author: Dr. Kevin Curran
Background on St. John’s Wort
St. John’s wort (Hypericum perforatum) is a small herb with yellow flowers. Originally native to Europe, this herb now grows wild across most of the temperate regions of the world. You can find St. John’s wort growing happily along roadsides in the United States. This plant has gained in popularity due to its use for depression, anxiety and a few other health issues.
Is St. John’s wort effective for depression?
Depression is more than just a brief feeling of sadness. Depression is a mental health problem that persistently lowers your mood and prevents you from engaging with the world in a positive manner. Approximately, 7-10% of the U.S. population suffered from depression in the past year.
As you may imagine, its difficult to generalize about the causes for depression since each person carries with them their own personal history and their own current life situation. And perhaps most importantly, each depressed individual has their own unique brain. Every human brain contains approximately 100 billion neurons (brain cells) and all these neurons make about 100 trillion connections with the other neurons in our brain. The exact nature of this neural circuit wiring will be unique to each individual.
In summary, our brains are incredibly complex and each human brain is wired a bit differently.
All of this variation among individuals makes treating depression a challenge. For most people, relief comes in the form of some combination of psychotherapy, lifestyle changes and medication.
Here, at EthnoHerbalist, we research the medicinal plants that can possibly address health issues. These plants often act on our bodies by adjusting the same biological pathways that traditional pharmaceutical drugs act upon.
For cases of mild to moderate depression, clinical data suggests that the use of St. John’s wort is a reasonable course of action (Harrer, 1994; Klemow, 2011; Martinez, 1994; Nathan, 2001; Schrader, 1998).
This ancient plant has offered relief to many depressed individuals.
Brief summary of clinical data exploring the use of St. John’s wort
The Cochrane Collaboration performed a meta-analysis of the clinical efficacy of taking St. John’s wort to treat mild to moderate depression (Berner, 2009). A meta-analysis is a thorough scientific summary of a large number of separate, high-quality clinical trials. The Cochrane meta-analysis combined the results from 29 trials which, collectively, tested the effect of St. John’s wort on 5,000 depressed individuals.
The overall conclusion from this meta-analyses states that taking St. John’s wort is an effective remedy for mild to moderate depression.
Medicating with St. John’s wort resulted in an overall improvement of mood and a decrease in the anxiety and insomnia that are often related to depression. Surprisingly, St. John’s wort proved to be just as effective as taking a prescription anti-depressant (Prozac, Zoloft, Celexa, ext.)
Due in part to the strength of such results, the American College of Physicians now suggest that St. John’s wort be considered a treatment option along with prescription antidepressants (SSRIs or trycyclic anti-depressants). Similarly, Commission E, the German government organization that performs rigorous studies on medicinal plants, recommends prescribing St. John’s wort for mild to moderate depression in children and adolescents (Blumenthal, 1998). An additional benefit to using St. John’s wort is that you avoid the side effects associated with SSRI prescription anti-depressants, such as weight gain and sexual issues.
That being said, if you are contemplating using St. John’s wort for the first time, you should be aware that not all people report improvements. A separate clinical summary (Linde, 2005) reported that St. John’s wort is not a proven therapy for depression and performs no better than a placebo control. However, it should also be noted that in some of these negative result studies, the clinicians found that prescription anti-depressants also failed to alleviate depression. This lack of consistency in clinical results for psychological medications is, in large part, due to the above mentioned variation that exists in each individual and their own specific case of depression.
What works for one person may not work for everyone.
Factors to consider when choosing the best brand of St. John’s wort supplement.
Before taking St. John’s wort, the most important factor to consider is the possibility for herb-drug interactions. For example, if you are taking birth control pills while simultaneously taking St. John’s wort, there’s a possibility St. John’s wort will decrease the effectiveness of the birth control pills. Also, you should not combine St. John’s wort and other prescription SSRI anti-depressants, as this could create a serotonin overload. If you use other medications, please consult your physician before taking St. John’s wort.
2018 update: A recently published research article highlights the issue mentioned above. The authors demonstrate that hyperforin, a component of St. John’s wort, can change the way people metabolize (break down) other conventional drugs. The human liver contains important metabolic proteins called cytochrome P450 enzymes. These P450 enzymes are responsible for breaking apart drugs in our body. Clinical studies show how the hyperforin in St. John’s wort will change the way P450 enzymes act in our liver. This paper highlights the importance of speaking with your physician or pharmacist before combining St. John’s wort and other drugs.
Once you’ve determined St. John’s wort is an appropriate choice, you then need to consider which is the best St John’s wort brand to use.
