St. John's Wort Extract supplement, 300 mg

Warning:  For occasional use only.  Do not exceed recommended dose except on the advice of a health professional.  Do not take St. John's wort if pregnant or while nursing except on the advice of a health professional.  St. John's wort side effects include photosensitivity with prolonged exposure to sunlight.

St. Johns wort Supplement Facts
St. John's Wort - 300 mg
    (Hypericum perforatum) extract, Hypericin (0.3%) - 900 mcg, and Hyperforin (3%)  -  9 mg

Benefits of St. John's wort supplement
1)  Depression -- St. John's wort is helpful in the therapy of mild to moderate depression with fewer side effects than conventional pharmaceutical antidepressants. The effect of St. John's wort may be noticed the first day, but often it takes a few days or weeks for the full benefits of St. John's wort to occur. Some studies indicate that St. John's wort may be as good an antidepressant as some of the SSRIs such as Prozac and Zoloft. A 6 week double blind study using a combination of St. John's wort, valerian herb, and passion flower found the combination to be effective in treating mild depression. The dosage used was 360 mg for St. John's wort, 160 mg for valerian, and 190 for passionflower taken once daily. Other supplements used for depression include 5-HTP which is a serotonin precursor, SAM-e which is very potent and needs to be used in low dosages, and Tryptophan, which converts into serotonin.
   If your doctor approves, you can take one capsule of St. John's wort in the morning and half a capsule of a 50 mg 5 HTP in the afternoon or evening. Some people find the low dose combination of 5 HTP and St. John's wort to be helpful.

Cochrane Library 2008 - Review of St. John's wort for depression
St. John's wort, can provide effective relief in many people with mild to moderate depression. The benefits are similar to that achieved with standard antidepressants but with fewer side effects. Klaus Linde of the Centre for Complementary Medicine in Munich in Germany, reviewed 29 studies involving a total of 5,489 patients with depression that compared treatment with extracts of St. John's wort with placebo treatment or standard antidepressant medications. The studies were done in a variety of countries, tested several different St. John's wort extracts. Kluse Linde wrote, "Overall, we found that the St. John's wort extracts tested in the trials were superior to placebos and as effective as standard antidepressants, with fewer side effects,"  For details see http://www.cochrane.org/reviews/en/ab000448.html

2)  PMS -- St. John's wort supplement has been found to be partially helpful in treating PMS.

3)  Weight loss -- St. john's wort may be helpful in appetite control when combined with other natural supplements. A more effective herbal combination for appetite suppression is Diet Rx.

4)  Somatoform disorders (see study below).

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St. John's Wort ingredients
St. John’s wort has hypericin and other dianthrones, flavonoids, xanthones, and Hyperforin. New research suggests that St. John’s wort extracts may exert their antidepressant actions by inhibiting the reuptake of the neurotransmitters serotonin, norepinephrine, and dopamine. Long-term administration of St. John's wort modifies levels of neurotransmitters in brain regions involved in the pathophysiology of depression.

St. John's Wort side effects
The most common St. John's wort side effect is insomnia, which is likely to be worse on higher doses. Headaches and irritability or anxiety have also been reported. Sensitivity to light is another St. John's wort side effect. St. John's wort side effects could also include retinal harm if this herb is taken and the eyes are exposed to strong sunlight. Those who are predisposed to macular degeneration or have macular degeneration may with to either avoid the use of St. John's wort or to avoid sunlight when taking this herbal extract.

Q. I read the information on your site about St. John's Wort, and I didn't find any suggestions in case of side effects like anxiety, insomnia and irritability when someone takes St. John's wort occur. Do the side effects disappear in time? Or should St. John's Wort must be taken with another supplement to counteract the side effects?
   A. It is best to reduce the dosage rather than to take something else to counteract the St. John's wort side effects.

Q. I started taking St. John's Wort herb recently to help with menopause depression. I had read that St. John's Wort herb could help with other menopause symptoms. I took a German preparation which was a single 900 mg tablet in the morning for a week. I was waking frequently in the night, but knew that insomnia was a potential side effect. I happened to start with a new doctor and she took my blood pressure. I am normally quite 'normal'. My blood pressure was an astronomical 180 / 100. I could not think why, and then later did some research online that seemed to indicate this could be a side effect of St. John's Wort. I had the same experience when taking licorice. I must be very sensitive. I stopped taking the St. John's Wort herb and feel quite a bit better. I haven't had my blood pressure checked but will do so soon, however I am sure it is back to normal as I don't feel so anxious and fluttery. I realise there are lots of studies to show that St. John's Wort does not affect blood pressure. Unfortunately the studies clearly do not cover rare cases like myself. I thought you and others should know. If my blood pressure proves to be still high, I will let you know.

