My Favorite Herb: St. John’s Wort

It’s really annoying the way the pharmaceutical industry snookered US physicians over the herbal antidepressant St. John’s wort. If only the profession had been just a little skeptical of an article that appeared in the Journal of the American Medical Association (JAMA) a while back we might not be as up to our bellybuttons in antidepressants as we are now.

The JAMA piece was subsequently criticized by an article in the British Medical Journal (BMJ) for deliberately ignoring more than 100 previous studies showing SJW’s effectiveness and also challenging the project as tainted because researchers were on Pfizer’s payroll.

Here are the statistics that make the mess:

  • 11% of Americans over 12 take one or more antidepressants every day. And more than half this group does so with no medical supervision (refills are automatic but visits with a mental health professional are not).
  • Women take 2.5 times more antidepressants than men.
  • Between ages 40 and 59, one woman in four (25%) takes an antidepressant.
  • The warhorse antidepressants–Prozac, Paxil, Zoloft, Effexor, Celexa, Lexapro, Luvox, Wellbutrin, Cymbalta–are all generic and so inexpensive (Prozac costs about $30 a year) that primary care physicians with their ten-minute office visits have little incentive not to write an antidepressant prescription when a patient says, “I’m feeling sad these days.”
  • And because these drugs are cheap and easily refillable, patients themselves have little incentive to get off them, except for the side effects. We’re awash in antidepressants (as is our drinking water, by the way).

Brain chemistry
All antidepressants, including SJW, work on brain chemistry by increasing the brain’s levels of feel-good serotonin, your factory-installed stress buffer. Your personal level of serotonin is genetically determined, although other factors including diet, sunlight exposure, and sex hormones also play a role in serotonin levels.

If you’re a woman, your serotonin level is significantly lower than that of most men you know. And since serotonin is linked to sex hormones, you may have noticed that you’re more vulnerable to stress just before your period, when estrogen plummets (as it does in menopause), or that you felt especially happy during pregnancy, when estrogen levels go through the roof.

When stress exceeds your serotonin buffer, you might feel depressed or anxious, start thinking obsessively, and/or experience a variety of physical symptoms like muscle aches or tiredness.

Virtually all antidepressants have side effects and, ironically, some of these (headache, depression, and fatigue) are quite similar to what they’re supposed to be treating. Other side effects are more subtle: weight gain, sexual dysfunction, jaw clenching, personality changes like feeling “numb.” Sadly, most prescribing doctors admit they don’t have the time to discuss side effects, and only a handful of patients or concerned family members actually bother to read the package inserts that come with the prescription.

Gentle St John’s wort unjustly maligned
Compared to big-gun antidepressants like Luvox or Effexor, SJW is very gentle. European physicians prescribe it to children.

When SJW first became available in the US, though, researchers on the payroll of Big Pharma classified it as an MAO inhibitor, a type of antidepressant rarely used because of its side effects and interactions with other drugs. In fact, because of this, physicians are extremely skittish about writing prescriptions for MAO inhibitors, and what better way to nip competition in the bud than by deliberately mis-classifying SJW.

When European researchers reported that SJW was in fact not an MAO-inhibitor, but simply a mild SSRI equivalent to a half-dose of Prozac or Zoloft, Big Pharma got worried about its revenues. The SSRIs were still under patent and extremely expensive, generic versions years in the future. They’d already seen how cholesterol-lowering red yeast rice had cut into statin sales and didn’t want that to happen again. Billions were at stake.

What mega-pharma Pfizer (maker of Zoloft) did was singularly devious.  First, they purchased a small herbal company, one of whose products just happened to be SJW. Then, in the interest of “public safety” they funded a large study at several major medical centers, recruiting psychiatrists (an itchy-palmed specialty never averse to accepting pharmaceutical largesse) to recruit patients. The study would be double-blind and placebo-controlled, neither physician nor patient knowing if SJW or a dummy pill was being taken.

The only flaw (intentional or not) was a big one. The recruited patients all had serious major depression issues, exactly the sort of depression for which SJW is not effective. And, surprise, surprise, despite dozens of previous European studies showing effectiveness, this time SJW failed. No better than placebo, concluded the JAMA article, popular magazines echoing the refrain. And thus Big Pharma created a state of permanent disinformation among US physicians. As a result, you’re prescribed Zoloft and get a contemptuous snort or impatient look if you ask about SJW.

Two years and 40 pounds later, you wonder why no one told you about the weight issue.

A few months after the JAMA article, the BMJ, which had already published several articles recommending SJW, wrote an editorial commenting on the flaws in the JAMA study, urging physicians to continue recommending SJW to their patients for mild-to-moderate depression. Of course, very few American docs read the BMJ, so the misinformation stayed rooted in place.

