Published on February 25th, 2014 | by Margaret Pardoe0
SAD and St John’s Wort
St John’s wort (Hypericum perforatum) is a herb that has been used for hundreds of years for mental health problems and for healing wounds.
Nowadays it is mostly used for depression, mild anxiety, and sleep problems and has been found to help with SAD syndrome (Seasonal Affective Disorder). See the article Sad This Winter?
The active ingredient for depression is called hypericin (if you decide to self medicate you need to note how much hypericin (or ‘hypericum extract’), is in each tablet or capsule).
The other active ingredient is hyperforin which has antibiotic properties.
Herbs work differently to pharmaceutical drugs and the whole herb is so much more than its individual parts.
Herbs are also much more effective when coupled to a healthy lifestyle.
According to MIND in the UK, research suggests that it increases the activity and prolongs the action of the brain chemicals serotonin and noradrenaline, in a similar way to antidepressants, but with far fewer side effects.
Tablets made using a standardised extract of St John’s wort, to treat depression, have been extensively researched in Germany since the early 1980s, and were found to be effective for mild to moderate depression.
Research in America found it unhelpful for severe depression (now questioned by more recent research which suggested that it was comparable with paroxetine, a synthesised antidepressant, in moderate to severe depression).
St John’s wort usually takes effect more quickly than prescribed antidepressants.
St John’s wort can be taken as tablets, capsules, tincture and medicinal herbal tea. It can be combined with other herbs e.g. lemon balm (Melissa officianalis) and hops (Humulus lupulus), both of which help with sleep.
The different forms of St John’s wort vary in dosage, which is not standardised. Research trials done in Germany used a daily dosage of total extract, ranging from 0.4mg (400 micrograms) up to 1,000mg (1 gram).
Preparations available in the UK often give a strength in terms of percentage of hypericin, or hypericum extract, with a suggested dosage of 200 mg – 1,000 mg of 0.3 per cent standardised hypericum extract per day, usually taken in two or three doses.
It’s advisable to use herbs under the care of a qualified medical herbalist. But if you choose to self medicate with St John’s wort there are circumstances when you should be particularly cautious e.g. if you have a diagnosis of bipolar disorder because (as with all antidepressants), it has the potential to cause hypomania (i.e. rapid mood changes from low to high mood).
You should also be cautious about taking St John’s wort if you are pregnant or breastfeeding, because there are currently no safety recommendations.
There is also no information about its safety for children under the age of 18.
The most common side effects of St John’s wort include:
symptoms affecting your stomach and digestion e.g. nausea, vomiting, diarrhoea
NB a rare side effect is increased sensitivity to sunlight; if you think this is affecting you, you should consider using a high factor sunscreen, cover up, or stay out of the sun. You should also be cautious with taking St John’s wort if you use a lamp for seasonal affective disorder.
A number of medicines which are in common use inter-react with St John’s wort, either making them less effective or causing side effects. These range from prescription drugs to over-the-counter drugs such as paracetamol. You need professional advice from a pharmacist, medical herbalist or doctor before taking St John’s wort at the same time as any other medication.
St John’s wort should not be taken with any other antidepressant.
St John’s wort may prolong the effects of some sleeping pills and anaesthetics (so tell the anaesthetist if you are taking St John’s wort and have surgery planned).
St John’s wort reduces the level of oral contraceptives in your blood, increasing the risk of pregnancy and breakthrough bleeding.
Withdrawal symptoms include nausea and dizziness and feeling tense if St John’s wort is suddenly stopped, and it is suggested that it’s withdrawn slowly.
St John’s wort is not recommended by the British National Formulary (the main drug reference book used by UK health professionals) or by the National Institute for Health and Clinical Excellence (NICE).It is also not supported by NHS funding.
However you can buy it over the counter in the UK, it’s prescribed in many European countries and is prescription-only in Ireland
The MHRA (Medicines and Healthcare products Regulatory Agency), responsible for licensing medicines in the UK, licenses St John’s wort products under the Traditional Herbal Medicine scheme. Registration is based on the long-standing use of a plant as a traditional herbal medicine, and not based on clinical trials.
To read more about the use of St John’s wort take a look at this report in the British Medical Journal: