St JOHN'S WORT
Common Names

St John's Wort
Botanical Name
Hypericum perforatum
Family
Hypericaceae

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What is it?

St John’s wort is an upright, long-lived herb that grows to about half a meter in height and produces bright, lovely, yellow five-petalled flowers on the ends of smooth stems from its many branches. If you hold the small leaves of St John’s wort to the sun you can see that they have many tiny holes, or perforations, hence the second half of the Latin name; perforatum


FLOWER


PLANT


DRIED

How has it been used?

St John’s wort has been revered as a medicinal plant throughout history. The first part of St John’s wort’s old botanical name, Hypericum, loosely translates to ‘rising above one’s daemon’. This has long been seen as a herb that helps people to lift out of the dark places.

Susanne Fischer-Rizzi writes 'from medieval days St John’s wort was thought to banish demons. Peasants hung it in the tables to protect livestock from sorcery and placed a small tuft in their chamber windows to keep evil spirits from entering. The plants power to undo spells resulted in names like 'chase the devil' and 'flight of the demons'. According to legend the Devil himself perforated the leaves of St John’s wort because he fretted about its healing power. However rather than perish the plant became a sure means of repelling evil spirits... The old ones said 'St John's wort stores the Sun's life in its leaves and flowers to give to us'

People with anxiety and depression and people who are suffering from tension and irritability can experience a marked calming and uplifting benefit from St John’s wort.

In fact, there is an interesting body/mind duality to St John’s wort. It has become somewhat famous in modern times as a natural 'anti-depressant' but there is an equally physically compelling story to it that shows how its actions in the nervous system are just as much to do with its flesh and blood effects as anything to do with the mind.

King's Dispensatory writes 'Hypericum has undoubted power over the nervous system, and particularly the spinal cord. It is used in injuries of the spine and in lacerated and punctured wounds of the limbs to prevent tetanic complications and to relieve the excruciating pains of such injuries (Scudder). It is highly valued by Webster in spinal irritation when, upon gentle pressure upon the spinous processes of the vertebrae, burning pain is elicited. Throbbing of the whole body in nervous individuals, fever being absent, is said to be a good indication for hypericum. The blossoms, infused in sweet oil or bear's oil, by means of exposure to the sun, make a fine, red balsamic ointment for wounds, ulcers, swellings, tumours, etc'

Thomas Bartram describes the actions of St John's wort as an 'alterative, astringent, anti-viral, relaxing nervine, anti-depressant, sedative, anti-inflammatory, cardiac tonic & an external analgesic' and he suggests it may be used for many conditions including 'neuralgia, facial and intercostal, sciatica, concussion of the spine, post-operative pain and neuralgia, physical shock. Pain in coccyx, polymyalgia with tingling of fingers or feet, to reduce pain of dental extractions. Injuries to flesh rich in nerves - finger tips or sole of feet. Shooting, stitching pains. Punctured wounds, bites of dogs or cats where pain shoots up the arm from the wound. Temporary relief reported in Parkinsonism. Has been used with some success in relieving cramps of terminal disease. Menstrual cramps and menopausal nervousness. Anxiety, stress, depression'

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Science on St John's wort

~ A number of clinical trials have demonstrated that St John's wort compares favourably with the popular antidepressant drugs fluoxetine, sertraline and imipramine but without those drugs' side effects. It has been shown to be particularly helpful in treating depressed patients with anxiety symptoms (Woelk H: BMJ 321(7260):536-539,2000) (Philipp M, Kohnen R, Hiller KO: BMJ 319:1534-1539,1999) (Friede M, Henneicki-von H-H, Fredenstein J: Phytomed (supp 2):18-19,2000)

~ A surveillance study of 76 children under the age of 12 with mild to moderate depression showed that St John's wort was beneficial and well tolerated (Hubner WD, Kirste T: Phytother Res 15(4):367-370,2001)

~ St John's wort has been shown in clinical studies to be helpful for patients suffering from seasonal-affective-disorder and obsessive compulsive disorder (Harrer G: Schweiz Rundsch Med Prax 89(50):2123-2129,2000)

~ St John's wort may help many women experiencing difficulty with the menopause both by itself - (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):326-31) and also when used in conjunction with Black Cohosh (a herb that has been well established to help many women with the menopause) it showed better results than the Black Cohosh by itself (Briese V, Stammwitz U, Friede M, Henneicke-von Zepelin HH. Black cohosh with or without St. John's wort for symptom-specific climacteric treatment--results of a large-scale, controlled, observational study. Maturitas 2007;57:405-14)