Why is St. John’s wort my favorite herb?
Not only has it been proven effective for mild depression, but like all other SSRI antidepressants SJW will work its magic when a serotonin boost is called for. Doctors routinely prescribe SSRIs for such varied diagnoses as generalized anxiety disorder, panic attacks, obsessive thinking, compulsive behavior, various phobias, and for patients self-medicating emotional problems with alcohol or food. SSRIs are also part of the treatment for fibromyalgia, migraine headaches, seasonal affective disorder, premenstrual syndrome, postpartum depression, and even irritable bowel syndrome.

For any of these, there’s no harm in trying SJW first.

In my own practice, if a patient needs a dose increase on an SSRI she’s already taking, I’ll add SJW instead to avoid the side effects that might otherwise accompany the higher antidepressant dose. Do not, however, attempt this without physician guidance. Taking SJW and a prescription antidepressant, you could end up with too much serotonin in your brain. Let your doctor figure out the chemistry.

I also recommend SJW when a patient wants to discontinue her prescription antidepressant. Unlike prescription SSRIs, SJW is remarkable for its lack of side effects. No “numbing” of your personality, no weight gain, no sexual dysfunction, no heart arrhythmias.

Dosing St. John’s wort

  • The minimum effective dose of SJW is 900 mg per day.
  • Take 450 mg twice daily, with food.
  • For patients with more severe symptoms, before resorting to a prescription antidepressant I’ll increase to 900 mg twice daily for a month.
  • Like many herbs and prescription medications, drug interactions, although very rare, can occur with SJW. Check with your prescribing doctor or pharmacist if you have concerns about this

Just like all antidepressants, you need to be patient while you wait for SJW to work. The mood-enhancing effect won’t be felt for about three weeks, but then, to your pleasant surprise you’ll likely think “I’m feeling better.”

The SJW product I work with is HyperiMed by Integrative Therapeutics.

Be well,
David Edelberg, MD


Posted in Blog, Knowledge Base, M, Mental Health, Nutrition, Nutritional Supplements, Vitamins, & Herbal Remedies, S Tagged with: , , , , ,
37 comments on “My Favorite Herb: St. John’s Wort
  1. Maria says:

    Does this natural supplement interact with prescription medication?

  2. Dr E says:

    All herbs and prescription meds are capable of interactions but most of these are harmless. You’d need to ask your doctor although much of the information about these interactions is available online

  3. Mary says:

    Interesting article. Thanks, DR. Edelberg!

  4. Jennifer says:

    Is it okay to stay on SJW indefinitely, or could it compromise liver function, etc.?

  5. Dr E says:

    I have patients who have been using it continuously for as long as 15 years without any problems. I am sure your primary care doctor is checking routine blood tests during your check-ups and these would include liver tests

  6. Carina Gibson says:

    Thank you for the post. I myself was diagnosed with severe Depression round 17 (the teen years where we are going through many hormonal and emotional changes) and took Zoloft for a year. I had a rather severe case, so I assume Zoloft might have helped a bit, but I can never be quite sure. I begged to be taken off as I started to feel “numb” as you mentioned, and it almost felt as if it was doing more harm then good I managed to easily stop taking it in a year(thank goodness!). A couple years later I was having troubles again, and started doing consistent courses of STW and Fish oil. They helped subtly, but tremendously. The only side not was that SJW gave me rather intense skin pain when I was in the sun. While I was taking it, every time I had been in the sun, when I walked into the shade it felt as if my skin was icy cold and prickly, so I had to stop taking it…

  7. Roma says:

    What about the ‘hyperforin’ angle? I am currently trying SJW after a bad/good experience with an SSRI. While the SSRI undoubtedly made me feel better and eased my anxiety (the latter being the main reason I was taking it), I had debilitating fatigue, felt unmotivated and… gained 15 pounds within six months. So I’ve recently switched to SJW. I chose a German brand standardized to contain hyperforin, which is supposed to be more effective, and/or more certain to be effective. Or is it? I need to order this brand online and it’s very expensive compared to others. It would be nice if I could just pick up some SJW at my local health store instead. So I would like to know your opinion on this. Thx.

  8. Dr. R says:

    To Roma. Probably best to try a pharmaceutical grade brand of SJW (such as Integrative Therapeutics) and see how you do.

  9. Susan says:

    I don’t take any other meds except the St. John’s wort herb in dried leave and flower form. I make myself a tea everyday, and since I have done this, I have noticed increase in weight. I don’t understand this. I have been a lifetime member on a weightloss program since 2003 and know all about how to maintain a healhty weight, but this is throwing me for a loop. Are there any chances whatsoever that the tea is causing this gain?

  10. Susan says:

    And I should add that I stopped the tea for the last two days, and I am down 1.5lbs. Now I’m really scratching my head. How can an herb have this kind of effect?

