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St John's wort is wonderful for anxiety, depression and exhaustion

St John’s wort

Hypericum perforatum

Hypericaceae

St John’s wort is a traditional European wound healer and calming tonic that has accumulated important new evidence as a remedy for mild to moderate depression.

Last reviewed 13/08/2020

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Key benefits
  • Chronic fatigue
  • Anxiety
  • Depression
  • Menopause

  • How does it feel?

    Probably the best way to appreciate the organoleptic qualities of St John’s wort is to obtain a good tincture. The first thing you will notice is that it has a deep red colour, due to its active hypericin constituent. When you taste a sip you will first notice its bitterness, though only for a short time, quickly followed by an acrid quality, and then by a more lingering aromatic and astringent, slightly resinous aftertaste. However overall the taste is short: there is little long term effect in the mouth.

    From first impressions St John’s wort appears as a (blood) red, astringent remedy: ie. an ideal ‘Doctrine of Signatures’ candidate for a wound remedy, which was its original folk use. The same red ‘sanguine’ quality may have inspired its early use to raise the spirits and for melancholia.

    St. John's Wort (Hypericum perforatum)
    St John's wort (Hypericum perforatum)

  • What can I use it for?

    The herb and flowers of St John’s wort have been used over recent centuries throughout Europe for symptoms of nervous tension: insomnia, cramps, intestinal colic and irritable bowel, dysmenorrhoea (menstrual cramps), bed-wetting, and anxiety. It also has a reputation for relieving pains, and is taken internally, as well as applied topically, for neuralgic pains and the pain of mild burns and contusions.

    The plant also has a traditional use as a restorative treatment for melancholic conditions, depression and the convalescence following concussion and other trauma. This combination of restorative and relaxant effect is not contradictory, and underlies the plant’s recommendation for the treatment of a number of such conditions where tension and exhaustion combine. Its most useful modern application is towards a programme of recovery from chronic fatigue conditions.

    One particular example is menopause, and St. John’s wort has a specific application for the various symptoms of that change. Most of the symptoms of menopausal syndrome, the hot flushes, night sweats, depression, fatigue, irritability, lack of concentration, fluid retention and so on, were recognised as symptoms of debility long before a hormonal factor was implicated. The modern natural therapist still finds advantage in treating menopausal problems primarily as symptoms of depletion, requiring restorative and convalescent measures. St. John’s wort seems to have an ideal balance of qualities for this task: it is even felt by many of those who use it that it has a hormonal influence as well.

    The red oil of St. John’s wort brings appreciable relief in the topical treatment of wounds and burns. The whole plant extract has also been used as a wound healer, and taken internally for inflammation of the upper digestive system including oesophagitis, gastritis and peptic ulceration.

  • Into the heart of st John’s wort

    This herb has been regarded in British and European herbal medicine as a calming tonic, initially used for anxiety symptoms and restlessness associated with fatigue, exhaustion and in recovery from illness.

    This earlier tradition is perhaps a better guide to the value of St John’s wort than to seeing it simply as an effective treatment for depression. It is when depression is combined with the symptoms above, as it often is, that this remedy comes into its own.

  • Traditional uses

    St John’s wort has been used as a remedy since ancient times externally to treat ulcers, burns, wounds, abdominal pains and bacterial infections.

  • Traditional actions

    Herbal actions describe therapeutic changes that occur in the body in response to taking a herb. These actions are used to express how a herb physiologically influences cells, tissues, organs or systems. Clinical observations are traditionally what have defined these actions: an increase in urine output, diuretic; improved wound healing, vulnerary; or a reduction in fever, antipyretic. These descriptors too have become a means to group herbs by their effects on the body — herbs with a nervine action have become the nervines, herbs with a bitter action are the bitters. Recognising herbs as members of these groups provides a preliminary familiarity with their mechanisms from which to then develop an understanding of their affinities and nuance and discern their clinical significance.

