Updated 18 February 2013

St John's wort

A popular, but controversial anti-depressant, St. John's wort is also effective in warding off viruses and is therefore being studied for potential use in treating HIV and Aids.

  • Alleviates depression and anxiety
  • Helps stiff and aching joints
  • Good for inducing sleep
  • Antispasmodic
  • Stimulates bile flow
  • Astringent
  • Sedative
  • Antiviral

Interesting facts:

The herb is effective in warding off viruses and is therefore being studied for potential use in treating HIV and Aids.


A controversial herb that has been banned in some countries.
Can cause sensitivity to sunlight.

What is St John's Wort?

St John’s Wort is a summer flowering plant, indigenous to all parts of Britain and Europe, Western Asia, North Africa and the Western Cape region of South Africa. St John’s probably refers to John the Baptist. The blood red spots on the underside of some of the herb’s leaves symbolise healing. The flowers were put under the pillow on St John’s Eve so that the saint would appear in a dream to give a blessing and to ensure that the dreamer would survive the next 12 months. “Wort” is the Old English name for “plant”.

St John’s Wort has a recorded history of about 2 500 years of its use as a medicinal plant. St John’s Wort has re-emerged in the past few years as a very effective alternative treatment for depression. It offers a safe, non-addictive alternative to assist the body during times of anxiety, stress and nervous tension – naturally.

All mention of St John’s Wort in this section refers to Hypericum perforatum. Hypericum augustifolia, another species, is very seldom used in herbal preparations.

The uses of St John's Wort

St John’s Wort is the leading antidepressant agent prescribed by doctors in Germany. The German Commission E monograph recommends St John's Wort for various conditions including depression, insomnia, open wounds and burns.

St John’s Wort is the leading antidepressant agent prescribed by doctors in Germany. The German Commission E monograph recommends St John's Wort for the following conditions:

To use per mouth:

Psychogenic disturbances, depressive states, sleep disorders, anxiety and/or nervous excitement, particularly those associated with menopause. Oily Hypericum preparations are approved for stomach and gastrointestinal complaints and have anti-diarrhoeal activity.

To use topically on the skin:

Oily Hypericum preparations are approved for the treatment of post-surgical cuts, open wounds, skin ulcers, muscle aches and first-degree burns.

The accepted indications for St John's Wort in the UK include “menopausal neurosis”, excitability, neuralgia, fibrositis (fibromyalgia) and sciatica. Externally on the skin it is indicated as an analgesic for superficial pain and as an antiseptic.

St John’s Wort is approved in France for external use as a cream or emollient for the treatment of urticaria, chaps, bruises, frostbite, insect bites, sunburn and other burns, as well as for the relief of pain in the mouth and throat.

The interaction between St John’s Wort, anaesthetics and other drugs

Animal studies have shown that the effects of St. John's Wort are minimised by agents that reduce the activity of dopamine, such as haloperidol (used for general anaesthetic). It is not known if this is the case in humans or not.

In mice St John’s Wort extracts have been shown to significantly increase sleep induced by anaesthetic and narcotic drugs and to antagonize the effects of reserpine, used in the treatment of heart failure.

A report published in the Lancet of 10 February 2000, a renowned British medical journal, alleged that St John’s Wort may decrease the effectiveness of drugs used to treat heart-transplant and HIV patients. Some component of St John’s Wort is said to dull the effectiveness of the HIV medicine indinavir and the transplant drug cyclosporin.

About 50 drugs circulate through the body in the same way that indinavir and organ-rejection drugs are — including cholesterol-lowering drugs and oral contraceptives. Breakthrough bleeding has been reported with the use of low dose oral contraceptives. The mechanism is unclear and it is unknown whether this effect increases the risk of pregnancy. I would therefore recommend that you take St John’s Wort and the contraceptive pill at different times of the day – at least four to six hours apart.

People using St. John’s Wort, should inform their pharmacist or doctor before taking prescription medication.

The correct dosage of St John’s Wort

The usual dosage is 350mg twice a day. The recommended dosage used in clinical studies is St John’s Wort extract standardised to 0,3% hypericin with a dosage of 300mg St John’s Wort three times a day: a total of 900mg per day.