Q. I started taking St. John's wort to help with menopause depression. I had read that St. John's wort extract could help with other menopause symptoms. I took a German preparation which was a single 900 mg tablet in the morning for a week. I was waking frequently in the night, but knew that insomnia was a potential side effect. I happened to start with a new doctor and she took my blood pressure. I am normally quite normal. My blood pressure was an astronomical 180 / 100. I could not think why, and then later did some research online that seemed to indicate this could be a side effect of St. John's wort. I had the same experience when taking licorice. I must be very sensitive. I stopped taking the St. John's wort and feel quite a bit better. I haven't had my blood pressure checked but will do so soon,
however I am sure it is back to normal as I don't feel so anxious and fluttery. I realize there are lots of studies to show that St. John's wort does not affect blood pressure. Unfortunately the studies clearly do not cover rare cases like myself. I thought you and others should know. If my blood pressure proves to be still high, I will let you know.
   A. In my opinion, 900 mg of St. John's wort extract is quite a high dosage even though most studies have used this high amount. I prefer to prescribe 300 mg of St. John's wort extract and even reduce the frequency of use to every other day once the benefits begin. Insomnia is a side effect of St. John's wort on high dosages.

Additional nutrients involved in mood support
5-HTP sometimes has an effect within hours and is best suited for those whose low mood is related to serotonin deficiency. SAM-e a powerful nutrient that starts working within hours but should not be used by those who have a tendency for depression associated with anxiety. B vitamins have a mild influence on depression. The combination of 5 HTP St. John's wort may help some people. If you plan to take St. John's wort and 5HTP together, use low dosages. These supplements should not be mixed together with pharmaceutical medicines prescribed for depression such as Prozac, Paxil, Zoloft, and other SSRI drugs unless done so or supervised by a health care provider experience with these combinations.

St. John's Wort and long term use
There is always a concern when taking a particular herb for prolonged periods. Thus far, it does not seem that St. John's wort has any significant side effects (particularly compared to standard pharmaceutical antidepressants). However, I often recommend taking breaks from a supplement every few weeks. It also depends on dosage. If a person is only taking one pill a day, they can continue taking this much longer that someone taking three pills a day.
   One study indicates St. John's wort does not influence heart rate variability.

St. John's Wort Caution
Reduce exposure to sunlight when you take St. John's wort. One study has indicated that in the presence of light, hypericin (a component of St. John's wort) can induce changes in lens protein that could lead to the formation of cataracts. Appropriate precautions should be taken to protect the eye from intense sunlight while taking St. John's wort.
   St. John’s wort may interfere with oral contraceptives. St John's wort is an inducer of cytochrome P450 (CYP) 3A enzymes and may reduce the efficacy of oral contraceptives.
   St. John's wort interacts with many medicines, including antidepressants, so caution is advised when combining this herb with other medicines. Combining St. John's wort with SSRIs or other pharmaceutical antidepressants should only be done under medical supervision since their effects are additive and it is possible that the combination could cause serotonin syndrome.
   St. John's wort may increase metabolism of certain drugs such as indinavir used in treating HIV. The mechanism is likely due to st. john's wort inducing the production of cytochrome P450 3A, an enzyme that breaks down certain drugs, but the specifics of this interaction are not yet clear. St. John's wort may also interfere with the metabolism of Camptosar, a medicine used to treat some kinds of cancer.
   Certain formulations of St. John's wort seem to reduce levels of digoxin, a drug that helps the heart to pump in people who have heart failure. If the digoxin level falls too low, the drug may not provide a beneficial effect. St. John's formulations rich in chemicals called hypericin and hyperforin seemed to reduce blood-stream levels of digoxin. There were no interactions, however, when volunteers took "traditionally used" St. John's wort preparations. The hypericin- and hyperforin-rich formulations produce their effect by turning on enzymes that break down digoxin.

St. John's Wort dosage
Since each person is different, the proper dosage of St. John's wort could range from as little as half of a 300 mg capsule to 3 capsules a day. Most people find one capsule of St. John's wort extract at 300 mg a day to be sufficient.

St. John's Wort and depression research
An extract of the herbal remedy St. John's wort is as effective as a commonly prescribed drug for people with moderate-to-severe depression. They compared the st. john's wort extract called WS 5570, which is made by the German company Dr. Willmar Schwabe Pharmaceuticals, and the antidepressant paroxetine sold by GlaxoSmithKline Plc under the brand name Paxil or Seroxat. St. John's wort is also known as hypericum perforatum. "In the treatment of moderate to severe major depression, St. Joh's wort hypericum extract WS 5570 is at least as effective as paroxetine and is better tolerated," Professor Armin Szegedi of the Charite-Universitatsmedizin, part of the University of Berlin, said in a report published online by the British Medical Journal. In a study funded by the German company, the researchers compared the treatments in 251 patients, between 18 and 70 years of age, for six weeks. Half of the patients taking the st. john's wort extract reported an improvement, compared with one third taking paroxetine. Patients taking the extract also reported fewer side effects, such as stomach disorders, according to the researchers.