~ Women who experience the premenstrual syndrome may receive substantial benefit from using St John's wort over several months (Canning, S., Waterman, M., Orsi, N., Ayres, J., Simpson, N., and Dye, L. The efficacy of Hypericum perforatum (St John's wort) for the treatment of premenstrual syndrome: a randomized, double-blind, placebo-controlled trial. CNS.Drugs 2010;24(3):207-225)  

~ Further evidence suggests that St. John's wort extract containing hypericin 1.36 mg daily for two menstrual cycles can reduce symptoms of PMS, including anxiety, depression, forgetfulness, crying, headache, and fatigue, compared to placebo (Ghazanfarpour, M., Kaviani, M., Asadi, N., Ghaffarpasand, F., Ziyadlou, S., Tabatabaee, H. R., and Dehghankhalili, M. Hypericum perforatum for the treatment of premenstrual syndrome. Int.J.Gynaecol.Obstet. 2011;113(1):84-85)

~ Somatic symptom disorder has been shown to be able to be significantly helped by St John's wort - this is a very difficult condition to understand and treat compassionately, whereby the patient experiences a range of profoundly disturbing physical symptoms that have no organic cause. Based on the evidence, St John's should certainly be considered in such cases (Volz HP, Murck H, Kasper S, Moller HJ. St John's wort extract (LI 160) in somatoform disorders: results of a placebo-controlled trial. Psychopharmacology (Berl) 2002;164:294-300) and also (Muller, T., Mannel, M., Murck, H., and Rahlfs, V. W. Treatment of somatoform disorders with St. John's wort: a randomized, double-blind and placebo-controlled trial. Psychosom.Med. 2004;66(4):538-547)

~ St John's wort has been shown in experimental studies to inhibit the reuptake of serotonin, norepinephrine and dopamine. Many compounds in St John's wort, including flavonoids, hypericins and hyperforin appear to contribute to its mood lifting effects (Kasper S, Schulz V: Wein Med Wochenschr 149(8-10):191-196, 1999)

The authors, titles and the 'where-and-when' published of nearly 400 further studies and articles on St John's wort are listed in a PDF found here

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Safety of St John's wort

There are now many cautions in the medical and popular literature about St John's wort. Herbal medicines are powerful substances; in fact, if you put any of them under the microscope as much as St John's has been you will find that they too do things within the body. This should not surprise anyone, herbs are, after all, natural drugs, they must do things within the body!

In actual fact, St John's is a very safe herb for the most part and, used by itself, the only real concern cab be that high doses can increase 'photosensitivity'. So, if taking this herb in medicinal levels you may need to be aware of an increased need to use sunglasses and to be careful about the level of sunlight you are exposed to (that is not to say to avoid it, just be careful not to get burnt!)

The great majority of the concerns that have come up over St John's wort relate to its ability to interact with drugs and, by far, the main reason for this is that it increases the body's ability to metabolise and excrete the drug. In other words, by virtue of helping the body's natural process of detoxification, St John's can render drugs less effective. One could argue that something that helped the body get rid of a substance that it regarded as toxic was a very good thing, but you can see why it has become rather unpopular in certain circles!

That said, there are going to be many situations where the drugs need to work to their full extent and certainly St John's wort should not be used at the same time as such drugs as warfarin, digoxin, cyclosporine, indinavir and related anti-HIV drugs.

Some further examples are that taking St. John's wort with voriconazole may reduce its effectiveness as an antifungal agent. Likewise, concomitant use with St. John's wort can reduce serum concentrations of omeprazole by up to 50% and St. John's wort can increase the oral clearance of nevirapine (Viramune) by 35%. Taking St. John's wort 300 mg three times daily for 14 days can significantly decrease maximum serum levels of ketamine by around 66%

A woman who was using the contraceptive pill to prevent pregnancy should not take St John's wort, as it will decrease the effectiveness of the pill, or she should use a further method of contraception as well.

There are theoretical concerns that St John's wort may cause adverse effects to people taking SSRIs (selective serotonin reuptake inhibitors). It may be wise not to use them together but what has been found in practice is that many hundreds of people have been seen to get much benefit from using St John's wort to help get off SSRI drugs, especially in the early stages where it appears to significantly help with the withdrawals from the drugs.

General safety note on herbs

Therapeutic substances, and this certainly all includes all medicinal herbs, can do good and, therefore, also have the potential to do harm. The maxim that 'the poison is in the dose' precisely describes how too much of anything can be bad for us and the ancient rule to 'firstly, do no harm is, to this day, held as the core directive by all practitioners of traditional herbal medicine. So, not only are we careful to do our best to use the right herbs but, equally, we take care to not give too much of them or use them overlong.

