SPOTLIGHT ON ST. JOHN'S WORT: ONLY AVOID IF YOU HAVE TO! WITH REBECCA SNOW

Where does the name come from?

St. John’s Wort, Hypericum perforatum  

• St John’s – the flower blooms at midsummer or around the summer solstice which according to the Christian calendar is around the time of the feast of St. John the Baptist.

• Hypericum –the root of this word is hyper (above) eikon (image), the flowers were hung above images

• Perforatum – the leaf looks perforated.  If you hold the leaf up to the sun it has tiny little holes in it.

Why do nutritionists avoid using St. John’s Wort? 

So many of my interns avoid recommending St. John’s wort to clients with mood disorders. I might be partly to blame. At TNHC, we spend a lot of time teaching about herb–drug interactions and safety precautions.

It’s true—St. John’s wort interacts with a LOT of medications. And these interactions aren’t just hypothetical, as they are for so many other herbs. There are real-world case studies of people taking both birth control and St. John’s wort. The reason? St. John’s wort upregulates the Cytochrome P450 enzyme system.

Whoa, what?

If you want to learn more about Cytochrome P450 (CYP450) enzymes, check out this video.

This large, diverse group of enzymes is responsible for metabolizing a wide variety of compounds—drugs, toxins, and more. They’re found mostly in the liver, but also in other tissues throughout the body.

Specifically, St. John’s wort increases the activity of CYP3A4, an enzyme that metabolizes about half of all prescription drugs. More enzyme activity means faster drug clearance. That’s great for clearing toxins, but not so great if someone’s medication relies on that enzyme—because the medication’s effectiveness can drop.

That’s why it’s so important to know which drugs should not be taken alongside St. John’s wort.

Our go-to reference is Natmed Pro, but you can also check Integrative Therapeutics, NIH Office of Dietary Supplements, or Drugs.com.

Of course, not every client is on medication—and some medications don’t interact at all. Examples include metformin, levothyroxine, HCTZ, Claritin, and gabapentin, to name a few.

One last note: St. John’s wort’s effect on liver metabolism is fascinating when you consider traditional medicine. Historically, there’s been a strong link between liver health and mood disorders like depression.

Consider St John’s wort for depression

St. John’s wort is the most widely available herb in the U.S. with the strongest evidence for supporting depression.

In a 2016 meta-analysis of 27 studies, SJW extract showed the same clinical response and average reduction on the Hamilton Depression Rating Scale (HAMD) as SSRIs—yet with fewer side effects. These studies included a total of 3,126 adults.

A similar 2008 meta-analysis, reviewing 29 randomized controlled trials (5,489 patients) with major depression, found that SJW reduced depressive symptoms more than placebo. There was no significant difference between SJW and tricyclic or SSRI antidepressants—but again, SJW had fewer adverse effects.

In several European countries—especially Germany—St. John’s wort is prescribed by general practitioners for mild to moderate depression. In Germany, it is even available by prescription only.

One of its greatest advantages is that it doesn’t carry the common side effects associated with many SSRIs and SNRIs, such as weight gain, low libido, insomnia, diarrhea, and more.

For individuals with mild to moderate depression—especially those who have side effects from SSRIs or want to explore a natural option—St. John’s wort may be worth considering. Always collaborate with your client’s healthcare provider when discussing herbal options.

Side note: Diet and lifestyle play a huge role in mood health. Always address root causes while using herbs like St. John’s wort to support the body.

Mechanism

SJW may work on all three neurotransmitters serotonin, norepinephrine, and dopamine, known to impact depression. 

How do you take it?

For oral dosing, you want to take a standardized extract of St. John’s wort, 300 mg 3 x daily.  Some of the best studied European extracts include WS5570 sold in the US as Nature’s Way Perika.

Other uses

St John’s wort is used topically in the form of an oil.  The yellow flowers infused in oil turn the oil a beautiful red color.  This is used for nerve pain, bruises and muscular skeletal injuries.  

St John’s wort is one of the best herpes prevention remedies I have found in combination with L-lysine.  For folks who have frequent recurrent herpes simplex 1 or 2 outbreaks, you can take the same dose as prescribed for mild – severe depression.  

St. John’s wort is useful for PMS and anxiety and mood related changes around hormonal transitions such as perimenopause.  

RESOURCES

Cui YH, Zheng Y. A meta-analysis on the efficacy and safety of St John's wort extract in depression therapy in comparison with selective serotonin reuptake inhibitors in adults. Neuropsychiatr Dis Treat. 2016 Jul 11;12:1715-23. doi: 10.2147/NDT.S106752. PMID: 27468236; PMCID: PMC4946846.

Linde K, Berner MM, Kriston L. St John's wort for major depression. Cochrane Database Syst Rev. 2008 Oct 8;2008(4):CD000448. doi: 10.1002/14651858.CD000448.pub3. PMID: 18843608; PMCID: PMC7032678.

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