Influence of St John's wort on catecholamine turnover and cardiovascular regulation in humans.
Clin Pharmacol Ther. 2004 Nov;76(5):480-9.
St John's wort (Hypericum perforatum) is a popular over-the-counter antidepressant. Its antidepressive effect has been attributed in part to inhibition of monoamine transporters and monoamine oxidase, on the basis of in vitro studies. In a double-blind, randomized, placebo-controlled, crossover study, 16 healthy subjects (11 men and 5 women; mean age, 31 +/- 5 years) ingested either St John's wort (300 mg three times daily) or placebo for 7 days. Imipramine treatment (50 mg three times daily) in 7 subjects served as a positive control. After treatment, physiologic and biochemical tests included cardiovascular reflex testing, graded head-up tilt testing, and plasma catecholamine determinations. St John's wort had no effect on blood pressure, heart rate, heart rate variability, or blood pressure variability, regardless of the test condition. St John's wort had no effect on plasma concentrations of norepinephrine and its main metabolite, dihydroxyphenylglycol, whereas plasma dihydroxyphenylacetic acid (DOPAC; the main metabolite of dopamine) concentrations increased in every subject. In contrast, imipramine increased resting blood pressure and heart rate and elicited a marked orthostatic tachycardia. Our findings challenge the concept that St John's wort elicits a major change in norepinephrine uptake or monoamine oxidase activity in vivo. The consistent increase in plasma DOPAC concentrations might suggest a novel mode of action or an inhibitory effect on dopamine beta-hydroxylase that should be followed up. We propose that a combination of physiologic and biochemical profiling may help better define the mode of action and potential side effects of herbal remedies.

The herb St. John's Wort, used as an alternative therapy for mild depression, may hinder the effectiveness of a newer type of cancer drugs. Their study of 10 healthy volunteers found that the herbal remedy lowered blood levels of the cancer drug Gleevec (known in some countries as Glivec) by as much as 42 percent. In a cancer patient, the study authors warn, this could mean the difference between success or failure on Gleevec, an oral drug used mainly to treat the blood cancer chronic myeloid leukemia. The findings, published in the journal Pharmacology, add to the list of prescription drugs that don't mix well with St. John's Wort. Past studies have shown that the drug may alter blood levels of some other chemotherapy drugs, as well as certain cardiovascular drugs, HIV medications, antidepressants and birth control pills.

Flavonoids of St. John's Wort Reduce HPA Axis Function in the Rat.
Planta Med. 2004 Oct;70(10):1008-11.
A common biological alteration in patients with major depression is the activation of the hypothalamic-pituitary-adrenal (HPA) axis, manifested as hypersecretion of adrenocorticotropic hormone (ACTH) and cortisol. The hyperactivity of the HPA axis in depressed patients can be corrected during clinically effective therapy with standard antidepressant drugs such as imipramine, indicating that the HPA axis may be an important target for antidepressant action. We previously showed that a methanolic extract of St. John's wort (St. Johns wort) and hypericin, one of its active constituents, both have delayed effects on the expression of genes that are involved in the regulation of the hypothalamic-pituitary-adrenal (HPA) axis , whereas the phloroglucinol derivative hyperforin was inactive in the same model . Since flavonoids of St. John's wort are also discussed as active constituents it was of interest to determine whether these compounds can modulate HPA axis function. Imipramine (15 mg/kg), hypericin (0.2 mg/kg), hyperoside (0.6 mg/kg), isoquercitrin (0.6 mg/kg) and miquelianin (0.6 mg/kg) given daily by gavage for two weeks significantly down-regulated circulating plasma levels of ACTH and corticosterone by 40 - 70 %. However, none of the compounds tested had an effect on plasma ACTH and corticosterone levels after chronic treatment (daily gavage for 8 weeks). Our data suggest that besides hypericin, flavonoids of St. John's wort play an important role in the modulation of HPA axis function. Furthermore, the results support the hypothesis that flavonoids are involved in the antidepressant effects of St. John's wort.

Comparison of the synaptosomal uptake inhibition of serotonin by St John's wort products.
J Pharm Pharmacol. 2004 Jun;56(6):813-8.
Although the number of prescriptions for psychotropic drugs has decreased in recent years, prescriptions for antidepressants are still increasing. Hypericum perforatum ( St John's wort ) is the main psychotherapeutic herbal medicinal product used for treatment of mild-to-moderate depression. The lipophilic constituent hyperforin (2-5% of the st. john's wort extract) demonstrated, similarly to chemical antidepressants, a significant effect on the synaptosomal uptake inhibition of several neurotransmitters in in-vitro assays. In Germany, St John's wort products are distributed via two different markets: products that are pharmacy restricted are only allowed to be distributed in pharmacies; traditionally used products, which do not claim to have a curative character, are allowed to be sold in supermarkets. Depending on the market wherein a St John's wort product is offered, it needs to fulfill the legal requirements regarding pharmaceutical quality, safety and efficacy. Our goal was to compare the quality of St John's wort products distributed in pharmacies with that of those available from supermarkets. Therefore, the quantity of the pharmaceutical active ingredients (the phloroglucinol derivate hyperforin, the flavonoids rutin, hyperoside, isoquercitrin, quercitrin and the biflavonoid biapigenin) was determined by high-performance liquid chromatography (HPLC). The results of our study confirm the assumption that the potency of St John's wort products in inhibiting the uptake of serotonin depends on the amount of hyperforin in their dosage forms. St John's wort products having greater hyperforin content and potency on synaptosomal serotonin uptake inhibition are restricted to be sold only in pharmacies.

