St. John's Wort supplement side effects, benefits, use for depression and mood disorders, hot flashes, dosage, safety and risk, Information by Ray Sahelian, M.D.
May 1 2014


Standardized extracts of St. John's wort herb are commonly used as a treatment for depression, to improve mood and to treat certain mood disorders. The herb has been used for several centuries as a natural herbal treatment for different types of mental conditions. More doctors are gradually beginning to recognize that natural supplements such as St. John's wort, SAM-e, and the nutrient 5HTP are as potent as pharmaceutical medicines in terms of mood enhancement and the treatment of depressive disorders, with far fewer side effects compared to the prescription drugs. We have people ask us whether 5 HTP, SAM-e and St. John's wort can be used together, see below for a discussion. I am still not sure which neurotransmitters it effects predominantly.

Buy St. John's Wort Extract supplement, 300 mg pill

Scientific research shows hat St. John's wort may lighten mood and support a positive emotional balance.  Remember that a sensible program of diet and exercise can enhance the benefits of this standardized herbal product. This St. John's wort (Hypericum perforatum) product is standardized to contain 0.3% hypericin and 3% hyperiforin.
   Also consider Mind Power Rx which helps with alertness, focus, and mood improvement.

 

 

 

Buy St John's Wort supplement 5HTP SAM-e or Mind Power Rx
  
Warning and caution:  For occasional use only. Do not exceed recommended dose except on the advice of a health professional. Do not take this herb 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. There may be an increased risk for cataract in those who use this natural antidepressant for prolonged periods and expose themselves to regular sunlight. Wear dark glasses when in sunlight. Take breaks from use, particularly in the summertime when the sun is strong. Consider other options to manage mood while off it, such as 5-HTP or SAM-e.

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

Benefits of St. John's wort herbal supplement

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 may be noticed the evening of the first day, but often it takes a few days or weeks for the full benefits of this herb to occur. Some studies indicate that this herbal extract may be as good an antidepressant as some of the SSRIs such as Prozac, Paxil and Zoloft. A 6 week double blind study using a combination of St. John's wort, valerian herb, and passion flower found the mix 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 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.

Researchers 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. "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.

Hot flashes - Marjan Khajehei, of Shiraz University of Medical Sciences in Iran, report that among a group of women they randomly assigned to take either St. John's wort or a placebo for eight weeks, those using the herb noticed a greater reduction in daily hot flashes. Among women taking the herb, the average number of hot flashes was reduced  from roughly four per day to fewer than two per day after several weeks of use. St. John's wort reduced the duration and severity of the women's hot flashes. The trial included 100 women who were 50 years old, on average, and had been experiencing moderate to severe hot flashes at least once per day. St. John's wort contains estrogen-like plant compounds called phytoestrogens, and Marjan Khajehei thinks it's possible that these compounds may have been responsible for the benefits although other substances within the plant could also be responsible. Menopause, February 2010.

PMS -- St. John's wort supplements have been found to be partially helpful in treating PMS.
Some of the most widely prescribed medications for this condition are selective serotonin reuptake inhibitors (SSRIs), based on the hypothesized role of serotonin in the production of PMS symptoms.

The Efficacy of Hypericum perforatum for the Treatment of Premenstrual Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial.
CNS Drugs. 2010.
This randomized, double-blind, placebo-controlled, crossover study was conducted at the. Institute of Psychological Sciences, University of Leeds, Leeds, UK. 36 women aged 18-45 years with regular menstrual cycles, were prospectively diagnosed with mild PMS. Women were then randomly assigned to receive St. John's wort tablets 900 mg/day (standardized to 0.18% hypericin; 3.3% hyperforin) or identical placebo tablets for two menstrual cycles. Plasma hormone (follicle-stimulating hormone [FSH], luteinizing hormone [LH], estradiol, progesterone, prolactin and testosterone) and cytokine (interleukin [IL]-1beta, IL-6, IL-8, interferon [IFN]-gamma and tumor necrosis factor [TNF]-alpha) levels were measured in the follicular and luteal phases during Hypericum perforatum and placebo treatment. St John's Wort was statistically superior to placebo in improving physical and behavioral symptoms of PMS. There were no significant effects of Hypericum perforatum compared with placebo treatment for mood- and pain-related PMS symptoms. Plasma hormone (FSH, LH, estradiol, progesterone, prolactin and testosterone) and cytokine (IL-1beta, IL-6, IL-8, IFNgamma and TNFalpha) levels, and weekly reports of anxiety, depression, aggression and impulsivity, did not differ significantly during the herbal and placebo cycles.

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.

Somatoform disorders (see study below).

Mind Power Rx has: Ashwagandha, Bacopa, Fo-Ti, Ginkgo biloba, Ginseng, Mucuna pruriens, Rhodiola, and Reishi.  The nutrients and vitamins in Mind Power Rx include Acetyl-l-carnitine, Carnitine, Carnosine, Choline, DMAE, Inositol, Methylcobalamin, Pantothenic acid, Trimethylglycine, Tyrosine, and Vinpocetine.

