St John’s Wort - Depression

St John’s Wort - Depression

From Mark Larkin

Mood disorders affect your personality, how you think and feel, and how you perform daily activities.1 Daily activities include sleeping and eating. A common mood disorder is depression. Medications used for depressio...

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There is no straightforward medication therapy for many mood disorders. One supplement suggested for add-on therapy is St John’s wort. For example, St John’s wort helps reduce symptoms of depression and troubles sleeping. In this article, we will discuss St John’s wort and its role in therapy for depression.

Types of depression

Depression has different stages and intensities. Listed below are a few classifications of depression.

  • Persistent depressive disorder: depressed mood for two years
  • Postpartum depression: major depression experienced during pregnancy or after delivery
  • Psychotic depression: severe depression with a form of psychosis. Psychosis includes delusions or hallucinations.
  • Seasonal affective disorder: depression during the winter months. This is usually due to less natural sunlight.
  • Bipolar disorder: not true depression, but people experience episodes of extreme highs (mania) and extreme lows (depression and sadness).

Signs and symptoms

Diagnosis of depression is when symptoms last for at least two weeks. However, not everyone experiences all symptoms. Furthermore, your primary care provider diagnoses depression. They diagnosis it by conducting a test called DSM-5.

Common symptoms include:

  • Feeling sad, anxious, or “empty”
  • Constant feelings of hopelessness, pessimism, guilt, or worthlessness
  • Irritable
  • Loss of interest in hobbies and activities
  • Decreased energy
  • Fatigue
  • Moving or talking slowly
  • Feeling restless
  • Difficulty concentrating, remembering, or making decisions
  • Troubles with sleeping, awakening, or oversleeping
  • Appetite and weight changes
  • Thoughts of death or suicide
  • Persistent aches, pain, headaches, cramps, or digestive issues with no clear cause

What is St John’s wort?

St John’s wort, or Hypericum perforatum, is a native plant of multiple countries. For example, its properties make it a good candidate for treating mild depression and difficulties sleeping. Patients looking for alternative therapies sometimes turn to St John’s wort to reduce their symptoms.

How does St John’s wort work?

St John’s wort has many beneficial properties that improve symptoms of depression and mental health. It is not completely determined how St John’s wort works. However, it is believed that hyperforin and hypericin prevent reuptake of serotonin, dopamine, norepinephrine, and GABA. Hyperforin and hypericin are chemical compounds in St John’s wort. Serotonin, dopamine, norepinephrine, and GABA are specific neurotransmitters in the body. They are important for transmitting mood signals in the brain. Listed below are characteristics of St John’s wort.

Sleep troubles

Melatonin is important for sleep cycles. It is a chemical that goes hand-in-hand with the body’s natural circadian rhythm. For example, it is produced during the night when blue light is not present. St John’s wort regulates sleep cycle by increasing the production of melatonin. The body’s natural circadian rhythm is maintained by increased melatonin.


St John’s wort regulates cortisol production and release. The body naturally makes the cortisol hormone. Cortisol responds to stressful conditions. For example, hormone levels rise in order to maintain a stable environment in the body when it is stressed.

In addition, hyperforin and hypericin in St John’s wort prevent the reuptake of neurotransmitters. As a result, there are increased levels of neurotransmitters. Increased levels of serotonin, dopamine, norepinephrine, and GABA are important for improving happiness and mood. In fact, the effects of hyperforin are similar to prescribed SSRI antidepressants.

Phototoxic properties

Skin reactions such as sunburn, rashes, and pain or discomfort can occur when skin is exposed to UV light. St John’s worth possesses similar photodynamic properties as medicines like psoralen. Psoralen comes from plants. It is an ingredient in medications that treat skin conditions. For example, skin conditions include eczema and psoriasis.

Antiviral and antibacterial properties

Antiviral and antibacterial properties in St John’s wort is uncertain in humans. However, mice studies show benefit. For instance, hypericin used in mice showed blockage of viruses and bacteria. More research in humans needs to be conducted to prove effectiveness of the drug.

Other properties

Other researched properties include reduced inflammation, increased disease-fighting white blood cells, and increased immune support. However, many of these properties still need to be tested in human studies.

Is it safe to use?

Some studies have shown little-to-no benefit of using St John’s wort. However, others have found that it is comparable to prescription antidepressants. It takes several weeks of therapy to show benefit and effectiveness like prescribed antidepressants. Furthermore, the U.S. Food and Drug Administration has not approved St John’s wort for depression. This is due to safety concerns because it is a potent inducer. This means that it drastically affects other drug and medication levels in the body.

Drug Interactions

St John’s wort has many drug interactions. This natural product may reduce the plasma concentrations of some drugs. As previously mentioned, it is a potent drug inducer.

Also, do not use it with other antidepressants. When used together, it may result in serotonin syndrome. This changes mental status and is also life-threatening.

How much should I take?

St John’s wort is a natural supplement that is administered orally. It comes as a tablet, capsule, or brewed tea. However, the amount of St John’s wort in each product varies.

For mild depression, adults should take 300mg three times a day. Also, the drug can be titrated up after it is tolerated and used for at least four weeks.


Depression is a mood disorder that affects your daily activities and life. The symptoms of depression vary between individuals, but most feel extreme sadness that lasts for at least two weeks. Unfortunately, there is no straightforward or explicit treatment for depression. In an attempt to combat symptoms, individuals take natural supplements. For example, a common antidepressant supplement is St John’s wort. St John’s wort has other properties that are being researched in human studies. Although St John’s wort acts as an antidepressant, there are many safety issues. For instance, it is a potent inducer that affects other drug levels. For more information about this topic, please visit Nature’s Reveal.


1. National Institute of Mental Health. “Depression.” NIH – National Institute of Mental Health, February 2018,

2. Drug Monograph - Gold Standard. “St. John’s Wort, Hypericum perforatum.” ClinicalKey, March 2014.

3. Shen, Shiqian and Lucy Chen. “Anesthetic Implications of Complementary and Alternative Therapies.” Miller’s Anesthesia, by Michael Gropper, Elsevier 9 edition (2020): 1065-1078.

4. Naiman, Rubin. “Insomnia.” Integrative Medicine, by David Rakel, Elsevier 4 edition (2018): 74-85.

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