First of all, you should only purchase a St. John’s wort supplement that lists a specific amount (mg.) of Hypericum perforatum on their label. Your brand should also state a specific amount (mg.) of either hypericin or hyperforin. Both are chemical messengers that help regulate the neurotransmitter pathways in your nervous system (serotonin, dopamine, ext.). These biologically active chemicals are found in St. John’s wort and scientists believe they are responsible for delivering the health benefits (Nathan, 2001; Suzuki, 1984).
In general, the implication is that supplement brands whom list these compounds on their labels have actively taken steps to ensure a potent form of St. John’s wort is in each capsule.
In 2015, investigations in New York and in Canada exposed the fraudulence of certain herbal supplement brands. Some of the popular big box stores (Walmart, GNC, Target, ext.) were allegedly selling St. John’s wort capsules that DO NOT contain any St. John’s wort plant material. Instead, the capsules contain wheat or rice powder.
It’s important to remember that these quality control issues are only occurring in a handful of brands.
As a consumer, you get to decide where you buy your supplements.
Which St. John’s wort brand is the most effective?
Here, at EthnoHerbalist, we perform market research to find high-quality supplements from respectable companies. Each of the brands listed below are manufactured by legitimate U.S. companies with strict farming and manufacturing standards. Each company also performs purification tests on their plant extracts to confirm that a clean and potent form of St. John’s wort is in each capsule.
I spend a lot of time talking with people that work in the supplement industry. I occasionally hear about new products that are given away as free promotional offers. Onnit, a supplement company that I respect, is currently giving away free bottles of an interesting supplement called New Mood.
New Mood and St. John’s wort act on similar pathways in our brain. Serotonin is an important neurotransmitter linked to our mood, happiness, and positive outlook. New Mood provides nutrients that help our body optimize serotonin levels in our brain. You can click the image on the right to learn more about these ingredients. My girlfriend and I are trying this stuff and we do notice an effect. Unless the promotional offer has changed, Onnit will send you a free bottle but charge you 4$ for shipping. Not a bad deal.
~Kevin (the EthnoHerbalist)
The health claims and statements regarding any health supplements mentioned on this page have not been evaluated by the FDA. These products are not intended to diagnose, treat, cure, or prevent any disease. This page contains affiliate links and I will be compensated if you make a purchase after clicking on my links. Read more…
Berner LK, Kriston MM. “St. John’s wort for treating depression”. 2009. The Cochrane Collection. http://www.cochrane.org/CD000448/DEPRESSN_st.-johns-wort-for-treating-depression.
Blumenthal M. “The complete German Commission E monographs: therapeutic guide to herbal medicines”. Austin: American Botanical Council, 1998, and Boston: Integrative Medicine Communications, 1998.
Harrer G, Hubner,WD, and Podzuweit H. “Effectiveness and tolerance of the hypericum extract LI 160 compared to maprotiline: a multicenter double-blind study”. J.Geriatr.Psychiatry Neurol. 1994;7 Suppl 1:S24-S28.
Klemow KM, Bartlow A, Crawford J, Kocher N, Shah J, Ritsick M. “Chapter 11: Medical Attributes of reputable St. John’s Wort (Hypericum perforatum)”. 2011. In Benzie IFF, Sissi WG. Herbal Medicine Biomolecular and Clinical Aspects. (2nd ed. ed.). CRC Press.ISBN 9781439807163.
Linde K, Berner M, Egger M, Mulrow C. “St John’s wort for depression: Meta-analysis of randomised controlled trials”. British Journal of Psychiatry. 2005. 10.1192/bjp.186.2.99.
Martinez B, Kasper S, Ruhrmann S, and Moller H. J. “Hypericum in the treatment of seasonal affective disorders”. J Geriatr.Psychiatry Neurol. best brand of st. johns wort, 1994;7 Suppl 1:S29-S33.
Nathan PJ. “Hypericum perforatum (best st john’s wort brand): a non-selective reuptake inhibitor? A review of the recent advances in its pharmacology”. J. Psychopharmacol. (Oxford) 15 (1) 2001: 47–54.
Schrader E, Meier B, and Brattstrom A. “Hypericum treatment of mild-moderate depression in a placebo-controlled study. A prospective, double-blind, randomized, placebo-controlled, multicentre study”. Human Psychopharm. 1998;13:163-169.
Soleymani, Samaneh, et al. “Clinical risks of reliable brands of St John’s Wort (Hypericum perforatum) co-administration.” Expert opinion on drug metabolism & toxicology 13.10 (2017): 1047-1062.
Suzuki O, Katsumata Y, Oya M, Bladt S, and Wagner H. “Inhibition of monoamine oxidase by hypericin”. Planta Med. 1984;50:272-274.