Can St John's Wort help for PMS?

St John’s Wort has been used with great success in the treatment of PMS (premenstrual syndrome) in women. PMS often goes hand in hand with feelings of depression, insomnia, anxiety and irritability. St John’s Wort would be effective for all these symptoms.

It is important to take into account the mind-body link to the feminine psyche/soul. Outside influences have too much power over you or you might be rejecting the feminine processes at a deep psychological level due to too much confidence placed in the masculine aspect/logos/work competitive environment. Positive affirmations (e.g. I approve of myself, I am a dynamic strong woman, I take charge of my life) and stress management are essential elements of the natural treatment of PMS.

Refer to the book “Herbal Remedies” (Tafelberg Publishers) for more information on the natural approach to feminine health.

Comparing St John's Wort with antidepressant drugs

The antidepressants such as fluoxetine and setraline are successful in improving the symptoms of depression in nearly 60% of depression sufferers. They, together with the tricyclic antidepressants, however, have many side effects.

Results from clinical trials on fluoxetine have demonstrated that 21% of patients taking it experience nausea, 20% headaches, 15% anxiety and nervousness, 14% insomnia, 12% drowsiness, 12% diarrhoea, 9,5% dry mouth, 9% loss of appetite, 8% sweating and tremor and 3% rash. In studies where sexual side effects were evaluated, 43% of men and women taking other antidepressants and 34% taking fluoxetine reported diminished or loss of libido. 17% of patients taking fluoxetine, and 31% of patients taking tricyclic antidepressants discontinue it because of the side effects. The sexual problems are the main reasons why people stop taking these drugs.

The most convincing evidence for the efficacy and safety of St John’s Wort is a meta-analysis published in the British Medical Journal August 1996. The abstract reaches the following conclusion: "Hypericum extracts were significantly superior to placebo ... and similarly effective as standard antidepressants ... There were two (0.8%) dropouts for side effects with hypericum and seven (3.0%) with standard antidepressant drugs. Side effects occurred in 50 (19.8%) of patients on hypericum and 84 (52.8%) of patients on standard antidepressants".

Patients should insist on the package insert when they get their prescription antidepressants. They can study the side effects and then make an informed decision as to whether they want to use it or try a natural alternative such as St John’s Wort.

Does St John's Wort have any side effects or precautions?

Documented side effects of St John’s include gastrointestinal symptoms (e.g. nausea), allergic reactions, fatigue and photosensitivity to sunlight in sensitive people with fair skin. The management of the last includes the use of sunglasses and sunblock creams.

How quickly does St John's Wort work?

St John’s Wort extract should be taken continuously for up to eight weeks before clinical improvement in mood may be noted.

How St John's Wort works to alleviate depression

Nobody knows for certain. In fact, there are not one but several antidepressant agents in the plant. However, the strongest candidate for a single antidepressant agent is hyperforin, a phloroglucine found in the plant.

Research has shown that St John’s Wort extract seems to alter brain chemistry by inhibiting the breakdown of several neurotransmitters, including serotonin, dopamine and noradrenalin. This results in an increase in the level of neurotransmitters responsible for mood and emotional stability inside the brain.

Serotonin is mood-enhancing; noradrenalin is responsible for feelings of alertness and energy; dopamine is a “feel good” brain chemical. One other effect seems to be that St John’s Wort improves the signal produced by serotonin after it binds to its receptor site on brain cells. In this way the messages concerning enhanced mood and wellbeing, being carried from one brain cell to the next, are transferred more effectively.

This mechanism of action on all three main neurotransmitters is unique and may partly account for the lower incidence of antidepressant-related side effects with St. John's Wort. Most researchers believe that the effects of St. John's Wort are due to a synergistic interaction between several of its many compounds.

Improve the benefit of St John's Wort

There are several supplements that one can use together with St John’s Wort to combat depression.