Treatment of Somatoform Disorders With St. John's Wort : A Randomized, Double-Blind and Placebo-Controlled Trial.
Psychosom Med. 2004 Jul-Aug;66(4):538-47.
To investigate efficacy and safety of St. John's wort LI 160 in somatoform disorders. In a prospective, randomized, placebo-controlled, and double-blind parallel group study, 184 outpatients with somatization disorder, undifferentiated somatoform disorder, and somatoform autonomic dysfunction, but not major depression, received either 300 mg of St. John's wort extract LI 160 twice daily or matching placebo for 6 weeks. RESULTS: In the intention to treat population (N=173), for each of the six primary efficacy measures as well as for the combined test, statistically significant medium to large-sized superiority of St. John's wort treatment over placebo was demonstrated. Of the St. John's wort patients, 45% were classified as responders compared with 20% with placebo. Tolerability of St. John's wort treatment was equivalent to placebo. Administration of 600 mg of St. John's wort extract LI 160 daily is effective and safe in the treatment of somatoform disorders, thereby confirming results from a previous study.

Pharmacokinetic interactions of drugs with St John's wort
National University of Singapore.
Psychopharmacol. 2004 Jun;18(2):262-76.
There is a worldwide increasing use of herbs which are often administered in combination with therapeutic drugs, raising the potential for herb-drug interactions. St John's wort (Hypericum perforatum) is one of the most commonly used herbal antidepressants. A literature search was performed to identify known drug interaction with St John's wort. The available data indicate that St John's wort is a potent inducer of CYP 3A4 and P-glycoprotein (PgP), although it may inhibit or induce other CYPs, depending on the dose, route and duration of administration. Data from human studies and case reports indicate that St John's wort decreased the blood concentrations of amitriptyline, cyclosporine, digoxin, fexofenadine, indinavir, methadone, midazolam, nevirapine, phenprocoumon, simvastatin, tacrolimus, theophylline and warfarin, whereas it did not alter the pharmacokinetics of carbamazepine, dextromethorphan, mycophenolic acid and pravastatin. St John's wort decreased the plasma concentration of the active metabolite SN-38 in cancer patients receiving irinotecan treatment. St John's wort did not alter the pharmacokinetics of tolbutamide, but increased the incidence of hypoglycaemia. Several cases have been reported that St John's wort decreased cyclosporine blood concentration leading to organ rejection. St John's wort caused breakthrough bleeding and unplanned pregnancies when used concomitantly with oral contraceptives. It also caused serotonin syndrome when coadministered with selective serotonin-reuptake inhibitors (e.g. sertaline and paroxetine). Both pharmacokinetic and pharmacodynamic components may play a role in these interactions. Because the potential interaction of St John's wort with other drugs is a major safety concern, additional systematic research on herb-drug interactions and appropriate regulation in herbal safety and efficacy is needed.

Meta-analysis of effectiveness and tolerability of treatment of mild to moderate depression with St. John's Wort
Humboldt Universitat zu Berlin, Institut fur Klinische Pharmakologie.
Fortschr Neurol Psychiatr. 2004 Jun;72(6):330-43.
After anxiety, depression is one of the most common psychiatric diseases, showing a lifetime prevalence of 4 - 18 %. St. John's Wort is a herbal antidepressant combining a long tradition of use with well-proven medical research. We conducted a meta-analysis to review St. John's Wort's place in the treatment of depression. A comprehensive literature search was conducted for studies comparing effectiveness and tolerability of St. John's Wort with either placebo or synthetic antidepressant. Thirty studies met the inclusion as well as the quality criteria and were included in the meta-analysis. Four studies consisted of all three arms and were thus included in both analyses. Our results demonstrated a significant advantage for St. John's Wort compared to placebo. Compared to synthetic antidepressants St. John's Wort demonstrated similar effectiveness. In the sub-group of mild to moderate depression, corresponding with the indication for St. John's Wort assigned by the German health authority, the herbal antidepressant showed better results against the synthetic antidepressants. This result viewed together with St. John's Wort's favorable side-effects profile, leading to a lower rate of drop-outs, suggests treatment with St. John's Wort should be attempted for milder forms of depression.

Is St. John’s Wort an Anti-inflammatory Herb? -- For many centuries St. John’s Wort has been used in Europe to treat a variety of conditions including infections and depression. Compounds within this herb, one being hypericum, have very strong biological activity, including the ability to reduce inflammation and fight against bacterial infections. In a study conducted at Ege University, in Izmir, Turkey, scientists investigated the in vitro effects of three Hypericum species, on human white blood cell myeloperoxidase (MPO) activity. MPO is a major component of the antimicrobial system of white blood cells. MPO helps the conversion of hydrogen peroxide and chloride to hypochlorous acid. Hypochlorous acid is a strong oxidant produced by white blood cells that contributes to inflammatory tissue damage. The researchers found that hypericum in St. John’s wort reduces the oxidative activity of white blood cells, thus potentially reducing damage from oxidation.
     Dr. Sahelian says: It appears that St. John’s wort has many roles to play in the human body. For now, the most common use for St. John’s wort is as an antidepressant. Even though studies have used 300 mg three times a day, I find that most people notice some uplifting in mood even with 300 mg once a day in the morning. High doses could cause insomnia.

