactions with St. John’s wort can weaken the effects of life-saving medicines or cause dangerous side effects.

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Key References

• Apaydin EA, Maher AR, Shanman R, et al. A systematic review of St. John’s wort for major depressive disorder. Systematic Reviews. 2016;5(1):148.
• Cott JM. St. John’s wort. In: Coates PM, Betz JM, Blackman MR, et al., eds. Encyclopedia of Dietary Supplements. 2nd ed. New York, NY: Informa Healthcare; 2010:727-737.
• Gurley BJ, Fifer EK, Gardner Z. Pharmacokinetic herb-drug interactions (part 2): drug interactions involving popular botanical dietary supplements and their clinical relevance. Planta Medica. 2012;78(13):1490-1514.
• Ng QX, Venkatanarayanan N, Ho CYX. Clinical use of Hypericum perforatum (St John’s wort) in depression: A meta-analysis. Journal of Affective Disorders. 2017;210:211-221.
• Qaseem A, Barry MJ, Kansagara D. Nonpharmacologic versus pharmacologic treatment of adult patients with major depressive disorder: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine. 2016;164:350-359.
• Soleymani S, Bahramsoltani R, Rahimi R, et al. Clinical risks of St John’s wort (Hypericum perforatum) co-administration. Expert Opinion on Drug Metabolism & Toxicology. 2017;13(10):1047-1062.
• St. John’s wort. In: Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000:359-366.
• St. John’s wort. Natural Medicines website. Accessed at naturalmedicines.therapeuticresearch.com on May 10, 2020. [Database subscription].

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NCCIH has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your health care provider(s). We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by NCCIH.

Last Updated: October 2020

St. John’s Wort: Uses, dosage, and risks

St. John’s wort is an herbal supplement that people may use to help reduce symptoms of depression, menopause, and certain skin conditions. But more research is necessary to verify these benefits.

Derived from a flowering plant known as Hypericum perforatum, St. John’s wort is a herb people commonly use as a part of alternative medicine to treat depression, anxiety, and attention deficit hyperactivity (ADHD).

It also appears to have antibacterial properties and may act as an antiviral agent.

The plant contains hypericin, a chemical that may be responsible for most of the herb’s efficacy. Other ingredients such as hyperforin and flavonoids may play a role.

Though its exact mechanism is unclear, the herb may act similarly to certain types of antidepressants by increasing the availability of neurotransmitters like dopamine, serotonin, and norepinephrine in the brain.

This article discusses the benefits of St. John’s wort, the best ways to use it, as well as potential side effects and risks.

People most commonly use st. John’s wort to treat depression naturally.

In fact, a 2017 review found that St. John’s wort may be as effective as selective serotonin reuptake inhibitors (SSRIs), which are a class of antidepressants, at reducing symptoms of mild-to-moderate depression over a period of 4-12 weeks.

Additionally, a 2016 review of studies concluded that St. John’s wort was more effective than a placebo at treating mild or moderate depression.

Researchers cautioned, however, that there is a lack of research into the use of the herb to treat severe depression. In addition, the available research may not have properly accounted for possible adverse events.

In addition, research shows st. John’s wort may help with the symptoms of several other conditions, including:

• ADHD: One small study conducted in 2010 showed that St. John’s wort might be “slightly effective” in treating ADHD. However, a 2020 report published by the American Academy of Family Physicians indicates that physicians do not recommend using St. John’s wort to treat ADHD until more evidence supports its use.
• Atopic dermatitis: While one pilot study reported that applying St. John’s wort topically could improve symptoms of eczema compared to a placebo, researchers note that a person should treat these results with caution.
• Psoriasis: According to one small study on 20 people with plaque-type psoriasis, applying St. John’s wort topically improved inflammation and decreased psoriasis severity. However, more research is needed.
• Menopause: Some research suggests that St. John’s wort could help reduce symptoms associated with menopause, including hot flashes and depression.