  • Use a daily combination of St John’s Wort together with Ginkgo biloba, Vitamin B1 (thiamine 25-50mg), B2 (niacin 25-50mg), B3 (riboflavin 25-50mg), B5 (pantothenic acid 25-50mg), B6 (pyridoxine 25-50mg) and B12 (cobalamin 50microgram). Add to that folic acid 300-400 microgram a day, inositol and choline 100mg of each.
  • Take a calcium (300-600mg in a food form) and magnesium (150-300mg in a food form) supplement. Take the calcium and magnesium with vit C 500mg at night. This improves your sleeping pattern and helps the nerves and muscles to relax.
  • Use an antioxidant with vit A (5 000 IU or 1,5mg RE activity), vit E (200-400 IU), vit C (500mg), pycnogenol, zinc and selenium every morning. Cysteine and glutamine, amino acids with potent antioxidant activity in the brain and nervous system are also recommended.

All of these are important for the optimal functioning of the nervous system. The amino acids L-tyrosine, phosphatidylserine, phenylalanine and acetyl-L-carnitine (250mg a day) are recommended to improve mood, memory and mental alertness.

Essential fatty acids are also very important: use starflower oil, evening primrose oil and marine fish oil to supply the body with enough omega 3 and 6 fatty acids for improved neurotransmission and nervous system health.

Stress management techniques

It is always important to remember that mental function, mood, memory and concentration are also dependent on regular daily stress management techniques. The accumulation of the daily stresses together with the constant monkey chatter noise going on in our own minds, often lead to memory lapses, lack of concentration, tiredness and depression, to name but a few. Effective stress management is “prescribed” for every day together with your supplements and St John’s Wort for an increased sense of wellness and happiness.

The mind-body links to look into: depression is a high energy state that becomes negative and turned inward. You have a lot of suppressed anger, resentment, fear that you feel you’re not entitled to. You suffer feelings of hopelessness and helplessness. Positive affirmations: I have a right to express my feelings, I have a right to be who I am, I accept and approve of myself, I get to know myself. Stress management, dream interpretation, yoga and meditation, with counselling and psychotherapy often prove most helpful in overcoming depression.

Effective stress management, inercise (inner work to know yourself better through yoga, meditation, psychotherapy, counselling, etc.) and most important, regular daily practice with relaxation techniques, ensures an all over improvement in health of mind, body, soul and emotions. This will be reflected in your general attitude towards life and will have a ripple effect into all aspects of your life: personal and work relationships, sense of wellbeing, happiness and joy which will finally improve the quality of your life at home and at work.

Research has proven time and again that effective stress management improves immunity, heart function, oxygen uptake by the body's cells, self-image and sense of wellbeing. It also ensures lots of vitalising energy! Effective stress management lowers the levels of the stress hormones like cortisol and adrenalin, which in turn provides various health benefits and prevents the occurrence of negative stress.


Regular aerobic exercise such as walking, swimming and dancing, has been scientifically proven to be very effective in the holistic treatment of depression.

Some health care practitioners treat depression through changes in dietary habits and exercise alone! If you suffer from depression, eat “feel good” foods that increase your mood enhancing neurotransmitters naturally. Bananas increase the levels of tryptohane, a precursor amino acid to serotonin, as do unrefined carbohydrates, such as wholewheat bread, provitas, whole grain cereal, nuts, oats, etc. The general dietary guidelines for optimal health would also apply for depression: lots of fresh food and vegetables, grains, nuts, seeds, unprocessed foods, high quality protein, low saturated fats, fair amount of unsaturated plant and fish oils.

Is St John’s Wort safe to use during pregnancy and breastfeeding?

No, it is not recommended. Pregnant women should not take it since St John’s may cause uterine contractions, which could lead to premature labour or even abortion. Native Americans used it as an abortive. All antidepressants are contraindicated during pregnancy due to its possible effects on the development of the foetal brain and nervous tissue. For this reason, the herb is also not recommended during breastfeeding.

This article was written by natural health expert Dr Arien van der Merwe (MBChB). You can order her following books, published by Tafelberg, in English and Afrikaans online at
Health & Happiness
Geluk & Gesondheid
Herbal Remedies
Kruie met Geneeskrag

(Zaakirah Rossier, Health24, updated October 2010)


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