An open-label pilot study of St. John's wort in juvenile depression.
Findling RL. Department of Psychiatry, Case Western Reserve University/University Hospitals of Cleveland
J Am Acad Child Adolesc Psychiatry. 2003 Aug;42(8):908-14.
This pilot study examined the effectiveness, safety, tolerability, and pharmacodynamics of Hypericum perforatum (St. John's wort) in the treatment of youths diagnosed with major depressive disorder. METHOD: Youths 6 to 16 years of age meeting DSM-IV criteria for major depressive disorder with depressive symptoms of at least moderate severity were eligible to enroll between January 1999 and January 2001 in this 8-week, prospective, open-label, outpatient study. Outcome measures included the Children's Depression Rating Scale-Revised (CDRS-R) and the Clinical Global Impressions (CGI) scale. A priori criteria for response consisted of a CDRS-R score of </=28 and a CGI severity score </=2. Patients were initially prescribed 150 mg St. John's wort three times daily. If at the end of week 4 the patient did not meet a priori response criteria, the dose was increased to 300 mg three times daily. RESULTS: Thirty-three youths with a mean (SD) age of 10.5 (2.9) years were enrolled. After 4 weeks of St. John's wort therapy, 22 youths had their dose increased to 900 mg/day. Twenty-five of the patients met response criteria after 8 weeks of treatment. Overall, St. John's wort was well tolerated. CONCLUSION: St. John's wort may be an effective treatment for youths diagnosed with major depressive disorder. Placebo controlled trials seem indicated.

The effects of St John's wort extract on heart rate variability, cognitive function and quantitative EEG: a comparison with amitriptyline and placebo in healthy men.
Siepmann M,. Institute of Clinical Pharmacology, Medical Faculty, Technical University, Dresden, Germany.
Br J Clin Pharmacol. 2002 Sep;54(3):277-82.
AIMS: To compare the effects of multiple dosing with St John's wort (Hypericum perforatum) extract and amitriptyline on heart rate variability, cognitive function and quantitative EEG (qEEG) with placebo in healthy humans. METHODS: A randomized, double-blind, cross over study of 12 healthy male volunteers. Subjects orally received capsules with 255-285 mg St John's wort extract (900 micro g hypericin content), 25 mg amitriptyline and placebo three times daily for periods of 14 days each with at least 14 days between. The doses of amitriptyline and St John's wort extract are comparable with respect to their antidepressant activity. Compliance was confirmed by coadministration of 10 mg of riboflavin with each capsule and detection of urinary vitamin B2 on treatment day 11 with high performance liquid chromatography. Measurements of heart rate variability, psychometric tests and qEEG were performed before start of medication and repeatedly on the last treatment day. RESULTS: St John's wort extract did not affect heart rate variability (HRV) whereas amitripytline significantly decreased it: the difference in the percentage number of adjacent RR intervals> 50 ms (pNN50) was 8.6 (-2.6, 19.9; mean; 95% confidence interval) between St John's wort extract and placebo and -17.6 between amitriptyline and placebo. Neither St John's wort extract nor amitriptyline had an influence on cognitive performance such as choice reaction, psychomotor coordination, short-term memory and responsiveness to distractive stimuli. Amitriptyline but not St John's wort extract decreased self rated activity (P < 0.05). Both drugs caused significant qEEG changes. St John's wort extract increased theta power density. Amitriptyline increased theta as well as fast alpha power density. CONCLUSIONS: Multiple doses of St John's wort extract do not affect heart rate variability nor cognitive function. Chronic administration of amitriptyline causes a decrement of HRV and subjective sedation but it does not impair cognitive performance. johns ocd st wort johns liquid.

Efficacy of St. John's wort extract WS 5570 in major depression: a double-blind, placebo-controlled trial.
Lecrubier Y,. Unite Institut National de la Sante et de la Recherche Medicale 302, Hopital Pitie Salpetriere, Paris, France.
Am J Psychiatry. 2002 Aug;159(8):1361-6.
In a double-blind, randomized, placebo-controlled trial with 375 patients the authors investigated the antidepressant efficacy and safety of 300 mg t.i.d. of St. John's wort hydroalcoholic Hypericum perforatum extract WS 5570. The study participants were male and female adult outpatients with mild to moderate major depression (single or recurrent episode, DSM-IV criteria). After a single-blind placebo run-in phase, the patients were randomly assigned, 186 to St. John's Wort and 189 to placebo, after which they received double-blind treatment for 6 weeks. Follow-up visits were held after 1, 2, 4, and 6 weeks. The primary outcome measure was the change from baseline in the total score on the 17-item Hamilton Depression Rating Scale. In addition, analyses of responders (patients with at least a 50% reduction in Hamilton total score) and patients with remissions (patients with a total score of 6 or less on the Hamilton scale at treatment end) were carried out, and subscale/subgroup analyses were conducted. The design included an adaptive interim analysis performed after random assignment of 169 patients with options for group size adjustment or early termination. Compared to placebo, WS 5570 produced a significantly greater reduction in total score on the Hamilton depression scale and significantly more patients with treatment response or remission. It was more effective in patients with higher baseline Hamilton scores and led to global reduction of depression-related core symptoms, assessed with the melancholia subscale of the Hamilton scale. The placebo and St. John's Wort groups had comparable adverse events. St. John's wort was found to be safe and more effective than placebo for the treatment of mild to moderate depression.