Though people often use st. John’s wort to treat other issues like anxiety or seasonal affective disorder, the research on its effectiveness for these conditions is limited.

St. John’s wort may cause several side effects, including:

• anxiety
• dizziness
• dry mouth
• headache
• light sensitivity
• restlessness
• sedation
• sexual dysfunction
• skin reactions
• stomach upset
• tiredness or fatigue

It may take several weeks to experience any benefit. Like antidepressants, a person should stop using St. John’s wort gradually to prevent side effects.

Taking St. John’s wort may come with some risks. Certain groups of people may need to limit or avoid the consumption of this herb. They include:

People taking medications

People should not take St. John’s wort if they are taking any of the following medications, as its use may make these medications less effective:

• anticonvulsants
• cyclosporine
• digoxin
• oral contraceptives
• some anti-HIV drugs, including indinavir and nevirapine
• theophylline
• warfarin

St. John’s wort may also increase the effect of SSRI antidepressants. This can lead to a hazardous increase in serotonin in the body, which can cause symptoms such as:

• tremor
• diarrhea
• confusion
• muscle stiffness
• low body temperature

Also known as serotonin syndrome, this condition can even be fatal.

In addition, St. John’s wort can add to the effect of triptan drugs used for migraine, such as sumatriptan.

Research published in 2015 has also suggested that St. John’s wort has a similar profile to fluoxetine and can produce the same adverse reactions. Serious adverse effects could occur if the two drugs are taken together.

People with certain mood disorders

A person with a diagnosis of depression should not use St. John’s wort as an alternative to therapies recommended by a doctor. If the herb is not effective, the depression may worsen.

In some cases, St. John’s wort can triggerpsychosis. This is another reason people with major depression or bipolar disorder should be careful with the herb despite its potential benefits in this area. It may cause a person to develop a manic episode.

Pregnancy and nursing

It is not yet clear whether St. John’s wort is safe to use while pregnant, or while breastfeeding or chestfeeding.

One 2022 study seems to indicate it may be safe during pregnancy. However, the National Center for Complementary and Integrative Health (NCCIH) warns that it has been shown to cause birth defects in animal studies.

In addition, nursing people should know that St. John’s wort can get into breast milk and may cause babies to become fussy, drowsy, or experience colic.

People should always discuss with a doctor before taking St. John’s wort, other supplements, or alternative therapies.

Most people take St. John’s wort either in tablet or capsule form, but they can also consume it by brewing special teabags. For topical application, a person can get a tincture, which is a medicinal extract in a solution of alcohol.

For adults, the usual dose in capsule or dry tablet form is 300 milligrams (mg) three times a day, which a person should take with meals or as directed by a healthcare professional.

Do I need a prescription?

In the United States, the Food and Drug Administration (FDA) considers St. John’s wort a dietary supplement and does not approve it for use as a medication.

Therefore, St. John’s wort is available over-the-counter in the U.S. and in many other countries. In some countries such as Ireland, however, a person needs a prescription to get it.

Here are a few common questions about St. John’s wort.

How does St. John’s wort make you feel?

St. John’s wort may help ease symptoms of depression in some people by altering levels of certain neurotransmitters in the brain.

However, it can cause negative side effects in other cases, including anxiety, stomach upset, headache, dizziness, and fatigue.

Can St John’s wort cause weight gain?

There is no evidence to suggest that St. John’s wort causes weight gain directly.

Still, a person might experience weight loss or weight gain after taking St. John’s wort. This is because it could help improve symptoms of depression, a condition often associated with appetite and body weight changes.

What should you avoid when taking St. John’s wort?

St. John’s wort can interact with several medications, including antidepressants, oral contraceptives, warfarin, and certain types of medications for heart disease, cancer, and HIV.

If a person is taking any of these medications, it’s important to talk with a doctor before taking St. John’s wort to prevent adverse effects.

A person can easily purchase st. John’s wort is over-the-counter and can also find it as an ingredient in many teas, tablets, capsules, and topical ointments.

