November 6, 2023

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

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Updated On

September 18, 2024

St. John's wort has a rich history dating back centuries, revered for its medicinal properties and therapeutic benefits. The herb's ancient uses trace back to traditional medicine practices in various cultures, where it was believed to possess remarkable healing powers and aided in treating kidney and lung disease, insomnia, depression, and wounds. Historically, St. John's wort found its place in herbal remedies, 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 medicine has surged, St. John's wort has gained widespread recognition for its effectiveness in addressing various health concerns, particularly in managing depression and other mood-related conditions. Its enduring legacy as a medicinal herb continues to make it a subject of extensive research and a cornerstone in alternative therapies. (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 therapeutic properties, especially in herbal medicine, 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 medicinal prowess from its flowers and, to a lesser extent, its leaves, which are rich in 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 best studied and believed to exert many of their therapeutic effects by regulating levels of neurotransmitters in circulation. However, the phenolic compounds found in St. John's wort likely act synergistically to combat oxidative stress and reduce inflammation, further contributing to the herb's medicinal properties.

(17, 28)

Top Therapeutic Uses of St. John's Wort

St. John's wort has gained popularity for its diverse therapeutic applications. From its effectiveness in treating depression and anxiety to its potential in managing skin conditions, the herb's top therapeutic uses showcase its versatile and valuable contributions to natural medicine.

1. St. John's Wort for Depression

St. John's wort has gained significant attention in the realm of mental health, particularly for its ability to act as a natural antidepressant. The herb's constituents, hyperforin and adhyperforin, modulate the effects and inhibit the reuptake of neurotransmitters serotonin, dopamine, and norepinephrine. By preventing the rapid reabsorption of these neurotransmitters, the herb helps maintain higher levels in the brain, leading to improved mood.

Numerous clinical studies have supported its efficacy in alleviating emotional and somatic depressive symptoms. These studies indicate that St. John's wort is superior to placebo and as effective as low-dose tricyclic and selective serotonin reuptake inhibitor (SSRI) antidepressants for treating mild to moderate depression. Additionally, findings show that St. John's wort is often better tolerated, resulting in fewer adverse effects than standard pharmacologic therapies. Furthermore, the positive benefits of St. John's wort may be longer-lasting than its pharmaceutical counterparts. One clinical trial concluded that 900 mg of St. John's wort extract resulted in increased response duration and reduced rates of relapse and recurrence compared to citalopram and placebo. (3, 9)

2. St. John's Wort for Menopausal Symptoms

SSRIs are a class of medications primarily used to treat depression and anxiety disorders; however, they have also been found to be effective in managing menopausal vasomotor 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 blocking the reabsorption of serotonin in the brain, leading to increased serotonin levels. This alteration in serotonin levels 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 shows that taking 900 mg of St. John's wort for up to 16 weeks reduces the frequency and severity of hot flashes when compared to placebo. Other research also suggests the herb improves overall quality of life and psychological symptoms in menopausal adults (2, 10). St. John's wort is 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 Syndrome (PMS)

Women suffering from PMS often experience a range of emotional and physical symptoms, including mood swings, irritability, and fatigue. These symptoms may stem from chemical imbalances. Research shows that women with PMS have significantly lower serotonin levels during the last ten days of the menstrual cycle, accounting for the onset of changes to mood, energy, and sleep patterns associated with PMS. (5)

Similar to depression and menopause, SSRIs can be used as a conventional and pharmacologic option for treating PMS symptoms. St. John's wort has been used as an alternative over-the-counter treatment for natural PMS symptom relief. One clinical study showed that taking St. John's wort extract 450 mg twice daily reduced physical and behavioral symptoms of PMS after two menstrual cycles. A published case study has also demonstrated St. John's wort as an effective option for ameliorating symptoms of premenstrual dysphoric disorder (PMDD), a more severe form of PMS.

4. St. John's Wort for Skin Conditions

St. John's wort has antimicrobial properties and may help fight inflammation (28). Applied topically, these actions contribute to the herb's therapeutic potential in skin therapy, which is beneficial for inflammatory skin conditions and superficial wounds. Hypericin and hyperforin are responsible for inhibiting the epidermal inflammatory response and promoting the proliferation phase of the wound-healing cascade (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 significantly reduced TNF-alpha and resulted in reduced redness, thickness, and scaling of psoriatic skin plaques.

A published case study also depicts that St. John's wort can improve the epithelialization of skin, improving the healing of pressure sores in an intensive care unit patient. A larger study, including 144 women undergoing childbirth via cesarean section, demonstrated the efficacy of topical St. John's wort in facilitating skin healing post-cesarean section, minimizing scar formation, and reducing pain and itching at the surgical site.

5. St. John's Wort for Neuropathic Pain

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 treat, and management usually involves a multifaceted approach involving a combination of medications, physical therapy, and psychological support.

St. John's wort has emerged as a natural remedy for neuropathic pain. By modulating neurotransmitters in the brain, St. John's wort may help regulate pain perception pathways and reduce neuropathic pain. Another theory for St. John's wort's analgesic effects is its ability to inhibit protein kinase C pathways, which are implicated in neuropathic pain. (1)

6. St. John's Wort for Sleep Disorders

St. John's wort has shown potential therapeutic benefits in addressing sleep disorders, making it a subject of interest in the realm of sleep medicine. Most clinical studies of St. John's wort have focused on treating depression rather than insomnia specifically. However, sleep disturbances are a common clinical manifestation of depression, and studies have found that supplementing with St. John's wort results in reduced insomnia related to mild to severe major depression. (14, 18)

Some evidence suggests St. John's wort may be beneficial for sleep by prolonging the duration of deep sleep rather than optimizing overall sleep quality. The time spent in deep sleep, without any other changes to sleep architecture, has been measured to be longer in patients 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 remedy with many therapeutic attributes, it is crucial to be aware of potential 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 increases circulating levels of serotonin, taking it with other antidepressants or medications that also augment serotonin may cause serotonin syndrome, a potentially life-threatening 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 induce 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 therapy.

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Summary

Embracing the healing properties of St. John's wort opens the door to a myriad of therapeutic benefits, ranging from its efficacy in managing depression to its potential in alleviating neuropathic pain and skin conditions. With a rich history rooted in ancient remedies, this medicinal herb has found its place in modern complementary medicine. However, it is crucial to approach its use with informed caution, understanding its potential drug-herb interactions and possible side effects. When used thoughtfully and under professional guidance, individuals can maximize the advantages offered by St. John's wort, tapping into its diverse healing potential.

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)

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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 provided is not intended to be a substitute for professional medical advice. Always consult with your doctor or other qualified healthcare provider before taking any dietary supplement or making any changes to your diet or exercise routine.

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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

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Author

Dr. Jaime Cloyd ND

Naturopathic Physician based in the greater Seattle area

Medically Reviewed by