St. John’s Wort

St. John’s Wort is a flowering plant used in traditional medicine for its potential mood-boosting effects. It contains compounds that are believed to influence neurotransmitters in the brain such as serotonin. This property makes it of interest in menopause as mood disturbances can be exacerbated due to hormonal changes.

Why is it Relevant?

St. John's Wort has been used for centuries to help with symptoms of depression. It is sometimes used by women experiencing depressive symptoms due to hormonal changes and a study found that it may help reduce hot flushes.

Research supports its effectiveness for depressive symptoms. A Cochrane review found that St. John's Wort can work for major depression (1). Similarly, a review of 35 studies showed it reduced symptoms of mild to moderate depression more than a placebo and was about as effective as prescription antidepressants (2).

A study revealed a significant reduction in frequency, duration, and severity of hot flushes among perimenopausal and postmenopausal women treated with St. John's wort extract compared to placebo (3).

Another analysis of 27 studies found that St. John's Wort worked about as well as antidepressants for mild to moderate depression. It also seemed to have fewer side effects, with fewer people stopping its use compared to prescription medications (4).

Why Don't we use it?

St. John’s Wort may not mix well with other supplements and medications because of how it affects the liver's drug-processing system, known as cytochrome P450. This system is like a cleanup crew in our body that breaks down drugs and other chemicals in the bloodstream, including some important vitamins. When someone takes St. John’s Wort, it speeds up this cleanup process. This might sound good, but it can actually cause the body to get rid of other medications too quickly, reducing their effectiveness (5).

St. John’s Wort can interact with a wide range of common medications such as antidepressants, birth control pills, medications for epilepsy, blood thinners, drugs for preventing organ transplant rejection, heart medications, and treatments for anxiety, heart disease, HIV, and cancer (5, 6, 7).

Additionally, St. John’s Wort can make your skin more sensitive to sunlight, which is especially a problem for those already sensitive to the sun (8). A 2024 study on rats found that St. John’s Wort may have toxic effects on liver function and cause photosensitivity when combined with sunlight exposure (9).

Despite its popularity, there aren’t many reliable studies on the safety of St. John’s Wort, and the interactions it has with other supplements and medications make it potentially unsafe. A recent study even suggested that there may be another unknown constituent that is modifying the expression and function of the liver (10). We believe it is important to better understand its effects before considering it.

References

  1. Linde K, Berner MM, Kriston L. St John's wort for major depression. Cochrane Database of Systematic Reviews. 2008;(4):CD000448. doi:10.1002/14651858.CD000448.pub3
  2. Apaydin EA, Maher AR, Shanman R, et al. A systematic review of St. John's wort for major depressive disorder. Syst Rev. 2016;5(1):148. doi:10.1186/s13643-016-0325-2
  3. Abdali K, Khajehei M, Tabatabaee HR. Effect of St John's wort on severity, frequency, and duration of hot flashes in premenopausal, perimenopausal, and postmenopausal women: a randomized, double-blind, placebo-controlled study. Menopause. 2010;17(2):326-331. doi:10.1097/gme.0b013e3181b8e02d.
  4. Ng QX, Venkatanarayanan N, Ho CY. Clinical use of Hypericum perforatum (St John's wort) in depression: A meta-analysis.J Affect Disord. 2017;210:211-221. doi:10.1016/j.jad.2016.12.048
  5. Nicolussi S, Drewe J, Butterweck V, Meyer zu Schwabedissen HE. Clinical relevance of St. John's wort drug interactions revisited. Br J Pharmacol. 2020;177(6):1212-1226. doi:10.1111/bph.14936
  6. Fujihashi A, Ramesh S, Govindarajulu M, Almaghrabi M, Nadar RM, Deruiter J, Moore T, Pondugula S, Agrawal DC, Dhanasekaran M. St. John's Wort: A Therapeutic Herb to Be Cautioned for Its Potential Neurotoxic Effects and Major Drug Interactions. In: Agrawal DC, Dhanasekaran M, eds. Medicinal Herbs and Fungi: Neurotoxicity vs. Neuroprotection. Singapore: Springer Singapore; 2021:369-389. doi:10.1007/978-981-33-4141-8_15
  7. Canenguez Benitez JS, Hernandez TE, Sundararajan R, et al. Advantages and Disadvantages of Using St. John's Wort as a Treatment for Depression. Cureus. 2022;14(9):e29468. doi:10.7759/cureus.29468.
  8. de Wit L, Jeurissen S, Chen W. Risk assessment of herbal preparations containing St John's wort. Rijksinstituut voor Volksgezondheid en Milieu RIVM. 2021. doi:10.21945/RIVM-2019-0115
  9. Abdulla GM. Deterioration of liver function biomarkers induced by St. John's Wort. World J Pharm Life Sci. 2024;10(3):01-05. ISSN 2454-2229.
  10. Schäfer AM, Rysz MA, Schädeli J, Hübscher M, Khosravi H, Fehr M, Seibert I, Potterat O, Smieško M, Meyer zu Schwabedissen HE. St. John’s Wort Formulations Induce Rat CYP3A23-3A1 Independent of Their Hyperforin Content. *Molecular Pharmacology*. 2024;105(1):14-22. doi:10.1124/molpharm.123.000725
Home