As a result of this threat, we find repeated warnings about St. John’s wort, as though it is somehow dangerous. But the reality is, most of the adverse effects purported in these reports are produced when the herb is taken along with pharmaceutical medications.
This isn’t to say that St. John’s wort (Hypericum perforatum) is free of potential side effects. When it is correctly prescribed and taken, the research clearly proves it is a safe and effective medicinal herb.
Let's take a look at the evidence.
Large review proves St. John’s wort’s effectiveness
Researchers from the Akasha Center for Integrative Medicine and the Pardee RAND Graduate School recently investigated clinical research on St. John’s wort for treating major depressive disorder.
The researchers used two independent reviewer systems to screen and assess clinical studies for bias and quality. The Cochrane Risk of Bias assessment was used to qualify bias and quality.
The researchers found 35 clinical studies that treated depression patients for at least four weeks with St. John’s wort. They were all placebo-controlled and randomized.
In all, the clinical studies treated nearly 7,000 depression patients with St. John’s wort or placebo. The treatments utilized an extract that used 0.3 % hypericin and 1-4 % hyperforin, or a placebo.
The researchers found that compared to placebo, St. John’s wort was effective at treating major depression by an average of 53 percent. The clinical results also found that St. John’s wort’s effectiveness closely matched the effectiveness of pharmaceutical antidepressants.
“The included studies showed the efficacy of St. John’s wort for depression symptoms was comparable to antidepressant medication, with St. John’s wort being neither inferior nor superior.”
In terms of remission, St. John’s wort treatments resulted in remission 17 percent more than the use of antidepressants, though the researchers could not qualify this as significant:
“Patients who received St. John’s wort did not experience remission from depression at statistically significantly lower or higher rates than patients who received antidepressants.”
Yet the St. John’s wort treatments resulted in far fewer side effects compared to pharmaceutical antidepressants. The researchers found that the side effects were comparable to the side effects reported by the placebo groups:
“Adverse events reported in randomized clinical trials were comparable to placebo and fewer compared with antidepressants.”
St. John’s wort also resulted in fewer digestive side effects and fewer nervous system side effects compared to pharmaceutical antidepressants:
“In the included randomized clinical trials comparing St. John’s wort to standard antidepressant medications, there was evidence that more patients taking antidepressants experienced adverse events. Specifically, St. John’s wort was associated with fewer adverse events in the gastrointestinal and neurologic organ systems.”
The researchers concluded St. John’s wort’s total effectiveness:
“St. John’s wort monotherapy for mild and moderate depression is superior to placebo in improving depression symptoms and not significantly different from antidepressant medication.”
This is serious stuff. A medicinal herb that costs a fraction of the price of pharmaceuticals works just as well if not better than the pharmaceutical, and more safely.
Depression Scores Halved
An example of the clinical studies this review included in its meta-analysis is a study from Berlin’s Charité Humboldt University. For six weeks, the researchers gave 900 milligrams of Hypericum extract or a placebo to 140 patients diagnosed with moderate depression.
The study found the Hypericum treatment group’s Hamilton Depression Scale scores went from an average of 22.8 points all the way down to 11.1 points – halving their levels of depression after only six weeks of treatment.
Not the first major review to find these results
This is not the first major review of clinical research showing that St. John’s wort successfully treats depression.
In 2008, a major Cochrane review from Germany’s Technical University of Munich analyzed 29 quality clinical studies that included 5,489 depression patients.
Again, the researchers found that St. John’s wort extracts were between 28 and 87 percent effective, with a similar effectiveness as pharmaceutical antidepressants.
The researchers concluded:
“The available evidence suggests that the hypericum extracts tested in the included trials a) are superior to placebo in patients with major depression; b) are similarly effective as standard antidepressants; c) and have fewer side effects than standard antidepressants. The association of country of origin and precision with effects sizes complicates the interpretation.”
Antidepressant use is skyrocketing
The number of people taking antidepressants has skyrocketed. A 2015 study from Harvard University found that prescriptions for antidepressants nearly doubled between 1999 and 2012. The study found that 13 percent of all Americans were prescribed antidepressants in 2012, compared to 6.8 percent in 1999. Most of these are being prescribed to middle-aged people.
