St. John’s Wort (Hypericum perforatum) is a flowering plant, instantly recognizable by its vibrant yellow, star-shaped blossoms. This perennial herb, native to Europe, West and Central Asia, and parts of Africa and China, has been a subject of traditional medicine for centuries. Its common name originates from the plant’s tendency to bloom around June 24th, coinciding with the feast day of St. John the Baptist.
Forms and Preparation
St. John’s Wort is available in various forms. Commonly found as capsules, tablets, tinctures, and teas, it can also be prepared as topical oils or ointments. The recommended adult dosage for capsules or tablets involves taking 300 milligrams three times daily, often alongside meals, for up to 12 weeks.
For preparing St. John’s Wort tea, use about one teaspoon (2 to 3 grams) of dried flowers and leaves per 250 milliliters (one cup) of water. Bring the water to a boil, then remove it from the heat before adding the herb. Cover the mixture and allow it to steep for 5 to 10 minutes for a milder taste, or up to 30 minutes to enhance its medicinal properties, then strain. Two to three cups can be consumed daily after meals.
Tinctures, which are concentrated liquid extracts made by steeping the plant in alcohol, are used in smaller quantities. A common recommendation is 2 to 4 milliliters, diluted in about 100 milliliters (half a cup) of water. When applied topically, St. John’s Wort-infused oils, creams, or ointments are spread directly onto the skin.
Common Applications
St. John’s Wort has been used for various traditional applications. It is used for managing mild to moderate depression, along with associated symptoms like anxiety and difficulty sleeping. Many individuals also turn to it for relief from symptoms related to menopause, such as hot flashes.
Beyond internal uses, St. John’s Wort is also applied externally. Topical preparations are used on the skin for injuries, muscle discomfort, and minor burns. It also soothes abrasions and addresses various skin irritations. Some traditional uses include addressing somatic symptom disorder, characterized by anxiety about physical sensations.
Important Safety Considerations
St. John’s Wort is considered safe when taken orally in appropriate doses, up to 900 milligrams daily for a maximum of 12 weeks. However, research regarding its safety beyond this 12-week period remains limited. Possible side effects include upset stomach, dizziness, confusion, fatigue, and dry mouth. Other effects include frequent urination, swelling, sexual dysfunction, elevated blood pressure, rapid heartbeat, anxiety, restlessness, and headaches.
Photosensitivity is a concern, as St. John’s Wort can increase skin sensitivity to sunlight, particularly in fair-skinned individuals or when consumed in larger quantities. This heightened sensitivity can result in severe skin reactions, making sunscreen use advisable. Its interactions with other medications are a significant safety aspect. St. John’s Wort can interfere with liver enzymes and P-glycoprotein, which are crucial for drug metabolism, potentially reducing medication effectiveness or increasing adverse effects.
Combining St. John’s Wort with antidepressants, including SSRIs and tricyclic antidepressants, can lead to an excess of serotonin in the brain, a condition known as serotonin syndrome. Symptoms of serotonin syndrome include a fast heartbeat, elevated blood pressure, confusion, and even seizures. It can also diminish the effectiveness of birth control pills, potentially causing breakthrough bleeding or unintended pregnancy. Blood thinners like warfarin and DOACs (e.g., rivaroxaban) may also become less effective, increasing the risk of blood clots.
Individuals undergoing organ transplantation should be aware that St. John’s Wort can reduce the effectiveness of immunosuppressants such as cyclosporine, risking organ rejection. It also reduces the effectiveness of certain HIV/AIDS medications, chemotherapy drugs, benzodiazepines, digoxin, and statins. It may also lower the levels of antiseizure medications, making them less effective.
St. John’s Wort is not recommended for certain populations. Pregnant individuals should avoid it, as it may increase uterine tone, potentially raising the risk of miscarriage or birth defects, though human data are limited. Breastfeeding individuals are also advised against its use, as infants may experience fussiness, colic, or drowsiness.
For those with bipolar disorder, St. John’s Wort can induce mania or accelerate mood cycling. It may also trigger mania or psychosis in individuals with major depression or schizophrenia.
If surgery is planned, discontinue St. John’s Wort at least two weeks beforehand due to potential interactions with anesthesia and the risk of heart complications.
When to Seek Professional Advice
Consult a healthcare provider before beginning any St. John’s Wort regimen. This is important if you experience side effects, are taking other medications (prescription or over-the-counter), or use other supplements. Individuals with pre-existing health conditions should also discuss its use with their doctor. St. John’s Wort should not be used as a substitute for prescribed medication for serious medical conditions.