  11. Dr E says:

    Hi Susan
    Although I have never seen weight gain with St John’s wort, it is theoretically possible because it is an SSRI and this whole family of meds is associated with weight gain. This very rapid loss of weight suggests more that the herb causes some fluid retention and by stopping it you are flushing the excess fluid out through your kidneys

  12. Dana says:

    I have been taking SJW for 20+ years. I started for seasonal affective symptoms one winter and was amazed it made all the difference for me. Then 10 years later I began to take fish oil. Lastly I added walking for exercise and have made a few lifestyle changes so I do not have to deal with depression. I taper it down it the spring. I have discontinued it in the summer. Yet when fall start creeping around the corner that is the most telltale indicator for me, I need my SJW!

    My concern is I have also put on 50 lbs. My doctor says Prozac would be a better choice, it can decrease my appetite and I will feel amazing. I have never been on a prescription antidepressant. 3 years ago I lost 10 lbs. walking 4000 steps a day, monitoring my food intake, making better choices and I cut my cal down to 2500. When I moved I stopped walking but I continue to eat the same new meal plan. I do believe the SJW has caused the weight gain for me. I was 120lbs before I tried SJW. I have had many very physical jobs so I burned up plenty of cal. I don’t know much about Prozac and its side effects.

  13. Dr E says:

    Hi Dana
    Officially SJW is not supposed to cause weight gain but every person is biochemically unique. You might discuss with your doctor either of two meds: Wellbutrin and Brintellix. Both are used for depression and FDA studies have shown no weight gain. Prozac is associated with weight gain. Just type Prozac weight gain in your Google bar and read what pops up

  14. Celine Ralph says:

    Will St.Johns Worst help with Fibromylgia pain

  15. Dr. R says:

    To Celine. It may help but taking it with certain medications is often contraindicated. It is best to use all herbs under a physicians direction.

  16. Joseph says:

    I have transitioned from taking Prozac to St. Johns Wort. Is it likely to gain weight while on this medication? I am a 25 year old male nurse weighing a solid 175 at 5’8.

    Thank you!

  17. cliffmaurer says:

    Hi Joseph – I’ve encountered patients who say they’ve gained a bit of weight on St John’s Wort, though their weight gain, as we later discovered, may have been due to several different and unrelated factors (change in diet, activity level, other medications, etc.). If you’ve experienced unexplained weight gain, it would be a good idea to make an appointment with your primary care physician.
    Dr M

  18. Girlie says:

    Hi. After being on Prozac for 11 years for depression and anxiety I weaned off over a two month period. Two weeks after stopping the Prozac I started to experience some uncomfortable withdrawal symptoms. I preserved with this for 10 weeks before I had to go back on the Prozac. I would really like to try St Johns Wort but am extremely scared that I would end up back in that dark place again if I stop the Prozac. I am taking 20mg daily and was wanting to know if I could take St Johns Wort with this dosage as I wean off. You advice would be really appreciated as my GP seems to think that there is nothing wrong with me taking Prozac for the rest of my life.

  19. Dr E says:

    Hi Girlie
    Your GP has a point. Some people do just fine on a lifetime of Prozac and by staying on it, avoid the dark place you are referring to. If you’ve had no problems with the Prozac except relief of symptoms, I’d just stay on it

  20. Quartzknee says:

    You can make your own tincture of St johns wort. It is a weed and easy to find. It blooms in the summer. The tincture worked very well for mild depression (1/2 tbsp in the morning). It also took away my alcohol cravings.
    I had to switch to capsules, and while they were high quality capsules, they were far inferior to the tincture.

    Tincture is made from harvesting vital flowers and buds from hypericum perforatum (other species of SJW are not effective). Cover completely with vodka and soak for 6 weeks and strain. Details abound on the Web. Two 40s of vodka will supply a years supply at my dose.

    My doctor was very supportive of SJW. I am now switching to cipralex because I can’t use my tincture for work and the capsules were not good enough.

  21. Bonnie says:

    I’ve been taking St. John’s Wort for a month now, 900mg/day and I’ve been noticing a decrease in my appetite. I can’t say yet that it’s doing anything for my moderate depression, but I’ve definitely noticed a difference in the amount of food I’m eating.

  22. Janer says:

    I feel so much better. I wish I’d tried it years ago but honestly..thought it was herbal mumbo-jumbo.

  23. Tina says:

    St. John’s Wort with Valerian Root changed my life. I have panic attacks and I’ve taken medicine on and off for years but it makes me a zombie. The first time I took these supplements after refusing to take any more Xanax and Zoloft, literally within 2 hours, that giant fist of anxiety that constantly gripped my chest, was gone. I felt like I could breathe again. I’ll never go back to pharmaceuticals again.