This herb is a common ingredient used in alternative medication to treat various conditions, though not enough research exists to back up all of its uses.

In addition, St. John’s wort can interact with some prescription drugs and cause several adverse side effects for people who have certain mood disorders. It may also negatively affect unborn or nursing babies.

A person should be careful and consult with a healthcare professional before using it.

detailed information about the plant in the Evalar Encyclopedia

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Composition

St. John’s wort herb and flowers contain carbohydrates, tannins, resins, anthracene derivatives (hypericin, pseudohypericin, protopseudohypericin and others), flavonoids (glycoside hyperoside, rutin, quercetin, quercitrin, isoquercitrin and others), essential oils, terpenes, sesquiterpenes, anthocyanins , triterpene saponins, anthraquinones, carotenoids, nicotinic and ascorbic acids, vitamins E and P, choline, ceryl alcohol, alkaloids, mineral and other biologically active compounds.

St. John’s wort

St. John’s wort has antidepressant, anti-inflammatory, soothing, astringent, hemostatic, regenerating, wound healing, diuretic and choleretic effects. And this is not the whole list. St. John’s wort also has an antimicrobial property that surpasses the action of many antibiotics.

St. John’s wort application

Since St. John’s wort has anti-inflammatory, antiseptic and astringent effects, the treatment of respiratory diseases with this remedy always gives a good result. The astringent and anti-inflammatory effect is due to the presence of tannins in the composition of the plant. Together with other active elements, they destroy some microbes that are resistant to synthetic antibiotics. The plant has an expectorant effect in diseases of the respiratory tract.

Scientists have found a natural alternative to medications for depression. St. John’s wort extract will help normalize the psychological state. Specialists tested and compared the properties of St. John’s wort and modern antidepressants. It turned out that the plant has pronounced calming and toning properties and can be used to treat moderate depression.

As part of St. John’s wort, hypericin, which increases the level of serotonin in the central nervous system, determines the high antidepressant properties of the plant. Therefore, St. John’s wort is used as an effective herbal antidepressant, especially in conditions associated with neurotic disorders and menopause.

Thanks to its antidepressant properties, St. John’s wort helps fight alcoholism. The sedative effect of the plant reduces the patient’s craving for alcohol. St. John’s wort also contains substances that compensate for the deficiency of elements in the body of an alcoholic, causing a desire to drink. St. John’s wort has antibacterial and antiviral qualities that are used in the fight against the herpes virus.

Included in the following preparations:

medicinal properties, contraindications, use, reviews of doctors

St. John’s wort can rightly be called one of the most popular and well-known plants in folk medicine and herbal medicine. Decoctions, infusions or added to tea are prepared from this herb. They help to eliminate unpleasant symptoms and normalize well-being.

St. John’s wort: what are the characteristics of the plant

This raw material is actively used in herbal medicine due to its unique means and special composition, which helps in the normalization of metabolic processes. The plant contains myrcene, a compound that has antimicrobial activity against many dangerous bacteria. Geraniol has a similar effect, it has a bactericidal effect on the coccal flora, inhibits the growth of pathogenic intestinal flora and parasites.

Cineol has a positive effect on the functioning of the nervous system, it helps to normalize sleep, fights insomnia, including during periods of stress and depression. It also has a general tonic effect, eliminates muscle spasms due to overexertion. Due to the content of hypericin, cell growth is stimulated, which is useful in wound healing and during the recovery period after illnesses, the same effect helps to prolong youth. Due to the content of plant alkaloids, St. John’s wort helps in the fight against neuroses and depressive disorders. The content of azulene enhances the positive effect of the herb on the nervous system, accelerates the healing of wounds.

The effects are complemented by the content of saponins, which have a metabolic and diuretic effect, hyperoside, with its anti-inflammatory properties, and rutin, which protects blood vessels.

The plant contains a lot of vitamins – ascorbic acid, B vitamins, which help in the normalization of metabolic processes. Due to its composition, it is widely used for both oral and external therapy. The plant is used both fresh and dried, it does not lose its healing properties when properly collected and stored.