St. John's Wort for depression -- Who's right?
Did you see this headline a couple of weeks ago? "Major new study finds proprietary St. John's Wort extract at least as effective as popular prescription anti-depressant." Perhaps you recall another headline from 2 years ago "JAMA study fails to support the efficacy of St. John's Wort in moderately severe major depression." Well, one of these results has to be wrong... right?
     In the latest report, according to a randomized, double-blind clinical study published in the prestigious British Medical Journal, a St. John's Wort extract was at least as effective in treating depression and better tolerated by patients than the widely prescribed anti-depressant paroxetine, known by the product name Paxil (a SSRI similar to Prozac). In the study, 251 patients with moderate to severe forms of depression were divided into two groups: one receiving 900 mg/day of WS(R) 5570 (a proprietary form of St. John's Wort), and the other 20 mg/day of paroxetine, for six weeks. The results: St. John's Wort produced as good an improvement with fewer side effects.
     My comments: In order to know with a greater sense of certainty the effectiveness of a particular herb or medicine, several studies over a period of time have to be evaluated. At this point, the majority of studies testing St. John's wort have found that this herb has mood lifting effects. The dose required varies, ranging from 300 mg to 900 mg a day. Another good mood lifter is SAM-e. Here's another interesting report: Adults taking Prozac, Paxil, and Zoloft are more likely to attempt suicide than those given sugar pills.

St. John's wort extract supplement emails
Q. I have experienced the worst 8 months of my life thanks fo my first extreme bout of depression and anxiety at 38.  I have been unable to tolerate  a number of SSRI's so I tried Kira the German St John's Wort perscription.  I am significantly better, however, I never quite went back to normal.  Because on five pills a day, under my doctors supervision, I have experienced some side effects - electrical shocks in my hands and feet when cool and thick, tingling sensations in my brain.  It is all worth it though!

Q. Is St. johns wort stronger than kava kava?
   A. They are different. St. John's wort is better suited for depression while kava is helpful for anxiety.

Q. I have experienced the St. John's wort side effect of insomnia even on two capsules a day. Is this common?
   A. Some people who are sensitive to St. John's wort get the insomnia side effect even on one capsule.

Q. Is St. Johns Wort plant as good than antidepressant drugs?
   A. The largest-ever study of St. John’s wort reports that the plant should be given first choice over a commonly-prescribed drug to treat depression. St. John's wort, known in Latin as Hypericum perforatum, has long been used to ease mood swings and anxiety. Documented evidence of its use dates back to ancient Greece. Outpatient clinics in Germany carried out a trial on 324 people suffering from mild to moderate depression, half of whom were given St. John’s wort while the other half were given the anti-depressant imipramine. Both treatments, conducted over six weeks, yielded significant benefits. A mood-measuring scale found that, on average, all the patients' symptoms had dropped below the level of mild depression. However, St. John's wort scored "a significant advantage" in having far fewer side effects than imipramine. Side effects such as dry mouth, sweating and dizziness were reported in 39 percent of patients taking the herb, while the figure was 63 percent among those taking imipramine. As a result, only three percent taking St. John's wort stopped the treatment, compared to 16 percent on imipramine. The extract "is therapeutically equivalent to imipramine in treating mild to moderate depression, but patients tolerate hypericum better," says the authors of the study published in the British Medical Journal. This investigation is the biggest and most exhaustive in nearly two dozen trials that have given St. John's wort the thumb's-up as a treatment for melancholy.
   Dr. Sahelian comments: In view of the mounting evidence that St. John’s wort works as well as traditional antidepressant drugs and has fewer side effects, this herb should be considered first in the treatment of mild to moderate depression. Avoid excessive sun exposure since a rash can occur. Daily doses range from 300 to 900 mg.

Q. Does St. John's wort cause anxiety?
   A. In high doses it is possible the St. John's wort could make cause anxiety, restlessness, and insomnia.

Q. Hello. I came across your website when looking up the possibility of opening up capsules and putting them in food. I have a hard time taking large pills and don't like the idea of taking gelatin since I'm a vegetarian. I picked up some St. John's Wort capsules and was hoping to just open them up and put them in yogurt or juice. Is this ok to do with this herb? I just wanted to make sure before I do it. Also, it says that SJW can actually cause some anxiety. I am actually dealing with anxiety and depression and thought that SJW was supposed to treat anxiety not CAUSE anxiety. Should I worry?
   A. St. John's wort can be taken with juice, we're not sure about yogurt and whether it will slow the absorption or not. Most often herbs work quicker when taken on an empty stomach or little food. High doses of St. John's wort may cause anxiety. restlessness and insomnia. This can happen on 3 capsules or it can even happen on one capsule after several days of use.

Q. Can you tell me is there had been any research done with taking Sam-e and St. Johns wort simultaneously? For example, I take Sam-e in the mornings and sometimes actually crave some tincture of St. Johns wort occasionally on some afternoons.
   A. We are not aware of research done combining the two supplements. Some people may get overly stimulated and have insomnia combining St. John's wort and SAM-e.

Q. have there been any studies done on the combined usage of Ashwagandha and St. John's Wort for improving moderate depression?
   A. We have not seen such studies with this combination.

Q. Since taking St Johns Wort, I have been suffering with bladder problems, could this be a side effect?
   A. We have not heard of this potential St. John's wort side effect yet, but many side effects exist from herbs that are not yet known.