For some years now, against this old, proven and safe way of herbalism, there has been a rising tide of excessive caution and scare-mongering in many parts of the world. The same authorities and medical publications that no so long ago decried herbal medicines as ineffectual have now taken up a different kind of adversarial position. That they are dangerous substances that should not be taken for a long list of reasons and really should only be prescribed by Doctors, who of course have zero training in them.

Lists of '10 popular herbs and why you should avoid them' include things like Garlic and Ginger that might 'thin your blood'. It is absurd to the point of the ridiculous, but fear is a universal driver, and fear has also been long proven to be effective when used to manipulate and control others.

I realise that the reader who comes to a page like this is unlikely to be swayed by such misinformation, but I nevertheless want to remind you that the reason that herbs cannot be patented or owned by any individual or corporation is that they are the people's medicine. They belong to us all and it is my great hope that you will learn how to use them safely and wisely for yourself and the people you care for. Be safe but do not be afraid.

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Personal experiences

I deeply esteem St John’s wort and have used a great deal of it in my practice for many years now. Many of the people I give St John's wort to would not be described as depressed in any clinical sense but still need help from Nature to ease their pain, anxiety or tiredness.

I find it to have a particular calming, nourishing action that gives great benefit to people who are deeply tired or who have pain in their mind or body. It is a herb that feeds the nervous system and does much to lift a person's spirits and general energy levels.

In terms of St John's wort and depression, I see that many people who have been diagnosed with depression, and told they have a chemical imbalance, have in fact have some intense emotional pain from their past that they have not yet been able to process. St John's can be an extraordinary ally in this regard, not because it can do anything to change the past, but by being such a potent tonic to the nerves it helps the person do the work, the processing, that they need to do to get well.

Of course, no herb, or any other intervention for that matter, works for everyone, so Is there any way to tell ahead of time who is more likely to respond to St John’s wort?

If you who are reading this are studying herbal medicine or if you just have your own reasons to need to know this plant at a much deeper level then I urge you to take a dose of St Johns tincture or tea and then, with a quiet and attentive mind, observe for yourself how it makes you feel. Your body is a remarkably intelligent, sentient 'laboratory'. It will tell you if this is a herb that you need to take for a while or if it should rather just make your acquaintance briefly today. This old way of 'experiential learning' can do more to help you truly appreciate the 'action' of a plant remedy than any amount of academic learning about it. Try for yourself and see.

Further to this, I can also say from my own experience that if I 'pulse-test' someone with a few drops of St John's then, when it is the right herb for them, the difference in the pulse is quite striking to behold. If you would like to learn more about this ancient art, read here

Dosage, which in turn is in relation to the quality of the starting material of the herb, is always a critical factor in successful herbal medicine. As with nearly all of our herbs, I and most herbalists prefer to use the whole herb rather than an isolated extract from it, and I hope the scientific community are now well past thinking it is the hypericin, or the hyperforin, or any other single part of it that is making all these good things happen. That said, a reliable dose would be two good quality 300mg capsules where there is a guarantee of, for example, at least 0.3% of hypericins to show the starting material was high quality.

We are very lucky in New Zealand to be able to wildcraft-harvest some absolutely stunning St John's wort from South Canterbury and Otago regions. It's incredibly good to work with and when we make a tincture from it I am confident that just 2 or 3 mls in a day will be ample for most people. A well heaped tsp of the dried flowers from this source makes about 1.5 gms and I think this would certainly be enough for a medicinal tea. As with so many of our potent, 'activating' nervine herbs, 'more' is not better, the best dose is the one the person can feel and that their body will respond to, and it is often quite moderate if the herb itself is of high quality.

St John’s wort combines perfectly with Cramp bark for strong nerve pain, with Kava for tense anxious states, with Skullcap for restlessness and an over-active mind and with Hawthorn when there is pain or loss that needs help with healing.

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Constitutional note

Much of the information here about the traditional uses of St John's wort is consistent with the model of thinking whereby one may treat condition A with plant/substance B. There is value in this approach, especially in how it helps us pass on useful knowledge to one another, but it falls short in one vital area; and that is that people are not all cut from the same cloth! Something that works brilliantly for one person may do less for another --why is this?

Part of the reason is that people vary in their constitutions as to whether they are either hotter or cooler and, at the same time, either dryer or damper. This useful and rather fascinating subject is introduced further here

Another big part of using the right herb when it is most needed comes from understanding the need to treat what is going wrong for the person that had led up to their getting a health condition. In this light, St John's can particularly offer its benefits when an activation is needed in the 'cycle of healing', more about this here

Please understand that I cannot advise you, including on products or dosage, without seeing you in person in my clinic but for ideas on how you might find a good herbalist in your area read here

This living 'book' is my labour of love so, wherever you are, I wish you peace & good health!

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© 2011 R.J.Whelan Ltd