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St John’s Wort for Depression & Anxiety

St John’s Wort for Depression & Anxiety
by Dr. Daniel J. Heller

St. John’s Wort (Latin: Hypericum perforatum) is one of the best-known herbal medicines in the world, mostly for its use in depression and anxiety. In Europe, and especially in Germany, where herbal treatments are usually held in higher regard than in the United States, St. John’s Wort is a first line treatment for mild to moderate depression and anxiety. Several reputable scientific studies have compared St. John’s Wort favorably to prescription antidepressants.

In the past decade, St. John’s Wort has emerged as an important herbal medicine in the natural armamentarium against PMS and PMDD suffering. While it was never historically considered one of the traditional "women’s herbs," it has a new importance. The use of antidepressants such as Prozac® and Sarafem® to treat premenstrual problems that include mood swings, depression, anxiety, and irritability eventually led to the use of St. John’s Wort for the same problems. The results have been quite positive, with St. John’s Wort showing itself an effective partner to sensible diet, nutrition, and lifestyle measures offering a perfect complement to natural products like PMS Comfort (with Vitex Chastetree), calcium, magnesium, and vitamin B6.

The story of how St. John’s Wort came to be used in PMS and PMDD is quite interesting. It was only after antidepressants became a common treatment that investigators looked into the potential for St. John’s Wort to relieve premenstrual symptoms. Usually, medications borrow from nature, as in the many cases where drugs are based on natural compounds, and very often on traditional herbal medicines. The herb Digitalis, better known as the common garden perennial Foxglove, which is the original source of the common heart disease drug Digoxin, is one of the most famous examples of this. In the case of PMS and St. John’s Wort, a newer, but increasingly more common trend is taking place: modern pharmaceutical practice has led to an innovation in natural medicine.

The Depression-PMDD Connection

It is the remarkable similarities and overlap between PMS, PMDD, and depression that led to the use of St. John’s Wort as an herb for premenstrual symptoms. PMS and PMDD—or, at least, their characteristic mental and emotional symptoms—can be thought of as hormonally-induced depression and anxiety. Women with PMS and PMDD are fine for most of the month, whether it is for 24 or 25 out of 28 days, or for some unfortunate women, just 8 or 10 out of 28 days. But premenstrually, hormones can interact with something—we don’t know exactly what—in your brain to cause symptoms that are quite similar to depression and anxiety,

If you were to read a medical manual on the symptoms of depression or anxiety, and then read about the symptoms of PMDD, you’d be amazed, as there are so many similarities between the two. You might also be confused: Is there a difference? The answer to this is an emphatic "Yes": the difference is the hormonal aspect, and how the symptoms in women with PMDD happen only in the latter half of the menstrual cycle, not at any time of the month. However, women with PMS and PMDD are often predisposed to depression and anxiety, whether from a difficult life history or from genetic or familial tendencies.

This makes St. John’s Wort a natural choice in difficult or severe cases of PMS, and in PMDD, where there is a strong emotional and mood component. Symptoms such as social withdrawal, uncontrollable crying, anger problems, and difficulty concentrating are symptoms of depression as well as PMDD or PMS, and often respond well to St. John’s Wort. There is plenty of reason to think the best results in such severe cases would come from combining St. John’s Wort with traditional women’s herbs like Vitex Chastetree as well as important anti-PMS nutrients like calcium, magnesium, and vitamin B6. 

St. John’s Wort Side Effects

St. John’s Wort is a powerful and safe herbal extract that can really work for depression, anxiety, PMDD, and PMS. That effectiveness, however, comes with a few more warnings than is usually the case with other herbal medicines.

  • St. John’s Wort may interact with a wide variety of medications. Most important among these is hormonal birth control. If you take Yaz®, have a Mirena® IUD, or are on another form of hormonal birth control, you shouldn’t take St. John’s Wort, as the herb may interfere with the effectiveness of the birth control.
  • If you take antidepressants, you can’t take St. John’s Wort. The natural chemicals in St. John’s Wort that help fight depression have similar effects to antidepressants, which means they can easily interact and cause unpleasant or even dangerous side effects. You have to pick one or the other, the herb or the prescription medication—you can’t combine them.
  • St. John’s Wort has effects on the way your body metabolizes drugs. If you are take prescription medication, or if you habitually take over-the-counter medication such as Acetaminophen (Tylenol®) you should check with your pharmacist for potential interactions before starting St. John’s Wort.
  • Finally, in some people St. John’s Wort causes sun sensitivity in the form of a rash. This is usually mild, and reversible by avoiding the sun and/or discontinuing the St. John’s Wort.
St. John’s Wort is a safe, gentle, and well-tolerated herbal extract, but it does have the potential for these side effects. The vast majority of people who use it report no problems, and are happy with their results from taking it.

Why St. John’s Wort?

There are many chemical properties in St. John’s Wort extract that remind researchers of popular antidepressants. It may have some similar effects on serotonin, a deficiency of which is theorized to be implicated in depression. However, as we’ve discussed before, the relationship of serotonin and depression is just a theory, and, as it turns out, not a very good one. Nevertheless, St. John’s Wort has effects in the brain similar to antidepressants, and currently this is considered one of the most likely explanations for why St. John’s Wort is effective both in depression and PMDD and PMS.

However, St. John’s Wort is a surprising plant. We tend to think of medicinal plants as quite rare, or possibly endangered, or perhaps coming from a remote and exotic location like Peruvian highlands or the deep tropical rainforest. St. John’s Wort, by contrast, is a common roadside weed. That’s right—you’ve passed by it hundreds of times or more, probably without giving it a moment’s notice. It is a native of Europe, Russia, India, and China, and is an invasive species in North America. Nevertheless, it grows by roadsides and has noticeable and pretty yellow flowers. And, you’ll remember that the second half of its Latin name is "perforatum." This comes from the perforated appearance of its leaves when they are held up to the light, as if many tiny holes had been punched in them.

St. John’s Wort is an important herb for PMS and PMDD, as well as mild to moderate anxiety and depression, and another shining example of the wonderful healing powers of nature.