St john’s wort (hypericum perforatum) has been used since the middle ages as a valuable relaxing herb. It also has long-lasting tonic effects on the whole nervous system.
Its main properties are:
The are some well-proven benefits for this.
This is what most people know st john’s wort for – it has become the product of choice for mild to moderate depression. We examine this in detail below.
St john’s wort has proven very helpful during menopause.
In a clinical study in Germany, 111 women aged from 43-65 years were given 12 weeks treatment with st john’s wort at standard dosage. In 75-80% of women, their menopausal symptoms diminished or disappeared completely – an amazing result! In addition, the st john’s wort was also reported to improve ‘sexual well-being’. (Advances in Therapy 1999 Jul- Aug;16(4):177-86)
The results of this study sound – let’s be honest – a bit too good to be true; but there must be something in them. It must be worth trying st john’s wort if you are approaching or in the menopause. Please let us know your experiences.
One question I’d ask would be: “Were the benefits maintained when the women stopped taking st john’s wort?”
I suspect they were not maintained completely – but it certainly sounds as if st john’s wort could be a good bet for reducing the symptoms of menopause – and making you feel better, at least in the short to medium-term.
If this is so, it would be preferable to take it in addition to a herbal formula aimed more at balancing the hormone system deeper down. In other words, aimed more at the cause of the menopausal symptoms.
Such a formula could include a balanced mixture of herbs such as blessed thistle, agnus castus, dong quai, sarsaparilla, licorice, squaw vine, and other herbs. Such hormone-balancing herbal formulas are available.
In this respect, st john’s wort is very well respected by herbalists
St john’s wort is a persistent, gentle nerve tonic, boosting the whole nervous system when taken regularly over an extended period say for 3-6 months. If long-term stress has led to nervous exhaustion, st john’s wort will often help, slowly but surely, to building the energy level back up towards normal.
This long, slow building up of energy via the nervous system is something shared by a few other valuable Western herbs, such as vervain and scullcap. The value of such herbs is that they calm the nervous system while they build it up. This is an opposite effect to that of sedative drugs, which can certainly calm the nervous system, but have no tonic powers.
After taking sedative drugs, the nervous system is weakened, and the liver stressed – because it has to deal with the drugs in the blood stream, which are treated more or less as poisons by the body. This weakening of the liver by medicinal drugs just makes matters worse for the poor old nerves and the emotional balance of the body – both of which are affected tremendously by the health of the liver.
There is certainly a place for drugs in our ‘ideal healthcare’ system – especially in emergency situations. But herbal and similar remedies are a better answer in many – in fact, most – situations where drugs are used today. Especially as no drugs have yet been found which have a tonic effect on the body – they are all debilitating. For tonics, you have to use alternative therapy.
Depression and st john’s wort
On to the best known use for st john’s wort – that of helping banish depression.
St john’s wort is generally recommended for cases of mild to moderate depression. (There don’t seem to have been any studies of st john’s wort being used in cases of severe depression.)
In Germany, st john’s wort has been prescribed for depression by doctors for decades. In 1994 alone, 66 million doses of the herb were taken.
In fact, st john’s wort is a ‘quasi-drug’ in that country; in that it is packaged like a drug, produced by pharmaceutical companies, and prescribed widely by doctors.
News of st john’s wort’s benefits has slowly filtered out to the rest of Europe so that in the UK, for example, hardly a day goes by without an article in the papers about st john’s wort and depression.
How much evidence is there?
Lots. Many studies have been performed where st john’s wort has been tested against a placebo – ie a sugar tablet; and against a standard drug widely used for depression.
The results are generally that:
- St john’s wort is considerably better than a placebo at alleviating mild to moderate depression. In other words, it is not just ‘suggestion’ that makes people taking st john’s wort feel less depressed.
- It is equally as good, or nearly as good, as the drug it is compared with in the studies carried out, but has few or no side effects. This is a very important point, as doctors – and members of the public – are very aware of the many side effects of many common anti-depressant drugs – not least, addiction.
What the studies should say (but it is hard to measure, so I am going to add it !) is that st john’s wort actually builds up the nervous system – as discussed above. So, in this respect, it is superior to anti-depressive drugs, which tend to weaken the body. This is a vital point! These drugs often make you walk around in a semi-catatonic state – and who wouldn’t be weakened after a few months of that? Whereas st john’s wort has a centuries-old tradition of strengthening the nervous system while it reduces depression – a valuable combination indeed.
So, if you take drugs for depression, you are basically zapped into ‘suspended animation’ for a few months, then re-emerge, probably with less energy, to fight the battle of life again. I know some people are delighted with a short course of drugs for depression. But I would argue that st john’s wort would help the majority of those with mild to moderate depression just as well – and probably better, because of its other advantages.
This may be a bit of an over-simplification; but the general argument is sound.
Where a scientific study has been carried out, it is usually fairly dense and hard to interpret for most of us mortals. So it is useful to see a summary of the study. This is often provided by the team who performed the study, and is called an scientific ‘extract’. Here are links to a few scientific extracts from studies involving st john’s wort and depression.
In general, these scientific extracts support the points above.
Preparation of st john’s wort
Basically, I do not like standardised extracts. I prefer whole herbs.
Someone decides what the ‘main active ingredient’ is – out of the dozens of components of a herb. Well, this is ridiculous for a start. A herb is a synergistic blend of all of its components; and the ‘whole’ is greater than the sum of its parts. In other words – don’t mess about with it – use the whole, natural plant.
