St. John’s Wort

St. John’s Wort

Treatment Options - St. John’s Wort

St. John’s Wort is a flowering shrub that is native to Europe. The flowers and leaves contain active ingredients, such as hyperforin, available in many supplement forms. 

St. John’s Wort is a herbal remedy for depression that is available without a prescription in the United States. However, it has not been approved by the Food and Drug Administration (FDA) to treat depression. 

St. John’s Wort is recommended by Traditional Chinese Medicine (TCM) practitioners and is widely licensed and prescribed as a depression treatment in many European countries. 

There have been a number of studies on the effectiveness of St. John’s wort for depression. However, some of those studies have mixed results or are not conclusive, which is why it isn’t an approved depression treatment by the FDA. St. John’s wort also can cause severe side effects and interact with prescription medications.

Does St. John’s Wort improve depression?

St. John’s Wort is one of the most well-known natural supplements used to treat depression. Some studies have found that it may be as effective as certain antidepressant medications in treating mild to moderate depression.

It is unknown if St. John’s Wort works to treat severe depression or treatment-resistant depression. Depending on the cause of your depression, St. John’s wort may also be harmful. Therefore, it is not a substitute for medical diagnosis and treatment. Also, studies on St. John’s Wort ended after 12 weeks of treatment, so the long-term side effects are currently unknown.

St. John’s Wort can be an effective option for mild to moderate depression. It can have serious side effects when taken with other medications, and it is dangerous to combine with antidepressant medications. Always consult a doctor before taking St. John’s Wort. 

St. John’s Wort is designed to be taken by mouth as a capsule or tablet. Since taking St. John’s Wort as a supplement has only been studied for up to 12 weeks, the efficacy and side effects after 12 weeks are unknown. 

Supplements are not regulated by the FDA like medications, so you should only purchase supplements from brands that have been evaluated for quality. Supplements are not FDA-approved to treat depression. 

Side Effects of St. John’s Wort

St. John’s wort is associated with several side effects. 

Common side effects include:

  • Agitation and anxiety
  • Dizziness
  • Dry mouth
  • Diarrhea, constipation, and stomach discomfort

Less common side effects also include: 

  • Fatigue
  • Insomnia
  • Headaches
  • Causing mania in people with bipolar disorder
  • Serotonin syndrome

St. John’s Wort is not recommended for breastfeeding or pregnant women. It is also not recommended for children. 

Negative Interactions with Other Drugs

Be very cautious about taking St. John’s Wort as it has negative interactions with numerous drugs. 

For individuals with depression, St. John’s Wort should not be used with certain antidepressant medications because it can cause serotonin syndrome, which is potentially life-threatening. Consulting your psychiatrist or primary care physician before taking St. John’s Wort in combination with other medications is vital. 

If you are already taking St. John’s Wort, be sure to inform all of your healthcare providers before starting any new medications to ensure that they don’t conflict with one another. 

Here is a list of some of the medications known to interact negatively with St. John’s wort: 

  • Alprazolam (Xanax)
  • Antidepressants
  • Barbiturates
  • Bupropion (Wellbutrin SR, Forfivo XL)
  • Certain chemotherapy drugs
  • Certain immunosuppressive drugs such as tacrolimus (Prograf, Astagraf XL, others) or cyclosporine (Neoral, Sandimmune, others) 
  • Certain statins. 
  • Contraceptive drugs. 
  • Cytochrome P450 1A2 (CYP1A2), Cytochrome P450 2B6 (CYP2B6), Cytochrome P450 2C19 (CYP2C19) and cytochrome P450 2C9 (CYP2C9) and cytochrome P450 3A4 (CYP3A4) substrates. Don't take St. John's wort if you're taking a drug affected by these enzymes.
  • Dextromethorphan (cough suppressant)
  • Digoxin (Lanoxin)
  • Fexofenadine (Allegra Allergy)
  • Ketamine (Ketalar)
  • Narcotics
  • Non-nucleoside reverse transcriptase inhibitors
  • Omeprazole (Prilosec)
  • Phenytoin (Dilantin, Phenytek)
  • Photosensitizing drugs
  • Protease inhibitors
  • Triptans
  • Voriconazole
  • Warfarin (Jantoven)

Due to the numerous severe interactions with other drugs, St. John’s wort is not a recommended treatment for depression if you are taking other medication. Taking St. John’s Wort should only be considered after speaking with your doctor.

St. John’s Wort for Depression

Finding the proper treatment for treatment-resistant depression can be challenging. St. John’s wort, a supplement, may be helpful for some individuals with mild to moderate depression but not for patients with severe or treatment-resistant depression. 

At Options MD, our psychiatrists can discuss the potential risks and benefits of using supplements when putting together a custom plan for your treatment-resistant depression. 

Do you have questions?

Options MD is here to help. Text us to start treatment now. Join our Facebook community to connect with other individuals with treatment-resistant depression.

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