Side effects of selective serotonin reuptake inhibitor (SSRI) antidepressants include nausea, dizziness, drowsiness, insomnia, nervousness, restlessness, diarrhea, erectile dysfunction and others.
As mentioned above, most of St. John’s wort’s side effects come when it is combined with pharmaceutical medications of one sort or another.
When St. John’s wort is combined with SSRIs, it can produce serotonin syndrome – which can also be caused by SSRIs and other serotonin medications alone. St. John’s wort can also decrease the effectiveness of some drugs, as it slows their absorption. For example, pharmaceutical contraceptives can become less effective if combined with St. John’s wort.
There is a whole list of medications that St. John’s wort can potentially interfere with.
The key is not to take St. John’s wort when taking other medications of any sort.
How does St. John’s wort work?
Like most herbal medicines, St. John’s wort contains a myriad of medicinal compounds. These work together to buffer each other and create a synergistic healing mechanism.
The central compounds in St. John’s wort are hypericin, hyperforin, pseudohypericin and adhyperforin. These help balance the body’s levels of dopamine and serotonin. St. John’s wort also helps balance 5-HT receptors, increasing GABA – which produces a calming effect.
This myriad of effects has caused medical researchers to dub St. John’s wort as a “neuroprotective agent.” Its use for all sorts of mood disorders and anxiety is well documented throughout the world.
St. John also contains quercetin, quercitrin, hyperoside, avicularin, rutin, kaempferol, various flavonoids, oligomeric procyanidines and other compounds.
This natural myriad of compounds in St. John’s wort means that it also confers other benefits. Other clinical uses of the herb have included seasonal effective disorder, premenstrual syndrome, menopause, hemorrhoids, skin rashes, wounds and infections. It has been shown to have proven antifungal and antiviral effects. St. John’s wort also reduces inflammation.
It’s true that St. John’s wort can cause slight photosensitivity in some people. But this is typically minor and can occur as a result of a number of other medicinal plant extracts. This effect is often mitigated when the whole herb is taken instead of an isolated extract.
The plant is called St. John’s wort because its flower blooms right around the birthday of Saint John the Baptist’s birthday of June 25.
Due to St. John’s wort’s ability to interfere with pharmaceuticals, it is suggested that it be prescribed by one’s personal health care provider.
REFERENCES:
Apaydin EA, Maher AR, Shanman R, Booth MS, Miles JN, Sorbero ME, Hempel S. A systematic review of St. John’s wort for major depressive disorder. Syst Rev. 2016 Sep 2;5(1):148. doi: 10.1186/s13643-016-0325-2.
Uebelhack R, Gruenwald J, Graubaum HJ, Busch R. Efficacy and tolerability of Hypericum extract STW 3-VI in patients with moderate depression: a double-blind, randomized, placebo-controlled clinical trial. Adv Ther. 2004 Jul-Aug;21(4):265-75.
Linde K, Berner MM, Kriston L. St John’s wort for major depression. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD000448. doi: 10.1002/14651858.CD000448.pub3.
Schmidt M, Butterweck V. The mechanisms of action of St. John’s wort: an update. Wien Med Wochenschr. 2015 Jun;165(11-12):229-35. doi: 10.1007/s10354-015-0372-7.
Yildiz M, Batmaz S, Songur E, Oral ET. State of the art psychopharmacological treatment options in seasonal affective disorder. Psychiatr Danub. 2016 Mar;28(1):25-9.
Berry-Bibee EN, Kim MJ, Tepper NK, Riley HE, Curtis KM. Co-administration of St. John’s wort and hormonal contraceptives: a systematic review. Contraception. 2016 Jul 18. pii: S0010-7824(16)30164-0. doi: 10.1016/j.contraception.2016.07.010.
Oliveira AI, Pinho C, Sarmento B, Dias AC. Neuroprotective Activity of Hypericum perforatum and Its Major Components. Front Plant Sci. 2016 Jul 11;7:1004. doi: 10.3389/fpls.2016.01004.