    Western actions

  • Traditional energetic actions

    Herbal energetics are the descriptions Herbalists have given to plants, mushrooms, lichens, foods, and some minerals based on the direct experience of how they taste, feel, and work in the body. All traditional health systems use these principles to explain how the environment we live in and absorb, impacts our health. Find out more about traditional energetic actions in our article “An introduction to herbal energetics“.

  • What practitioners say

    Convalescence

    St John’s wort is one of the classic tonics, medicines used to help recovery from illness, injury, exhaustion and fatigue. It combines well with Asian tonic medicines in a coordinated approach to chronic fatigue.

    Nervous system

    Traditional practice has emphasised the effect of St John’s wort in reducing symptoms of anxiety and restlessness, with its antidepressant benefits more recently confirmed. Anxiety and depression very often come together and it is this combination that is the best application for the remedy.

    Anti-viral

    St John’s wort is sometimes included in prescriptions where the body is fighting a chronic viral infection. However the evidence would suggest that this is likely to be helpful only with high doses.

    Women’s health

    St John’s wort is an old favourite for supporting women through the menopause. This may be associated with low energy, anxiety and depression as above and these are particularly strong indications.

  • Research

    Systematic reviews have confirmed, subject to inconsistent trial qualities, that for mild and moderate depression St John’s wort is superior to placebo in improving symptoms, and not significantly different from antidepressant medication. Adverse events reported in RCTs were comparable to placebo and fewer than with antidepressants (1). Although this has been disputed, there is evidence that benefits may even be found in major depression (2).

    Reflecting older applications of St John’s wort, significant benefit in managing symptoms of the menopause (3), including hot flushes (4), has also been supported by a meta-analysis and systematic review (5).

    There is also evidence for the topical effects of St John’s wort on atopic eczema (6).

    The antiviral activity of constituent hypericin has been amply demonstrated in the laboratory although the clinical relevance to the activity of St John’s wort has not yet been confirmed (7).

  • Did you know?

    If you collect the flowers in summer and leave them coated in olive oil out in the sun in a glass jar, a surprising red pigment will emerge into the oil at the bottom of the glass. This oil is is a great home remedy for minor scalds and burns and may also account for the plant’s name, after the bleeding head of St John the Baptist!

Additional information

  • Botanical description

    St John’s wort is an erect perennial about 30-60cm high with cylindrical or oval smooth stems, branching in their upper parts and bearing opposite sessile oblong leaves with entire margins.

    A key distinguishing mark against the many other Hypericum species is that on inspection against a light source they are seen to be marked with tiny translucent pinpricks (hence “perforatum”), and also with a few black spots on the underside: the veins are opaque. The bright yellow 5-petalled flowers are borne in a terminal corymb, the long lanceolate petals and shorter sepals both marked with black dots the numerous stamens are bunched into three bundles, and there are three styles. 

    It is found throughout Britain and the whole of Europe well into Asia, and introduced into many other parts of the world, for example North America, on roadsides, banks, woods and hedgerows, preferring open situations and relatively dry and ideally calcereous soils.

  • Common names

    • Klamath weed
    • Goatweed (Eng)
    • Johanniskraut (Ger)
    • Millepertuis (Fr)
    • Erba di San Giovanni (Ital)
    • Hierba de San Juan (Sp)

  • Safety

    St John’s wort is mostly safe. However it may reduce the effectiveness of other medicines: it should be avoided if taking critical-dose prescriptions, especially for potentially serious conditions. It could in theory also reduce the effectiveness of the contraceptive pill. Excessive doses should also be avoided if you are sensitive to light or taking UV therapy.

    Adverse effects are rare from the use of St John’s wort at recommended dosages (8).

    The main concern with St John’s wort is its ability to induce key liver enzymes (cytochrome P450s or ‘CYP450s’) that break down complex non-food materials that get into the body. It may be that hyperforin is more active in this (9). This effect applies to many medicines, so that St John’s wort could reduce their effectiveness and length of action. It becomes a particular issue when the dose of that medicine is critical. So it is not wise to take St John’s wort if you are taking any critical-dose prescription, particularly for a serious condition, including immunosuppressive medication, blood thinning agents, and medicines for severe depression, epilepsy, or heart disease (10). There is also some limited evidence that St John’s wort may interfere with the effects of oral contraceptives (11).

