What is St John’s wort?

St John’s wort is a herbal remedy that has been used for hundreds of years to treat mental health problems. Today it is mainly used as an over-the-counter remedy to treat mild and moderate depression, and sometimes seasonal affective disorder (SAD), mild anxiety and sleep problems. The botanical name for St John’s wort is Hypericum perforatum, and it is sometimes marketed and sold as ‘Hypericum’. It contains many active substances, including hypericin and hyperforin, which are thought to affect mood.

How does St John’s wort work?

It is thought that St John’s wort works in a similar way to standard antidepressant medication. Research suggests that it increases the activity of brain chemicals such as serotonin and noradrenaline which are thought to play an important part in regulating our mood.

Can St John’s wort help me?

If you experience depression or low mood, you may decide to try St John’s wort as a herbal alternative to antidepressants. While you can buy St John’s wort from a pharmacy without a prescription, it is best to seek advice from your GP in the first instance. If you have any worries about your mental health and are unsure about treatment options, it is always useful to talk this through with your doctor before you make a decision.
Research suggests that, in some cases, St John’s wort might be just as effective as some antidepressant drugs to treat mild or moderate depression. It may also cause fewer or less intense side effects than commonly prescribed antidepressants. However, for severe depression there is limited evidence to show that it could help. Experiences vary person to person and more research needs to be done. If you are thinking about taking St John’s wort to treat other mental health problems, such as anxiety or seasonal affective disorder, it is worth noting that there is very little existing evidence on how effective it can be.

Speak to your doctor first about taking St John’s wort if you:

  • are pregnant or are breast feeding – there is limited information on its safety.
  • have a diagnosis of bipolar disorder – as with all antidepressants, it has been known to cause hypomania in some people, or rapid switching from a low to a high mood.
  • are under 18 – there is limited information on its safety.
  • are currently taking prescribed medication, contraceptive medication (such as the pill) or common over the counter medications.

What dosage should I take?

St John’s wort is sold in a variety of different forms. The dosages available vary depending on the form and brand that you buy. It is most commonly sold as tablets and capsules. You can also get it as a tea, or as a liquid called a ‘tincture’, which you can take as drops in water.

All medicines carry levels of risk in different circumstances, and can affect different people in different ways. There is no standard recommended dosage of St John’s wort  and it’s not currently clear what dosage works best.
It’s easiest to keep track of what dose you’re taking if you take St John’s wort in tablet or capsule form and if you stick to one particular brand. Be aware that if you buy a different type or brand, the dosage may be different or cause different side effects.
If you are considering taking St John’s wort, you may find it helpful to talk to your doctor or a pharmacist first to discuss what dosage would be best for you and check that taking St John’s wort will not interact dangerously with any other medications you are taking.

Before deciding what dose to take, read the packaging carefully and consider:

  • how strong the product is – the packaging should give you an indication of this by describing the amount of hypericin or hyperforin extract in the ingredients list or nutritional information section.
  • how many times you should take the product each day – directions should be given on the packaging. Tablets and capsules typically range from 1-3 times per day, depending on their strength.

Is it safe to take St John’s wort?

Even though herbal remedies are natural, this doesn’t mean that they are always safe and free of side effects. It is really important to think about this if you are already taking any other medication.

Some research shows that individuals who take St John’s wort report fewer or less adverse side effects than commonly prescribed antidepressant medications. However, all medicines affect different people in different ways, and doesn’t mean that you will have the same experience. It is always important to be aware of any potential risks when taking medication that has not been
prescribed by your GP.

What are the side effects of St John’s wort?

Some people who take St John’s wort do not report any side effects. However, those who do have side effects most commonly report:

  • feeling nauseous, being sick or diarrhoea.
  • headaches.
  • allergic reactions.
  • tiredness.
  • dizziness.
  • confusion.
  • a dry mouth.
  • skin problems.

A rare side effect of St John’s wort is increased sensitivity to sunlight. If you think this is affecting you, you should consider using a high factor sunscreen, cover up skin or stay out of the sun as much as possible. It is also best to talk to a doctor before trying light therapy for seasonal affective disorder (SAD), as St John’s wort can make your skin more sensitive to light.

Will I get withdrawal symptoms from stopping?

As St John’s wort has similar properties to prescribed antidepressants, it is advisable to slowly reduce your dosage to lessen the chance of withdrawal symptoms, especially if you have been taking it for longer than a few weeks.

If you are thinking about stopping taking St John’s wort, it can be really useful to talk to your doctor to discuss the safest methods to withdraw. Some people stop taking St John’s wort without any problems, while others experience withdrawal symptoms. Unfortunately, current information about withdrawal symptoms is limited and inconsistent.

Those who do experience withdrawal symptoms tend to report feeling sick, dizzy and tense during the withdrawal period, especially if they stop taking it suddenly without slowly reducing their dose.

hypericumHypericum perforatumSt John’s worthypericin – hyperforin

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