  24. Julie says:

    Tina, how awesome! My Zoloft Started making me depressed. My doc switched me to Lexapro and I have had too many side effects. I want to go the St. John’s Wort Valerian route. How much do you take?

  25. Dr E says:

    Do run any changes by your doctor.
    The correct switch would be St John’s wort 450 mg twice a day.Valerian is 500 mg during day (for calming) 1,500 mg at bedtime for sleep. If the valerian isn’t working, try L Theanine 200 mg capsules (same schedule). Allow a full month for the SJW to take full effect

  26. Julie says:

    Thank you!!!
    My doc said to just stop Lexapro because I was taking such a tiny bit. I read that sjw can help with the withdrawal and may be all I need. I am not having any luck finding a drug that I can take. Zoloft was perfect for many years and then stopped helping and made it worse. Thank you so much for the Valerian SJW info.

  27. Michigan Girl says:

    I use St John’s Wort faithfully for my mild depression, I know that it works, because I went a month without it, and noticed the change. It’s the slightest of lifts, but makes a world of difference to me.

  28. TeresaFall says:

    I take a very low dose of generic Lexapro (5mg) for anxiety and depression. What would the equivalent dosage be for SJW and Valerian ? I want to discuss it with my doctor. I am going to have to begin paying more for my prescription. Thank you for this advice page.

  29. cliffmaurer says:

    Hi Teresa – This can be different for everyone. The person who prescribed Lexapro for you should help you with this transition so that you can both be certain that you’re transitioning safely.
    -Dr M

  30. Susan Sensenbaugh says:

    I have a fiB and I am on the rail zero alto. I have a pacemaker. My cardiologist made may discontinue St. John’s wort one year ago. Since then I have been seriously depressed And gained 40 pounds. Is there someway I could continue taking St. John’s wort and still have a blood center for the a fib?

  31. Dr E says:

    Although St John’s wort can interact with certain meds, Xarelto is not one of them. You can print this link
    and show it to your cardiologist. Maybe it will help change his mind

  32. Alison Gross says:

    Is it safe to take SJW with hormonal contraceptives? Shortly after I took it the first time, I had an excruciating period that went on for weeks so I stopped after seeing a warning on the contraceptive not to take SJW. Almost two years later, I’m desperate to try to something for my depression. In the mean time, I’ve switched from pills to the nuvaring but it still warns against using SJW. Do you have any experience with this kind of situation?

  33. cliffmaurer says:

    Hi Alison – It’s true, patients are advised to avoid taking SJW and oral contraceptives at the same time. There are other natural remedies for depression such as acupuncture, yoga therapy and clinical psychological counseling which would not interfere with oral contraception. There are also other natural antidepressants you can take orally, but these should be recommended by a health care provider based on your unique health picture. If you’re in the Chicago area, any of our physicians or nurse practitioners can help with this.

    Dr M

  34. Alison Gross says:

    I already do acupuncture, yoga, take samE, 5HTTP, omega 3, vitamin D, and other herbal remedies, am extremely active, my diet is high in whole grains, fruits, and vegitables, low in processed sugars, and contains almost no caffeen or alcohol, I have a pretty regular sleep cycle and am still really depressed. I have been to whole health Chicago. They are the ones who put me on the samE 5http etc. which probably help some but not enough. I’ve tried counceling and it doesn’t work, and conventional antidepressents mess me up. I don’t have any hope left unless there’s something else out there I haven’t tried. I think it’s hormonal as the depression gets WAY worse right before my period. Unfortunately, the out of control hormones are also why I need the contraceptives. 🙁

  35. cliffmaurer says:

    Hi Alison – The hormonal connection is important. Have you tried doing some work with an acupuncturist who is also skilled in traditional chinese herbal medicine? Mari Stecker and Cindy Kudelka both treat hormonal imbalances in patients which often result in symptoms like depression as well as headaches, painful or heavy periods, digestive problems…the list goes on. If you’ve not yet met with either Mari or Cindy, this might be a good next step. And a second opinion from another doctor or nurse practitioner within WHC couldn’t hurt.
    Dr M

  36. Denise says:

    My doctor recom. I research 3 diff. meds. to lose weight. All 3 treat depression, but the wonderful side effect was weight loss. Theory is serotonin levels effect weight loss. All have horrible side effects. So she rec. SJW. I was thrilled to see the side effects are minimal in comparison. I am on a low dose Atacand and low dose Triamterene for blood pressure for 25 yrs. Gluten Free, all organic, veggies and lean meat, no junk food. Never losing weight. I do have mild anxiety. Thinking of adding SJW to my plan. I’m post menapausal and in late 50s. Question, Does this sound possible, Increasing the serotonin levels, reducing the mild anxiety could aid in weight loss?

  37. Dr E says:

    Hi Denise
    Raising your serotonin will reduce anxiety and reduce carb craving so yes, SJW can help with weight loss

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