Medicinal properties of St. John’s wort

In herbal medicine, St. John’s wort is used as a mono-component or as part of collections. It is typical of a number of therapeutic and prophylactic properties used in the complex treatment of a number of diseases.

St. John’s wort has a number of useful properties due to its multicomponent composition:

Antimicrobial. Reception of decoctions or infusions is recommended for microbial infections of various localization. The components of raw materials inhibit the reproduction of bacteria, destroy pathogenic microbes.

Sedative. Due to the high content of B vitamins and additional components, decoctions and infusions calm the nervous system, help in the fight against stress, depression and mental overload.

Wound healing. Due to the ability to enhance tissue regeneration, St. John’s wort helps in the treatment of burns and wounds, various skin lesions with erosions. It is mainly used in the form of ointments and lotions.

Pain reliever. Decoctions or infusions can help in the fight against pain that occurs with digestive problems, pathologies of the nervous system and joint damage.

Diuretic and choleretic. Due to the active components in the composition of the plant, decoctions or infusions help in removing excess fluid, normalize the outflow of bile from the liver.

Antiparasitic. Various herbal preparations with St. John’s wort help in the fight against intestinal parasites.

Antispasmodic. By relaxing smooth muscles and normalizing the functioning of the nervous system, phytopreparations with St. John’s wort help in the treatment of lesions of the digestive tract, accompanied by intestinal spasms.

Expectorant. Components of St. John’s wort help in thinning sputum and stimulating its removal from the bronchial lumen. The plant is actively used for respiratory pathologies, SARS and infections with a cough.

Plus, St. John’s wort has a positive effect on the heart and blood vessels, and also helps in the prevention of rheumatic diseases, stimulates the immune system, and improves overall tone.

St. John’s wort can help with stomach cramps. Photo: pexels/Sora Shimazaki

St. John’s wort 9 contraindications0007

Although St. John’s wort is very useful and widely used in herbal medicine, before starting treatment, you need to make sure that there are no contraindications to taking it. It is forbidden to use any means with St.

mental problems, especially those with manic tendencies, may be aggravated by taking St. John’s wort, so it is forbidden to take it;

St. John’s wort by mouth may reduce the effectiveness of some antibiotics and increase the photosensitizing effect of some drugs. Therefore, the joint intake of these funds with decoctions and infusions of St. John’s wort is unacceptable.

St. John’s wort is contraindicated against the background of antiretroviral therapy for HIV infection, it inhibits the activity of drugs.

While taking non-steroidal drugs and painkillers, the use of St. John’s wort may threaten to change the effect of drugs. It is dangerous to use St. John’s wort before surgical interventions with anesthesia, which threatens to damage the peripheral nerves.

It is forbidden to take this plant in pregnant and lactating women, it can harm the development of the child and threatens with allergies. Against the background of taking St. John’s wort in men, potency may temporarily decrease, which should also be remembered when treating with this drug. Long-term use of various types of drugs with St. John’s wort can threaten with an increase in the liver.

If you take St. John’s wort without the doctor’s consent and without his approval, side effects from therapy are possible in the form of:

• various allergic skin rashes, redness and itching;
• severe headache;
• anxiety and fatigue;
• anemia;
• abdominal pain, diarrhea or constipation;
• decreased appetite, bitter taste in the mouth.

If you take St. John’s wort without your doctor’s advice, you may experience allergic skin reactions, redness and itching. Photo: Pixabay

The use of St. John’s wort

In women , St. John’s wort is used as an additional remedy in the treatment of gynecological pathologies. It relieves PMS and pain during menstruation, normalizes hormone levels against menopause. Helps to strengthen the female body in times of stress. It is widely used in cosmetology, eliminating signs of aging, helping to smooth wrinkles and improve complexion.

For men helps relieve tension and stress, reduces the risk of vascular and heart disease, stimulates immunity and endurance.

