Herbal Medicine Fact Sheets
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November 6, 2023

How to Use St. John's Wort Therapeutically: The Health Uses You May Never Have Heard Of

Written By
Dr. Jaime Cloyd ND
Medically Reviewed by
Updated On
January 14, 2025

St. John's wort has a rich history dating back centuries, revered for its traditional uses and potential benefits. The herb's ancient uses trace back to various cultures, where it was believed to possess supportive properties for overall health and well-being. Historically, St. John's wort found its place in herbal practices, with its name derived from the fact that it is often in full bloom on John the Baptist's birthday. In recent years, as the interest in complementary approaches has surged, St. John's wort has gained recognition for its potential in supporting mood and emotional balance. Its enduring legacy as a plant used in traditional practices continues to make it a subject of research and a component in alternative approaches. (27)

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What is St. John's Wort?

St. John's wort boasts distinct botanical attributes that make it easily identifiable. This perennial plant, scientifically named Hypericum perforatum, features bright yellow flowers with five petals and numerous stamens. The leaves are characterized by small, translucent dots that resemble perforations when held against the light, a unique trait of this plant. St. John's wort typically grows in well-drained soils, favoring sunny, open spaces. It thrives in regions with temperate climates, often found in Europe, Asia, and North America. This hardy plant has been widely recognized for its potential benefits, especially in herbal practices, due to the presence of hypericin and other active compounds. (27, 28

What Are The Active Components of St. John's Wort?

St. John's wort derives its potential benefits from its flowers and, to a lesser extent, its leaves, which contain active compounds called napthodianthrones (e.g., hypericin and pseudohypericin), phloroglucinols (e.g., hyperforin), and flavonoids (e.g., quercetin, kaempferol, and luteolin). Hypericin, pseudohypericin, and hyperforin have been studied for their roles in supporting neurotransmitter balance. However, the phenolic compounds found in St. John's wort likely work together to help manage oxidative stress and support a healthy inflammatory response, contributing to the herb's potential benefits. 

(17, 28)

Top Uses of St. John's Wort

St. John's wort has gained popularity for its diverse applications. From its potential in supporting mood balance to its role in managing skin health, the herb's uses showcase its contributions to natural wellness practices.

1. St. John's Wort for Mood Support

St. John's wort has gained attention in the realm of mental wellness, particularly for its potential to support mood balance. The herb's constituents, hyperforin and adhyperforin, are believed to influence neurotransmitter activity, which may help maintain balanced levels in the brain, contributing to mood support. 

Numerous studies have explored its potential in supporting emotional well-being. These studies suggest that St. John's wort may be more effective than a placebo and comparable to certain medications for supporting mood in mild to moderate cases. Additionally, findings show that St. John's wort is often well-tolerated, with fewer adverse effects than some standard therapies. Furthermore, the positive effects of St. John's wort may be longer-lasting than some pharmaceutical options. One clinical trial suggested that 900 mg of St. John's wort extract may support mood over time compared to citalopram and placebo. (3, 9)

2. St. John's Wort for Menopausal Support

SSRIs are a class of medications primarily used to support mood balance; however, they have also been found to be effective in managing menopausal symptoms, including hot flashes and night sweats. The exact mechanism through which SSRIs alleviate hot flashes is not fully understood, but it is believed to be related to their impact on neurotransmitter levels in the brain. Hot flashes are thought to be triggered, in part, by fluctuations in serotonin and norepinephrine. SSRIs work by influencing serotonin levels, which may help regulate the body's temperature control system, reducing the frequency and intensity of hot flashes. (15

A meta-analysis of clinical trials in menopausal adults suggests that taking 900 mg of St. John's wort for up to 16 weeks may help manage the frequency and severity of hot flashes when compared to placebo. Other research also suggests the herb may support overall quality of life and psychological well-being in menopausal adults (2, 10). St. John's wort may be effective when used alone or with other botanicals. Black cohosh has been commonly studied in combination with St. John's wort.  

3. St. John's Wort for Premenstrual Support

Women experiencing premenstrual symptoms often report a range of emotional and physical changes, including mood swings, irritability, and fatigue. These symptoms may stem from chemical imbalances. Research suggests that women with premenstrual symptoms may have lower serotonin levels during the last ten days of the menstrual cycle, which could contribute to changes in mood, energy, and sleep patterns. (5

Similar to mood support and menopause, SSRIs can be used as a conventional option for managing premenstrual symptoms. St. John's wort has been explored as an alternative over-the-counter option for natural premenstrual symptom support. One clinical study suggested that taking St. John's wort extract 450 mg twice daily may help manage physical and behavioral symptoms of premenstrual syndrome after two menstrual cycles. A published case study has also explored St. John's wort as an option for supporting symptoms of premenstrual dysphoric disorder (PMDD), a more severe form of premenstrual syndrome. 

4. St. John's Wort for Skin Health

St. John's wort has properties that may help support skin health and manage inflammation (28). Applied topically, these actions contribute to the herb's potential in skin care, which may be beneficial for managing inflammatory skin conditions and supporting wound healing. Hypericin and hyperforin are believed to play a role in supporting the skin's response to inflammation and promoting the healing process (20).  

The inflammatory cytokine tumor necrosis factor-alpha (TNF-alpha) is commonly elevated in psoriatic skin lesions. In a double-blind study, researchers found that applying a 5% topical St. John's wort ointment to the skin of patients with moderate psoriasis may help manage TNF-alpha levels and support the reduction of redness, thickness, and scaling of psoriatic skin plaques.