  • Dosage

    2-5 grams of dried herb and flowering tops per day.

  • Constituents

    • Naphthodianthrones (0.05 to 0.6%), including hypericin and pseudohypericin (=’total hypericin’)
    • Phenolics including hyperforin and adhyperforin
    • Flavonoids
    • Tannins
    • Procyanidins
    • Xanthones
    • Essential oil
St. John's Wort (Hypericum perforatum)

  • Recipe

    ‘Let there be joy’ Tea

    Not all of life’s experiences are easy, but this tea will help you digest them with this blend of ‘instant-happiness-herbs’.

    Ingredients:

    • Lemon balm 3g
    • Limeflower 3g
    • Lavender flower 2g
    • Rosemary leaf 1g
    • St John’s wort flowering top 1g
    • Rose water 1 tsp per cup
    • Honey a dash per cup

    This will serve 2 cups of happiness.

    Method:

    • Put all of the ingredients in a pot (except for the rose water and honey).
    • Add 500ml (18fl oz) freshly boiled filtered water. Leave to steep for 10–15 minutes, then strain.
    • Add the rose water and honey to taste, then sip for joy.

    This recipe is from Cleanse, Nurture, Restore by Sebastian Pole

  • References

    1. Apaydin EA, Maher AR, Shanman R, et al. (2016) A systematic review of St. John’s wort for major depressive disorder. Syst Rev. 5(1): 148
    2. Linde K, Berner MM, Kriston L. (2008) St John’s wort for major depression. Cochrane Database Syst Rev. 2008 (4): CD000448
    3. Eatemadnia A, Ansari S, Abedi P, Najar S. (2019) The effect of Hypericum perforatum on postmenopausal symptoms and depression: A randomized controlled trial. Complement Ther Med. 45: 109-113
    4. Abdali K, Khajehei M, Tabatabaee HR. (2010) 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. 17(2): 326-331
    5. Liu YR, Jiang YL, Huang RQ, et al. (2014) Hypericum perforatum L. preparations for menopause: a meta-analysis of efficacy and safety. Climacteric. 17(4): 325-335
    6. Arndt S, Haag SF, Kleemann A, Lademann J, Meinke MC. (2013) Radical protection in the visible and infrared by a hyperforin-rich cream–in vivo versus ex vivo methods. Exp Dermatol. 22(5): 354-357
    7. Jacobson JM, Feinman L, Liebes L, et al. (2001) Pharmacokinetics, safety, and antiviral effects of hypericin, a derivative of St. John’s wort plant, in patients with chronic hepatitis C virus infection. Antimicrob Agents Chemother. 45(2): 517-524
    8. Knüppel L, Linde K. Adverse effects of St. John’s Wort: a systematic review. (2004) J Clin Psychiatry. 65(11): 1470-1479
    9. Whitten DL, Myers SP, Hawrelak JA, Wohlmuth H. (2006) The effect of St John’s wort extracts on CYP3A: a systematic review of prospective clinical trials. Br J Clin Pharmacol. 62(5): 512-526
    10. Mills E, Montori VM, Wu P, et al. (2004) Interaction of St John’s wort with conventional drugs: systematic review of clinical trials. BMJ. 329(7456): 27-30
    11. Berry-Bibee EN, Kim MJ, Tepper NK, et al. (2016) Co-administration of St. John’s wort and hormonal contraceptives: a systematic review. Contraception. 94(6): 668-677

