With heightened interest in everything natural, from organic products to yoga and acupuncture, many people are seeking more natural approaches for health issues, including herbal treatments for depression. Case in point: St. John’s wort.
St. John’s wort, botanically known as Hypericum perforatum, is a long-living yellow flowered plant used as far back as ancient Greece for its medicinal benefits. It is believed that the compounds hypericin and hyperforin are among its many chemical ingredients that contribute to its effectiveness as an herbal treatment of depression. Primarily available as pills or capsules, St. John’s wort is also produced in other forms including tea, liquid extracts, and even as a popcorn topping (However, it would probably take 100 or more bags of popcorn to get a large enough dose, so other formulations are preferable.)
In Europe, St. John’s wort is commonly prescribed as a treatment for depression. But the U.S. Food and Drug Administration views St. John’s wort as an herbal product and classifies it as a dietary supplement. As such, it can go straight into stores without testing of its effectiveness, dosage, or safety. Which begs the question, does it really work?
“Yes,” says David Mischoulon, MD, PhD, associate professor of psychiatry at Harvard Medical School and director of research in the depression and clinical research program at ****achusetts General Hospital. “There are about 40 published studies on the use of St. John’s wort for depression. In general, they suggest that St. John’s wort is more effective than a placebo and equally effective as tricyclic antidepressants.”
However, when compared with another type of antidepressant, selective serotonin reuptake inhibitors (SSRIs), the results were a little less clear. “Recent comparisons against SSRIs like fluoxetine and sertraline have yielded inconsistent results,” says Dr. Mischoulon, “though the studies may suffer from methodological problems. St. John’s wort is likely as effective as the SSRIs as well, but we need more investigation to conclusively demonstrate this.”
One example of such a methodological problem is that patients in the comparison with SSRIs may have been more severely depressed than those in the studies of St. John’s wort versus tricyclic antidepressants. “In general, natural products seem most effective for people with mild-to-moderate illness, as opposed to more severe illness,” says Mischoulon.


What Consumers Should Know About St. John’s Wort
Generally, the recommended dose for St. John’s wort is between 900 and 1800 milligrams per day. There are no studies comparing different brands, and there may be variations in potency depending on the preparation, manufacturing methods, and purity. Label information may not always be correct. Mischoulon suggests selecting a brand from reputable sellers and manufacturers who are more likely to have their own stricter manufacturing standards and greater odds of providing the product they promise. As with everything, buyer beware.

St. John’s Wort Side Effects
Just because it’s natural and doesn’t require a prescription does not automatically mean an herbal product is without dangers. “St. John’s wort has many side effects and can interact adversely with many prescription drugs, sometimes with disastrous results,” warns Mischoulon. The most common side effects include dizziness, dry mouth, nausea, diarrhea, fatigue, and greater sensitivity to the sun. Some, but by no means all, of the prescriptions it can interfere with include antidepressants, birth control pills, blood thinners, cancer medications, and the heart drug digoxin.
Ultimately, using St. John’s wort to treat depression symptoms may be a good idea, but as with any natural remedy, be sure to check with your doctor first.