A published case study also suggests that St. John's wort may support the healing of skin, improving the recovery of pressure sores in an intensive care unit patient. A larger study, including 144 women undergoing childbirth via cesarean section, demonstrated the potential of topical St. John's wort in supporting skin healing post-cesarean section, minimizing scar formation, and reducing discomfort at the surgical site.

5. St. John's Wort for Neuropathic Support

Neuropathic pain is a type of chronic pain that occurs as a result of damage or dysfunction in the nervous system. This type of pain affects an estimated 10% of the general population and can manifest in conditions including diabetic neuropathy, sciatica, shingles, and multiple sclerosis. Neuropathic pain is notoriously difficult to manage, and approaches usually involve a combination of medications, physical therapy, and psychological support.

St. John's wort has been explored as a natural option for supporting neuropathic health. By influencing neurotransmitters in the brain, St. John's wort may help support pain perception pathways. Another theory for St. John's wort's potential effects is its ability to influence protein kinase C pathways, which are implicated in neuropathic pain. (1)  

6. St. John's Wort for Sleep Support

St. John's wort has shown potential benefits in supporting sleep, making it a subject of interest in the realm of sleep wellness. Most clinical studies of St. John's wort have focused on mood support rather than sleep specifically. However, sleep disturbances are a common experience in mood imbalances, and studies have found that supplementing with St. John's wort may help manage sleep disturbances related to mild to severe mood challenges. (14, 18

Some evidence suggests St. John's wort may be beneficial for sleep by supporting the duration of deep sleep rather than optimizing overall sleep quality. The time spent in deep sleep, without any other changes to sleep patterns, has been measured to be longer in individuals taking supplemental St. John's wort. (23, 24

Potential Side Effects and Interactions with St. John's Wort

While St. John's Wort is considered a natural option with many potential benefits, it is crucial to be aware of possible side effects and interactions associated with its use. Some individuals may experience mild side effects, such as gastrointestinal upset, dry mouth, dizziness, fatigue, or skin sensitivity to sunlight. (17

Because St. John's wort may influence serotonin levels, taking it with other medications that also affect serotonin may cause serotonin syndrome, a potentially serious situation characterized by flushed skin, nausea, vomiting, rapid heart rate, tremor, and altered mental status.

One significant concern with St. John's Wort is its potential to interact with various medications and supplements. The herb can influence certain liver enzymes responsible for drug metabolism, leading to reduced effectiveness of medications metabolized by these enzymes. This interaction can interfere with the potency of several prescription drugs, including birth control pills, anticoagulants, heart medications, antidepressants, chemotherapy agents, and immunosuppressants. (17, 27) 

It is crucial for anyone considering St. John's wort supplementation to consult a healthcare professional, especially if they are already taking medications or have existing health conditions. Healthcare providers can assess potential interactions and provide personalized recommendations to ensure the safe and effective use of St. John's wort as a complementary option.

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Summary

Exploring the potential benefits of St. John's wort opens the door to a range of supportive uses, from its role in mood support to its potential in managing neuropathic health and skin wellness. With a rich history rooted in traditional practices, this plant has found its place in modern complementary approaches. However, it is crucial to approach its use with informed caution, understanding its potential interactions and possible side effects. When used thoughtfully and under professional guidance, individuals can explore the advantages offered by St. John's wort, tapping into its diverse potential.

The information in this article is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. This information should not be used to diagnose or treat any health problems or illnesses without consulting a doctor. Consult with a health care practitioner before relying on any information in this article or on this website.

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2. Al-Akoum, M., Maunsell, E., Verreault, R., et al. (2009). Effects of Hypericum perforatum (St. John's wort) on hot flashes and quality of life in perimenopausal women: a randomized pilot trial. Menopause (New York, N.Y.), 16(2), 307–314. https://doi.org/10.1097/gme.0b013e31818572a0

3. Apaydin, E. A., Maher, A. R., Shanman, R., et al. (2016). A systematic review of St. John's wort for major depressive disorder. Systematic Reviews, 5(1). https://doi.org/10.1186/s13643-016-0325-2

4. Canning, S., Waterman, M., Orsi, N., et al. (2010). The Efficacy of Hypericum perforatum (St Johnʼs Wort) for the Treatment of Premenstrual Syndrome. CNS Drugs, 24(3), 207–225. https://doi.org/10.2165/11530120-000000000-00000

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11. Hashemian, F., Mansouri, P., Mirafzal, S., et al. (2017). The impact of topical Saint John's Wort (Hypericum perforatum) treatment on tissue tumor necrosis factor-alpha levels in plaque-type psoriasis: A pilot study. Journal of Postgraduate Medicine, 63(4), 215. https://doi.org/10.4103/0022-3859.201423

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30. Uebelhack, R., Blohmer, J.-U., Graubaum, H.-J., et al. (2006). Black Cohosh and St. John's Wort for Climacteric Complaints. Obstetrics & Gynecology, 107(2, Part 1), 247–255. https://doi.org/10.1097/01.aog.0000196504.49378.83

31. Yoshimura, H. (2023, June 29). Integrative Medicine Approaches to Neuropathic Pain Management: Specialty Testing and Treatment Options. Rupa Health. https://www.rupahealth.com/post/integrative-approach-to-neuropathic-pain-management

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