This brain enhancer is a highly advanced cognitive formula containing a dozen herbs and nutrients. It combines a delicate balance of brain circulation agents and neurotransmitter precursors with powerful natural brain chemicals that support healthy:

Memory and Mood
Mental clarity
Concentration 
Alertness and Focus

 

 
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, danger, risk
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 concern. Adverse reactions could also include retinal harm or cataract formation 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 or wear dark sunglasses and a wide brimmed hat.

BMC Complement Altern Med. 2013. Evaluation of the cytotoxicity, mutagenicity and antimutagenicity of a natural antidepressant, Hypericum perforatum, on vegetal and animal test systems. The results of this study suggest that the administration of H. perforatum, especially by gavage similar to oral consumption used by humans, is safe and with beneficial antimutagenic potential.

I read the information on your site 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 it be taken with another supplement to counteract the side effects?
   It is best to reduce the dosage rather than to take something else to counteract the St. John's wort side effects.

I started taking St. John's wort extract to help with menopause depression. I had read that it 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 had the same experience when taking licorice. I must be very sensitive.
   In my opinion, 900 mg 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.

I just read your very informative page and noticed that someone was quiting this herb because of the fear of developing cataracts. They said that they had switched from Kira to New Chapter SC27. I wanted them to know that SC27 only has hyperforin, which is not responsible for the phototoxicity. It is the hypericum part of St. John's wort that may be phototoxic and therefore cause cataracts after long term exposure to sunlight. Great Website! Thanks for all the great info!
    I'll wait for more studies before I can definitely confirm that hyperforin is safer than hypericum in terms of its effect on the retina but at this time it appears to be safer. I would like to see studies comparing hyperforin to hypericum regarding their effects and differences in terms of treating depression.

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 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.

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.

I didn't see mention on your site of neuritis from high doses, but I experienced it and I think people should know about it. A few years ago I became dysfunctional from a major depression, due to grieving several losses in a short time span compounded by a miserable high-pressure job. Hoping to avoid antidepressant medication, I started taking St. John's wort, 250 mg daily. After 10 days of this with no effect, I doubled the daily dose. That seemed to help slightly, so eventually I increased the dose to 750 mg daily, and found that it lifted the depression somewhat, not entirely. After 3 months I noticed my hands burning and stinging. The pressure of holding a mug of coffee set off an intense needle-like pain that would last for several seconds after I'd let go of the mug. Holding the steering wheel of my car felt like the wheel was cutting right through my fingers. This continued to grow worse, and I started getting it in my feet, too. It reminded me of the diabetic neuritis someone I'd known had had, and I began reading about neuritis. I read that it can be caused by toxic levels of certain drugs and chemical substances. The only substance I was taking (besides the vitamins I'd always taken) was the "harmless" herb St. John's wort. I quit taking the herb. In a few days the needle-like pain was gone from my feet and had lessened in my hands, and within 2 weeks the neuritis symptoms were gone. Unfortunately, the depression came back with a vengeance, too.

St. John's wort caution, danger, safety, drug interactions
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.
  
It may interfere with oral contraceptives. It is an inducer of cytochrome P450 (CYP) 3A enzymes and may reduce the efficacy of oral contraceptives.
   it 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 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.

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.

Interactions with medications
This herbal supplement should be used cautiously by those who take certain medications, including antidepressants, the heart medication digoxin and the blood thinner warfarin.

St. John's Wort dosage, how much to take
Since each person is different, the proper dosage 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.

Research
Influence of St John's wort on catecholamine turnover and cardiovascular regulation in humans.
Clin Pharmacol Ther. 2004.
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.

Flavonoids of St. John's Wort Reduce HPA Axis Function in the Rat.
Planta Med. 2004.
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. We previously showed that a methanolic extract of St. John's 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. Our results support the hypothesis that flavonoids are involved in the antidepressant effects of St. John's wort.

Treatment of Somatoform Disorders With St. John's Wort : A Randomized, Double-Blind and Placebo-Controlled Trial.
Psychosom Med. 2004.
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. In the intention to treat population, 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. 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
Psychopharmacol. 2004.
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. 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
Fortschr Neurol Psychiatr. 2004.
 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.

An open-label pilot study of St. John's wort in juvenile depression.
J Am Acad Child Adolesc Psychiatry. 2003.
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. Thirty-three youths 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. St. John's wort may be an effective treatment for youths diagnosed with major depressive disorder.


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?
   A. They are different. The former 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 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 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. Johnís 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. Johnís 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. 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 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. 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. 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 every 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 Johnís wort and Lithium. What are your suggestions and which natural medication ( 5 HTP or St Johnís 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 them?
   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. 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? ďAdditional 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.Ē What is the science behind why should not use St. Johnís 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 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 regarding this combination. 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 koreanum Extract 6:1, 66 mg L-Theanine (from Camellia sinensis ) Extract 70:1 (TheaPure), 40 mg Beta Sitosterol, and 8 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.

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