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A look at decades of research behind the St. John's Wort herbal supplement and its effects on depression.

What is St. John’s Wort?

St. John’s Wort, an herb naturally grown in parts of Asia and Europe [1], has been discussed a great deal in the media and pop psychology outlets in the past few decades. Extract from this flowering plant has been used as a natural antidepressant tracing as far back as ancient Greece. Although, the ancient Greeks would have been more likely to claim its usefulness in treating cases of demonic possession [2]. St. John’s Wort extract can be taken in capsule form and bought over the counter wherever vitamins and supplements are sold. And as with any kind of vitamin or supplement, always be mindful that you are buying trusted, quality products without additives.

Does Taking St. John’s Wort Really Help Treat Depression?

Now, a lot of people have probably heard of this popular herbal supplement and its potential use as a natural antidepressant, but can St. John’s Wort really treat your depression? Over the past five decades, St. John’s Wort has been researched alone and compared to prescription depression medications in hundreds of scientific studies. In all this research and the resulting academic literature, there still remains some varying data across the board in terms of the certitude behind this natural alternative’s ability to sufficiently remedy depression for all [34]. Of course, we should also keep in mind that successfully treating depression in every depressed patient with a single means is highly unrealistic.

“Results mostly inconclusive” is a common—albeit frustrating—finding in a lot of depression research. Depression is complicated, to say the least, and these not-so-ideal findings may be due to many reasons.  All people are different and depression varies from individual to individual. The psychological and physiological causes and effects of depression are elusive and hard to pin down in their own right. Then on top of the mental and physical unanswered questions of this mental illness, there are so many different prescription drugs available to study that it can take a lot of time to sort out what works for which people. Comparison studies between drugs can be more difficult still. [3, 5]

This all being said, a meta-analysis looking at decades of St. John’s Wort research found that within many studies, SJW performed at a comparable level to other SSRI (selective-serotonin reuptake inhibitor) antidepressants with no significant difference between the two [1].

With all the overwhelming and often conflicting data about depression and its various treatments and with SJW often performing on par with prescription drugs, a better question to ask yourself might be...

In What Ways Does St. John’s Wort Outperform Prescription Antidepressants?

Patients may find prescription drug side effects intolerable. Each type of pharmaceutical antidepressant comes with its own potential list of adverse side effects that can range greatly from uncomfortable or annoying to life-threatening. Depending on the kind of antidepressant you are prescribed, you may experience fatigue or insomnia, sexual disturbances, tachycardia (rapid heart rate), increased anxiety, blurred vision, weight gain, and Parkinsonism (experiencing muscular, motion, and balance symptoms similar to those experienced by individuals with Parkinson’s Disease). These listed here do not exhaust the entire spectrum of side effects one may suffer from while taking prescription antidepressants. [6]

Prescription antidepressants can carry a high rate of discontinuation. When a patient is prescribed a traditional antidepressant, doctors are always concerned about the possibility of discontinuation of the medication. As time goes by, the likelihood of dropping out of a prescription medication treatment plan increases and many individuals cite negative side effects as their reason for discontinuation [6]. This is problematic because depression—especially severe depression—often requires a long (sometimes life-long) treatment period. Circumventing your doctor’s timeline for treatment and discontinuing use of an antidepressant medication will often result in relapse. [7]

St. John’s Wort users report very little adverse side effects. In terms of side effects experienced by individuals taking St. John’s Wort (alongside no other medications), nausea or allergic reaction was sometimes noted. Very rare side effects included sensitivity to light and increased likelihood of manic episodes in those who were predisposed. [1]

Are There Any Safety Issues with St. John’s Wort?

Generally speaking, St. John’s Wort has been found to be much safer than traditional prescription antidepressants. This is somewhat especially important to note in terms of SSRI antidepressants both because they are so commonly prescribed and also because SSRIs work similarly to St. John’s Wort. SSRIs and SJW treat depression by inhibiting the reuptake of the neurotransmitter, serotonin. St. John’s Wort works to block the reuptake of other neurotransmitters as well which can also aid in the treatment of depression. [1, 89]

St. John’s Wort is comparable with prescription drugs in treating depression, but there are a couple of things to watch out for that both involve drug interactions and can potentially have serious consequences.
  • St. John’s Wort can interfere with the effects of certain drugs by kicking liver enzymes into gear and speeding up drug metabolism. This can mean that if you are taking certain medications, they may be rendered ineffective by this chain of events. Drugs like oral birth control (the pill), anticoagulants, and antiviral medications can all be affected by the addition of St. John’s Wort. If you take any kind of medication, consult with your doctor as to whether or not St. John’s Wort may interact negatively. [1][9]

  • On the other side of things, St. John’s Wort can compound the effects of any other serotonin-boosting medication you may take resulting in serotonin syndrome. This occurs due to an overload of serotonin in the brain which, can be life-threatening. It is never a good idea to combine St. John’s Wort with another antidepressant. Again, consult your doctor if you suspect a possible risk of serotonin syndrome. [1][9]

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