Q. Thank you for your helpful website. My elderly mother has a hard time swallowing pills. Do you know of any liquid forms of St. John's Wort that I could add to her coffee? She always responded very well to the St. John's Wort 300 mg tablets. She is suffering from depression.
   A. Perhaps you can find some searching google since we are not familiar with the St. John's wort liquid forms, we are quite certain they exist, though but sometimes it is difficult to know the conversion of St. John's wort liquid in terms of its equivalence to capsule. Another option is to open a St. John's wort caspule and mix with juice or crush tablets. Just be careful with dosages, keep very low since the elderly may not react well to high doses.

Q. Just wanted to ask how to use St John's wort. Is it something also needed to be taken with just several times a week, let's say one tablet in the morning and then couple days rest, and then taking again, or more regularly like eveyr day 2 times a day?
   A. Just like any herb or medicine, the dose varies depending on the individual using it. Some people do fine with one St. John's wort capsule a day, others need two, and still others do fine using it every other day or every third day. Plus, the dosage could vary with time. For instance, if 2 St. John's wort capsules a day were required initially, as the depression is lifted your requirement may drop to one capsule a day or every other day, or at times you may not require any.

Q. Can you please let me know if there is an interaction between 5 HTP or St John’s wort and Lithium. What are your suggestions and which natural medication ( 5 HTP or St John’s wort ) is better for treating Manic Depressive Psychosis.
   A. There can be an interaction between 5HTP and St. John's wort, therefore it is best to learn how each one works by itself before combining, and when combined, half the dosage should be used. This has to be done under medical guidance. We are not aware of any research or reports using St. John's wort and lithium together, unexpected side effects can occur when drugs and potent herbs are combined. It is up to your doctor to learn about these herbs and decide the best treatment option for your depression.

Q. Sometimes I take a St. John's wort pill in the morning and 5-HTP in the afternoon or evening. Is there a danger combining 5-HTP with St. John's wort?
   A. We have not seen any research with the combination of St. John's wort and 5-HTP, however, if the dosage of the St. John's wort is kept to 300 mg and the dosage of 5-HTP is half a 50 mg capsule, there should be no major problems as long as you are healthy and take no other medicines. However, unexpected reactions can happen when potent supplements are mixed.

Q. Tyramine; Please advise. I read in detail about St. Johns wort by Dr. Sahelian. In reading, I did not find any reference to tyramines; from cheese, wine, beer, etc. I have read many documents stating tyramine can raise blood pressure when taking with the herb. But also read it negligible that MAO effect in the herb can cause any side effects for people with normal blood pressure. Can you please comment on this. Your feedback would be greatly appreciated.
   A. We have not seen any studies that indicate there is a serious reaction to the intake of tyramine containing food and the use of a St. John's wort supplement. As a general rule, it is best to use the least amount of St. John's wort dosage that works, and even though most studies have used 3 capsules of St. John's wort 300 mg a day, many people find one or two capsules works quite well with fewer side effects. Also, it is a good idea to limit the use of wine or alcohol when taking high doses of certain herbs. Many herbs can raise body temperature and so does alcohol. In summary, by using low amounts of St. John's wort and minimal amounts of alcohol, it is quite likely there would not be any significant untoward reactions.

Q. My 33-year old son is suffering from mild to moderate depression and may also have some mild ADD. Which of these 2 (St. John's or SAM-e) would be most beneficial for him to try? Would you recommend one or the other to be tried first? If so, how long should he wait between if he switches from one to the other?
   A. It is very difficult, in many cases nearly impossible, to predict which natural antidepressant will work in any particular individual. Taking three or four days off before switching is a good idea.

Q. After taking a capsule of St. John Wort -- about half an hour of taking it -- I experienced a sharp pain in the left side of my stomach *never have had this kind of pain before* ... it went away so I didn't give it great importance. The next morning I took another capsule of same -- to my distress -- the very same morning, I detected that my left eye had bled very badly (never in my life I had experienced this problem) -- to this symptom, the most choking to me was the bleeding that I noticed coming from my left arm (I couldn't believe it, for there was no cut or opening in my skin) ... trying to disregard what I was seeing ( bleeding with no obvious opening) I cleaned it up, but then confirmation came that it was really blood coming from a healthy skin, more drops of bloods start coming out, and then I started seeing small patches of red (blood) under the skin of my hands and lower arms, they looked like red scratches ) ... after that, when I used the toilet, I noticed that the toilet tissue was stained with some blood. When I went to the doctor, my blood pressure was unusually high for me (the first time in my life that my blood pressure got this high) for all of my life, my pressure has been in the very low levels! The doctors couldn't give any explanations (they never heard anything about it, of blood coming from a healthy skin) and to me ... this still a mystery! I have tried to consult with other professional people and research about it, but so far ... haven't found the answer ... my question: Do you think that St. John Wort could in some way thin the blood or change the structure of the blood cells, to cause this so strange reactions to the body? I'm positive to believe that this herb caused all these various symptoms, for this was the only new product that I started taking that day, of course, I discontinued it immediately ... these side effects have not returned since then!
   A. Strange, we have never had these St. John's wort side effects reported to us before.

