The Truth about St John’s Wort: Benefits, Risks, Side Effects

The Truth about St John’s Wort: Benefits, Risks, Side Effects

St. John’s Wort is an herbal remedy that has divided opinion. Depending on which side of the fence you’re on, it’s either the ultimate herbal cure for anxiety, or a dangerous medicine with more contraindications and side effects than benefits. So, what’s the truth, how beneficial (or otherwise) is it, and what do you need to know if you plan on taking it?

What is St John’s Wort?

St John’s Wort, or Hypericum perforatum to give it its generic name, is a plant native to Europe and Asia. It has been used in traditional medicine for many hundreds of years, and its name is thought to derive from the Order of St John, who used it to heal wounds after fighting in the Crusades.

These days, it’s mainly used in the treatment of depression and, as discussed below, there have been a few studies supporting this use. But it’s still considered a dietary supplement, as opposed to a medicine, and a few things have been holding it back and stopping it from being prescribed as a safe alternative to antidepressant drugs.

The Benefits

St John’s Wort is sold as an herbal alternative to drugs like Prozac, and a number of studies actually suggest it could work in the same way. It may not be as effective as the aforementioned antidepressant, or any similar prescription drugs, but when compared to placebo, St John’s Wort has proved to be very effective.

A 2006 meta-analysis looked at 35 studies and nearly 7,000 patients and noted that St John’s Wort was considerably more effective than placebo and also caused fewer adverse reactions than commonly prescribed antidepressants. (1) A 2017 analysis of nearly 4,000 patients found this herbal remedy displayed similar results to prescribed drugs when used to treat mild to moderate depression. (2) It also noted that patients on St John’s Wort were more likely to stick with their treatment than those taking antidepressants.

The problem is, these results haven’t been consistent across the board, and there has been very little research on long-term use. It also has limited efficiency when used to treat chronic depression and mood disorders, and there have been some concerns regarding its risks and interactions.

The Side Effects

St John’s Wort is very well tolerated, and most users will not experience side effects. It has earned a reputation for producing many unpleasant side effects and for being a dangerous drug, but this likely stems from its potentially life-threatening contraindications (discussed below) as opposed to any common side effect.

The most common adverse effects of St John’s Wort are related to digestive issues and include:

  • Nausea
  • Vomiting
  • Stomach pains
  • Diarrhoea
  • Changes in appetite
  • Restlessness
  • Dizziness
  • Changes in vision
  • Sleeplessness
  • Lightheadedness
  • Headache
  • Confusion
  • Tiredness

St John’s Wort is also not recommended for anyone with bipolar disorder, as it is thought to increase the risk of mania. Anyone who has—or think they may have—bipolar disorder should stay clear or at least consult their doctor first.

The Contraindications

The main concerns with St John’s Wort consumption are the contraindications, of which there are several. Unlike the passionflower contraindications previously discussed, the interactions with St John’s Wort can be very serious and even life-threatening, and anyone consuming any kind of prescription (or otherwise) medication should stay clear of this remedy.

Some of the more serious contraindications concern the consumption of St John’s Wort in addition to antidepressants, which can lead to a very serious condition known as serotonin syndrome, as well as cancer drugs, HIV drugs, and a number of medications taken to regulate blood pressure. It should also not be taken in combination with birth control pills, as it may interfere with their efficiency.

This is not a complete list of contraindications by any stretch, so we really have to stress that you need to consult your doctor first if you have a preexisting health condition or are taking any medication.

The Dose

There is no standardised dose for St John’s Wort, and the extract strengths can differ quite considerably, which means there is no single recommended dose either. As with other herbal extracts (such as milk thistle silymarin extracts), the strength will typically be displayed as a percentage or as a dose in milligrams, the latter of which seems to be the most common, with doses ranging from around 140mg to just under 400mg.

This strength will dictate how much you should take, so make sure you read the back of the bottle or the packet and follow the instructions. If you’re concerned about side effects, begin with a weaker concentration or fewer tablets. It is usually taken 2 to 3 times a day, but you may want to begin with a single dose in the evening just in case you feel any strong sedative effect.

Alternatives to St John’s Wort

The majority of herbal remedies can improve your physical health, providing a hearty dose of antioxidant and anti-inflammatory compounds, but there are also a minority that may impact your mental health. Very few herbal remedies have been certified by official health organisations here in the United Kingdom, but some stand out more than others, and some are even prescribed for insomnia, anxiety, and other issues in other countries.

We have listed a few alternatives to St John’s Wort below. Click the links to visit our guides and learn more.

  • Camomile: There are antioxidant compounds in this flower that may alleviate the symptoms of anxiety and could also help you fall asleep. It is also thought to be effective in treating digestive ailments, as it has the same soothing effect on the digestive tract that it has on the mind. It’s safe, widely tolerated, and tastes great, making it the perfect herbal remedy to enjoy in tea form.
  • Valerian Root: This herbal remedy doesn’t taste the best; in fact, it’s one of the worst tasting herbal remedies you will encounter, making it unpalatable as a tea. But it could be effective when consumed in tablet or tincture form and is thought to help combat insomnia when consumed in large doses in the evening, and anxiety when consumed in smaller doses throughout the day.
  • Lavender: This beautiful blue herb contains essential oils that may help you relax and unwind. As discussed in our guide to the benefits of lavender, the most intriguing health studies concern its effects when inhaled, which is why it’s commonly used as a massage oil, pillow spray, or in a diffuser. We added lavender to our CatNap blend in combination with soothing camomile and lemon verbena to provide a dose of these healthy oils and to ensure you’re breathing them in as you unwind with your hot cup of herbal tea.
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