In fact, ‘standardisation’ is a method used by scientific bods so they can say – with precision – such things as:
‘327 people were given an extract of xxxxxx herb, standardised to 0.05% of xxx ingredient, three times a day for 18 days, and 27% noticed such and such happened.’
The whole Alternative Health movement is pro-holistic healthcare, and anti-‘science for science’s sake’. In other words – science has its place – but don’t lets be silly about it.
A good question for those who are in favour of ‘standardised extracts’ is, “You have made an extract of a herb which contains a specified amount of one of the ingredients. Fine. But – what have you left out of your extract, which a holistic herbalist might prefer was left in?
The whole herb
I say – use “the whole herb and nothing but the whole herb”
Either use capsules or a liquid preparation from the whole herb such as a tincture or st john’s wort “fluid extract” – a stronger formulation so you don’t have to take so much.
What do you have to be careful of when using st john’s wort?
There have been no reported large scale reactions to st john’s wort – but there have been a small number of reactions reported among people taking the herb.
There are queries hanging over st john’s wort with regard to a number of drugs; particularly anti-depressants, hypertensive (high blood pressure) drugs, warfarin, AIDS medication, and the contraceptive pill.
The concern with anti-depressants, hypertensive drugs, and warfarin is that st john’s wort may possibly raise blood pressure, leading to an increased chance of a stroke. With the contraceptive pill and AIDS drugs, there is some indication that st john’s wort may reduce effectiveness of the drugs.
It is true that there is a very long history of use of st john’s wort in Europe – and only a tiny number of cases of strokes among st john’s wort users have been reported. However, they are there, and until or unless st john’s wort is cleared of all implication, it would be wise to avoid taking this herb with any drugs at all, including the contraceptive pill.
If you wish to switch to st john’s wort from an antidepressant drug, consult a doctor for advice on how to achieve this safely. As a minimum, close monitoring of blood pressure would be desirable.
Recommendation: Do not take st john’s wort together with drugs.
If changing to st john’s wort from antidepressant drugs, do so only under the supervision of a doctor or other qualified person who is closely monitoring your blood pressure.
It is accepted in scientific literature that anti-depressant drugs can cause fits in susceptible people. There have been a small number of anecdotal reports of epileptic fits occurring in patients taking st john’s wort.
As the herb has anti-depressant properties, it is recommended that it be avoided where there are epileptic tendencies.
Recommendation: Do not take st john’s wort if you have epilepsy, or a tendency towards fits or seizures.
In other words – sensitivity to light.
St john’s wort can – rarely – cause a rash when the skin is exposed to the sun. The hypericin from st john’s wort travels to the skin where, in a few individuals, the sun changes it to an itchy compound which causes the rash.
There are only a very small number of reported cases of this reaction; but it does happen. Where it has happened, when the St John’s Wort has been discontinued, the rash disappears.
Recommendation If you are taking St John’s Wort use extreme caution when in the sun, and do not use a sun bed, in case you are one of the minority who could develop photosensitivity. If you begin to develop a rash and have been in the sun, stay in the shade and discontinue the use of St John’s Wort until the rash clears up.
There was a report in New Scientist which stated that the photosensitive properties of the hypericin in st john’s wort could promote cataracts in rats. There are no reports of the same occurring in humans.
Recommendation: As a precaution, the researchers recommend that if you are in the sunshine, you should wearing ‘UV-resistant’ wrap-around sunglasses, if you are taking st john’s wort. Sunlight shining on the eyes is a cause of cataract in any case, so this is good advice to follow whether or not you are taking st john’s wort.
The usual dosage of whole herb st john’s wort (ie not ‘standardised extract’), is:
1 capsule 3 times a day.
Herbal fluid extract (1:1 strength)
10-15 drops 3 times a day in water or juice, (This form of the herb is not a standardised extract – which is a powder. It is a liquid preparation – usually alcoholic – where 1 litre of the liquid has been made with 1 kilo of the herb. Hence the ‘1:1’.)
1/2 teaspoon, 3 times a day in water or juice. A herbal tincture is made with 250-350g of herb steeped in a litre of alcohol. So it is 3-4 times weaker than the equivalent fluid extract.
Extract standardised to 0.3% hypericin
If you do use a standardised extract, follow the instructions on the pack – usually 2 or 3 capsules a day. The advantage of a standardised extract is that the quality control is more assured than for most preparations of the raw herb. But bear in mind that hypericin is now thought – fairly certainly – NOT to be one of the main active ingredients in this herb! So the fact that a preparation is standardised for a percentage of hypericin is irrelevant!
St john’s wort is a valuable herb with a long history of safe use in Europe.
It is valuable for:
- Mild to moderate depression
- Symptoms associated with the menopause
- Building up the Nervous System.
However, it appears that it can be a very active herb in some circumstances, so we advise the following cautions:
Do not take st john’s wort without thorough investigation if;
- You are any taking certain drugs – namely anti-depressants, warfarin or other blood-thinning medication, AIDS medication, or the contraceptive pill. For a UK government-approved list of medications to avoid, and advice on what to do if you are already taking st john’s wort and you are already taking one of these medications
- You have a tendency to suffer from any type of fit
- You are going to use a sun bed, or to sunbathe. Use with caution if you live in a hot country, or if travelling to a hot country, and discontinue the herb at the first sign of a skin rash developing.