St John’s Wort - Dr Jonathan Haverkampf

Medication and diagnosis safety note

This page is for general education. It is not a diagnosis, medication review, prescription advice, crisis service, or substitute for care from a trained professional who can assess you directly. Reading or commenting here does not create a doctor-patient, therapist-client, or counsellor-client relationship. See the full website disclaimer.

Diagnosis needs a real assessment

Low mood, anxiety, sleep changes, irritability, or loss of interest can have many causes. A supplement page cannot tell whether symptoms are depression, bipolar disorder, grief, trauma, medication effects, a physical health condition, or another issue needing assessment.

Medication decisions need a prescriber

St John's wort can interact with many medicines, including antidepressants and medicines outside mental health. Because it may reduce the effect of some medicines or increase serotonin-related risk when combined with others, discuss it with a doctor or pharmacist before using it, especially if you take any regular medication.

Do not start, stop, pause, increase, reduce, combine, switch, or restart medication because of something on this website. Discuss medication questions with a GP, psychiatrist, pharmacist, or another qualified prescriber who can consider your diagnosis, physical health, other medicines, substance use, pregnancy or breastfeeding, risks, and preferences.

When to use urgent help

Use urgent medical or emergency help for overdose concerns, severe allergic reaction, seizures, chest pain, fainting, severe confusion, symptoms of serotonin syndrome, dangerous withdrawal symptoms, new mania or psychosis, severe agitation, or thoughts of harming yourself or someone else. In Ireland call 112 or 999, or go to the nearest Emergency Department. Outside Ireland, use your local emergency number.

Sources checked for this safety note

St John’s Wort is a medicinal herb with antidepressant activity and potent anti-inflammatory properties. In several countries it is used as an antidepressant for mild (to moderate) depressions.

There are a large number of molecules in extracts of St. John’s Wort that are potentially active in the nervous system. St John’s Wort is known to upregulate postsynaptic serotonin receptors. However, the main mechanism of action of St. John’s wort is probably the inhibition of neurotransmitter uptake. Hyperforin and adhyperforin, for example, induce reuptake inhibition of monoamines, GABA, and glutamate. Hyperforim also has an antagonistic effect on NMDA receptors.

St John’s wort is generally well tolerated, though it may cause photosensitivity. This can lead to visual sensitivity to light and to sunburns in situations that would not normally cause them.

St. John’s Wort can affect the metabolism of several drugs, which means that their blood levels need to be monitored and adjusted in some cases. It has also been reported that it triggered psychotic episodes in some individuals.

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