In children, St. John’s wort should be used with extreme caution and only after a doctor’s permission. It can strengthen the immune system, eliminate skin diseases, relieve coughs and calm the nervous system.

Various forms of herbal medicine with St. John’s wort

This phyto-material is used to prepare various formulations for oral and external use. Each type of medicine, when taken correctly, helps in eliminating certain health problems. Before using any form of phytopreparations, it is necessary to determine the absence of allergies and individual intolerance.

Infusion

3 tbsp. spoons of dry raw materials pour 1 cup of very hot water, leave warm for at least 2 hours. Then strain.

Take 1/3 cup twice a day.

The infusion is used in the treatment of digestive disorders, sleep disorders and the fight against cystitis. In addition, it helps in eliminating pain in the body, increasing emotional tone, improving sleep and relieving stress. Course reception can significantly improve the general condition.

Tincture

Pour 1 part of dry and crushed raw material with 10 parts of alcohol (or 20 parts of vodka) and insist for 21 days in a cool dark place, shaking every 2-3 days. After the expiration of this period, strain the tincture through a sieve and store in a dark glass container.

Apply 10 – 20 drops per glass of water orally or externally, swab wounds, abrasions.

For gargling, dilute a teaspoon of tincture in a glass of warm water (not for children!).

Alcohol tincture helps eliminate inflammation in the oral cavity in case of gingivitis or stomatitis. It is also used as an antiseptic for the treatment of minor abrasions, cuts or wounds. A diluted tincture can be gargled with a cold. When taken orally, it has a general tonic and sedative effect.

Decoction

2 tbsp. tablespoons of dry chopped grass pour 250 ml of boiling water. Cook this mixture over low heat for 30 minutes, stirring constantly. Cool the finished broth to room temperature and strain through a sieve.

Take 1/4 cup by mouth three times daily as directed by your healthcare professional.

Externally – moisten a cotton pad with decoction and wipe the face in the morning and evening.

You can rinse the decoction on your hair and rub it into the hair roots.

The decoction can be used for microcirculation disorders, sleep problems and anxiety, to eliminate signs of aging, to treat various diseases on the recommendation of a doctor. Decoction can be wiped on the face and used as a healing mask.

H

ai

1 st. Add a spoonful of St. John’s wort, lemon balm, linden and rose hips to a teapot, pour 500 ml of boiling water, leave for 10 minutes, use instead of tea leaves. Add honey or lemon to taste.

Take 1 cup three times a day.

St. John’s wort tea is one of the popular herbal drinks. It helps in the fight against insomnia, depression and chronic fatigue syndrome, protects against the negative effects of stress. Tea is no less useful for strengthening immunity and fighting colds, eliminates inflammation of the nasopharynx and gums, and the oral cavity.

Doctors’ comments about St. John’s wort

Olga Zorina, pharmacist, teacher of pharmacology, chief editor of MedCorr:

– St. Often combined in the latter with oregano. It has a fairly strong anti-inflammatory effect, therefore it is also used as a gastric remedy. Infusions are also used in dentistry as an anti-inflammatory agent for rinsing the mouth.

Important! Contraindicated under 12 years of age, during pregnancy. It cannot be used in conjunction with common antidepressants (MAO uptake inhibitors) – it can distort or enhance the effect of the latter, has a photosensitizing effect, that is, while taking St. John’s wort, skin pigmentation may occur (you can not sunbathe).

Elena Korsun, Ph.D. head Department of Phytotherapy, ICM RUDN University, Head of the Educational and Health Center at the National Academy of Sciences of Ukraine:

– St. John’s wort has antimicrobial, anti-inflammatory, regenerating, detoxifying properties. St. John’s wort is prescribed in collections for all inflammatory diseases of the gastrointestinal tract, liver and pancreas, urogenital area, joints, and vascular atherosclerosis.

It has been noted to have a healing effect on the nervous system in chronic stress, neurosis, anxiety, asthenia, and pronounced choleric and melancholic temperament.