Q. Would you please briefly summarize the science behind your statement so that I can explain it to my doctor who is also a nutrition physician? “Additional nutrients involved in mood support 5-HTP sometimes has an effect within hours and is best suited for those whose low mood is related to serotonin deficiency. SAM-e a powerful nutrient that starts working within hours. B vitamins have a mild influence on depression. The combination of 5 HTP St. John's wort may help some people. If you plant to take St. John's wort and 5HTP together, use low dosages. These supplements should not be mixed together with pharmaceutical medicines prescribed for depression such as Prozac, Paxil, Zoloft, and other SSRI drugs.” What is the science behind why should not use St. John’s wort and 5HTP together with Paxil?
   A. A high dose of 5-HTP added to SSRI drugs may cause serotonin syndrome since SSRI drugs such as Paxil, Zoloft, Prozac, and others make more serotonin available in the brain and when 5HTP is taken in supplement form, it can increase serotonin levels even further. Experienced doctors may add 5-HTP as a treatment, but at the same time they would need to reduce the dosage of the SSRI to prevent serotonin syndrome.

Q. I notice that you are very cautious and conservative about dosing of herbal supplements, which is good. For that reason I was surprised to look at the info. on St. john's wort on your website and not see any cautions about combining it with food. I was taking a St. John's wort supplement for a while and my medical doctor told me it could have strong interactions with certain foods. I did some research and found that to be true, foods containing tyramine. In fact, it said that the interaction could be deadly.
   A. I have seen no reports in the medical literature that St. John's wort herbal supplement has any worrisome interactions with tyramine containing foods. A Medline search reveals no reports of any adverse reactions mentioned on combining St. John's wort and tyramine. Perhaps your doctor can provide us with the medical literature that he or she is aware of regarding this interaction.
      Q. I am no longer seeing that doctor. But I came across a web site called holistic online. It says, "The active ingredient of St. John's Wort is hypericin. Hypericin is believed to exert a similar influence on the brain as the monoamine oxidase (MAO) inhibitors such as the one in major antidepressants. Mixing MAO inhibitors with foods high in tyramine, an amino acid, produces one of the most dramatic and dangerous food-drug interactions. Symptoms, which can occur within minutes of ingesting such foods while taking an MAO inhibitor, include rapid rise in blood pressure, a severe headache, and perhaps collapse and even death. Foods high in tyramine include aged cheese, chicken liver, Chianti (and certain other red wines), yeast extracts, bologna (and other processed meats), dried or pickled fish, legumes, soy sauce, ale, and beer."
         A. You may wish to email Holistic Online web site and ask them to show a reference in a medical journal that shows St. John's wort is not safe to take with tyramine containing foods.

Q. I am from Honduras, Central America. Congratulations for your website. It has opened my eyes to some of the doubts I had about natural supplements. I have learned that they have to be taken seriously with caution because all the side effects and possible interactions, just like any synthetic drug. I am now taking Saint John's Wort supplement but I found that make my eyes a little sensitive to light. Is this possible? Also I am taking Cortitrol (blend of various herbs and amino acids) and I found that makes my sleep with so many dreams that i don't like it too much. Also i wake up several times a night. Each capsule of Cortitrol contains 133 mg of Magnolia bark ( Magnolia officinalis ), standardized to 2% Honokiol - a constituent with known anxiolytic properties, 100 mg Epimedium ( Epimedium koreanum ) Water Extract 6:1, 66.7 mg L-Theanine (from Camellia sinensis ) Extract 70:1 (TheaPure), 40 mg Beta Sitosterol, and 8.3 mg Phosphatidylserine.
   A. St. John's wort can make eyes sensitive to light and can also interfere with sleep in high dosages.

Q. Would it be inadvisable to take St. Johns Wort and Tyrosine supplements together?
   A. It is best to learn how each supplement works by itself and when combining supplements one should use very low dosages. No firm statements can be made on what supplements can be combined since each person may have a different reaction.

I have taken St. John's wort off and on for quite a while to alleviate depression. I have always had pleasant results taking Kira, but recently used sc27 for about four months. It was fantastic. I have become aware from an internet forum dedicated to this herb that St. John's can lead to serious eye trouble and cataracts. I have reluctantly stopped taking SJW as a result. I am an artist (painter) and can't afford to have eye issues! I was wondering if you could share your opinion of this side effect? I am under the impression that any kind of bright light, not just sunlight, can cause damage.
    I am not aware of studies linking the use of SJW and bright, non-sun, light exposure to eye problems, but, as with most herbs, it is a good idea to take breaks from use and to try different herbs or supplements that provide similar results.

I am thinking of taking St Johns wort for depression and anxiety. I read that some studies showed there might be a chance that it could affect fertility and the ability of sperm to penetrate an egg. I know that many say that the study is somewhat sketchy and inconclusive. My questions is: Are the researchers saying that it might permanently affect fertility or that it might affect fertility only when using it?
    I have not seen convincing human studies that the use of this supplement influences fertility to any great extent, particularly if it is only used for a few weeks or months.

Is there anything wrong with or any adverse reactions I might get from taking either of the following combinations: St Johns Wort, Inositol, Choline, and L-Theanine OR Saffron, Inositol, Choline, and L-Theanine? I am trying to combat depression and anxiety without any drowsiness or restlessness. It's also important to me to have mental sharpness and keep side effects to a minimum.
    Each person reacts differently to supplements and their combinations, and the dosages make a significant difference.

Note: Some people misspell St. John's wort as St. John's wart or St. John's wurt