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Aromatic
An ‘aromatic’ remedy, high in volatile essential oils, was most often associated with calming and sometimes ‘warming’ the digestion. Most kitchen spices and herbs have this quality: they were used both as flavouring and to ease the digestion of sometimes challenging pre-industrial foods. Many aromatics are classed as ‘carminatives’ and are used to reduce colic, bloating and agitated digestion. They also often feature in respiratory remedies for colds, chest and other airway infections. They are also classic calming inhalants and massage oils, and are the basis of aromatherapy for their mental benefits.
Astringent
The astringent taste you get with many plants (the most familiar is black tea after being stewed too long, or some red wines) is produced by complex polyphenols such as tannins. Tannins are used in concentrated form (eg from oak bark) to make leather from animal skins. The process of ‘tanning’ involves the coagulation of relatively fluid proteins in living tissues into tight clotted fibres (similar to the process of boiling an egg). Tannins in effect turn exposed surfaces on the body into leather. In the case of the lining of mouth and upper digestive tract this is only temporary as new mucosa are replenished, but in the meantime can calm inflamed or irritated surfaces. In the case of open wounds tannins can be a life-saver – when strong (as in the bark of broadleaved trees) they can seal a damaged surface. One group of tannins, the reddish-brown ‘condensed tannins’ are procyanidins, which can reduce inflammation and oxidative damage.
Bitter
Bitters are a very complex group of phytochemicals that stimulate the bitter receptors in the mouth. They were some of the most valuable remedies in ancient medicine. They were experienced as stimulating appetite and switching on a wide range of key digestive functions, including increasing bile clearance from the liver (as bile is a key factor in bowel health this can be translated into improving bowel functions and the microbiome). Many of these reputations are being supported by new research on the role of bitter receptors in the mouth and elsewhere round the body. Bitters were also seen as ‘cooling’ reducing the intensity of some fevers and inflammatory diseases.
Cooling
Traditional ‘cold’ or cooling’ remedies often contain bitter phytonutrients such a iridoids (gentian), sesiquterpenes (chamomile), anthraquinones (rhubarb root), mucilages (marshmallow), some alkaloids and flavonoids. They tend to influence the digestive system, liver and kidneys. Cooling herbs do just that; they diffuse, drain and clear heat from areas of inflammation, redness and irritation. Sweet, bitter and astringent herbs tend to be cooling.
Hot
Traditional ‘hot’ or ‘heating’ remedies, often containing spice ingredients like capsaicin, the gingerols (ginger), piperine (black or long pepper), curcumin (turmeric) or the sulfurous isothiocyanates from mustard, horseradich or wasabi, generate warmth when taken. In modern times this might translate as thermogenic and circulatory stimulant effects. There is evidence of improved tissue blood flow with such remedies: this would lead to a reduction in build-up of metabolites and tissue damage. Heating remedies were used to counter the impact of cold, reducing any symptoms made worse in the cold. .
Mucilaginous
Mucilages are complex carbohydrate based plant constituents with a slimy or ‘unctuous’ feel especially when chewed or macerated in water. Their effect is due simply to their physical coating exposed surfaces. From prehistory they were most often used as wound remedies for their soothing and healing effects on damaged tissues. Nowadays they are used more for these effects on the digestive lining, from the throat to the stomach, where they can relieve irritation and inflammation such as pharyngitis and gastritis. Some of the prominent mucilaginous remedies like slippery elm, aloe vera and the seaweeds can be used as physical buffers to reduce the harm and pain caused by reflux of excess stomach acid. Mucilages are also widely used to reduce dry coughing. Here the effect seems to be by reflex through embryonic nerve connections: reduced signals from the upper digestive wall appear to translate as reduced activity of airway muscles and increased activity of airway mucus cells. Some seed mucilages, such as in psyllium seed, flaxseed (linseed) or guar bean survive digestion to provide bulking laxative effects in the bowel. These can also reduce rate of absorption of sugar and cholesterol. .
Pungent
