St. John’s Wort is a widely recognized herbal supplement often sought out for natural support for mood. For breastfeeding mothers experiencing symptoms of depression or anxiety, using this readily available product can seem appealing. However, taking any supplement while nursing requires careful consideration of the potential risks to the infant. The lack of extensive safety data means the safety of St. John’s Wort for a nursing baby remains a serious concern that must be addressed with caution.
St. John’s Wort and its Common Uses
St. John’s Wort (SJW), derived from the plant Hypericum perforatum, is a popular botanical remedy used primarily to address symptoms of mild to moderate depression and anxiety. It is widely used as a natural alternative to conventional antidepressant medications, which is why many new mothers consider it for managing postpartum mood changes. Studies suggest its effectiveness for mood disorders, with some finding it comparable to certain prescription antidepressants for mild cases.
The plant contains several biologically active compounds, primarily hypericin and hyperforin, which are thought to contribute to its mood-lifting effects. These compounds influence neurotransmitter levels in the brain, such as serotonin, norepinephrine, and dopamine, similar to how pharmaceutical antidepressants function. Despite its common usage, St. John’s Wort is classified as a dietary supplement in the United States, meaning it does not undergo the same rigorous safety and efficacy testing as prescription drugs.
Transfer into Breast Milk
For a breastfeeding mother, the primary concern is the extent to which the active ingredients of St. John’s Wort pass into her milk and affect the infant. Research on the transfer of hypericin and hyperforin into human breast milk is limited, but existing studies suggest the transfer is relatively low. Specifically, the compound hypericin is often undetectable in breast milk samples.
The compound hyperforin is sometimes detected in breast milk, generally at very low concentrations. In one study, the amount of St. John’s Wort received by full-term, older infants through breast milk was found to be small. While the low levels in milk are reassuring, the lack of comprehensive human data means the full exposure risk is not completely understood, particularly regarding long-term accumulation in infants.
Documented Effects on the Nursing Infant
Despite the low transfer of active components, there have been reports of possible adverse effects in infants exposed to St. John’s Wort through breast milk. One prospective observational study comparing exposed infants to controls found an increased frequency of certain minor issues. These reported symptoms included increased crying, often described as colic, drowsiness, and lethargy.
The reported adverse events were generally mild and did not require specific medical treatment or intervention. Most available data relates to older, full-term infants, meaning the safety profile for newborns and premature infants is less clear, as they are more susceptible to adverse effects. A theoretical concern is the potential for photosensitivity in the infant, a known side effect in adults, although this has not been widely documented in nursing infants.
Medical Consensus and Recommended Alternatives
The current medical consensus leans toward caution and generally advises against the use of St. John’s Wort while breastfeeding due to insufficient reliable safety data. Authoritative resources tracking drug and supplement safety during lactation often classify St. John’s Wort as a supplement of concern for nursing mothers. Furthermore, the variability in the content and quality of over-the-counter herbal products complicates the assessment of infant risk.
Given the potential for unknown risks, healthcare providers typically recommend safer, better-studied alternatives for treating mood disorders. Medically approved options include specific selective serotonin reuptake inhibitors (SSRIs), such as sertraline or paroxetine, which have extensive data supporting their low risk during lactation. These conventional medications are preferred because the tiny amounts that pass into milk are well-tolerated by infants, and their use is a low-risk alternative to an untreated maternal mood disorder. Non-pharmacological treatments, such as counseling, psychotherapy, and light therapy, are also recommended as first-line therapies for mild to moderate symptoms.