The pungent flavour refers to the powerful taste of hot spices including mustard (Brassica spp.), ginger (Zingiber officinale), horseradish (Amoracia rusticana), chilli (Capsicum spp.), and garlic (Allium sativum). These herbs act to enliven and invigorate the senses, and they often also have heating qualities. Unlike other tastes, the effect is not linked to a specific receptor on the tongue and instead acts through direct irritation of tissues and nerve endings. Energetically, pungent herbs are known to disperse energy (qi) throughout the body. Pharmacologically, pungent herbs dry excess moisture and mucus, as well as stimulate digestion and metabolism.
Resinous
Resins are most familiar as tacky discharges from pine trees (and as the substance in amber, and rosin for violin bows). They were most valued however as the basis of ancient commodities like frankincense and myrrh (two of the three gifts of the Three Wise Men to the baby Jesus) and getting access to their source was one benefit to Solomon for marrying the Queen of Sheba (now Ethiopia). Resins were the original antiseptic remedies, ground and applied as powders or pastes to wounds or inflamed tissues, and were also used for mummification. With alcohol distillation it was found that they could be dissolved in 90% alcohol and in this form they remain a most powerful mouthwash and gargle, for infected sore throats and gum disease. They never attracted much early research interest because they permanently coat expensive glassware! For use in the mouth, gums and throat hey are best combined with concentrated licorice extracts to keep the resins in suspension and add extra soothing properties. It appears that they work both as local antiseptics and by stimulating white blood cell activity under the mucosal surface. They feel extremely effective!
Salty
The salty flavour is immediately distinctive. A grain dropped onto the tongue is instantly moistening and a sprinkle on food enkindles digestion. This easily recognisable flavour has its receptors right at the front of the tongue. The salty flavor creates moisture and heat, a sinking and heavy effect which is very grounding for the nervous system and encourages stability. People who are solid and reliable become known as ‘the salt of the earth'.
Sharp
The sharp taste of some fruits, and almost all unripe fruits, as well as vinegar and fermented foods, is produced by weak acids (the taste is generated by H+ ions from acids stimulating the sour taste buds). Sour taste buds are hard-wired to generate immediate reflex responses elsewhere in the body. Anyone who likes the refreshing taste of lemon or other citrus in the morning will know that one reflex effect is increased saliva production. Other effects are subjective rather than confirmed by research but there is a consistent view that they include increased digestive activity and contraction of the gallbladder.
Sour
The sour taste occurs because of the stimulation of hydrogen ions which trigger the sour taste receptors on the tongue. The more acidic a substance, the more hydrogen ions will be released. The sour taste comes from acidic substances including citrus, fermented foods, tannins, and vinegars. Sour foods and herbs absorb excess moisture, whilst also increasing the production of saliva. Energetically, sour substances tonify the lungs, playing a role in disease prevention. Excessive use, however, can result in malabsorption of nutrients. Examples of sour herbs include, rosehips (Rosa canina), raspberry (Rubus idaeus), rhubarb (Rheum palmatum), schisandra (Schisandra chinensis), hawthorn (Crataegus monogyna) and ginkgo (Ginkgo biloba).
Sweet
In the days when most people never tasted sugar, ‘sweetness’ was associated with the taste of basic foods: that of cooked vegetables, cereals and meat. In other words sweet was the quality of nourishment, and ‘tonic’ remedies. Describing a remedy as sweet generally led to that remedy being used in convalescence or recovery from illness. Interestingly, the plant constituents most often found in classic tonics like licorice, ginseng are plant steroids including saponins, which also have a sweet taste.
Umami
The umami taste was originally discovered in 1985 in Japan and is directly translated from the Japanese as a ‘pleasant savoury taste’. It is referred to as the ‘fifth taste’ and is a salty, rich, and meaty flavour. The umami flavour is produced by amino acids (glutamic acid and aspartic acid) found in many food and plant sources including tomatoes, mushrooms, seaweeds and soy-based foods. Umami foods can improve nutritional absorption and digestion as there are also umami receptors in the gut as well as the mouth. Examples of umami herbs include green tea (Camellia sinensis), reishi (Ganoderma lucidum), nettle (Urtica dioica), cordyceps (Ophiocordyceps sinensis), shitake (Lentinula edodes) and bladderwrack (Fucus vesiculosus).

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