Expert Advice

Can I Use St. John's Wort to Treat Depression?

Careful dosing instructions need to be followed when using this complex herb.
Can I Use St. John's Wort to Treat Depression?
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Known for mitigating mild-to-moderate depression, St. John’s Wort is considered safe. It’s complex, however, and can interact with other drugs, especially antidepressants. Follow these guidelines for using it safely: Dose carefully. Do not combine full doses of St. John’s Wort with other antidepressants or selective serotonin reuptake inhibitors (SSRIs) as this can lead to an overload of serotonin that deepens depression and may ignite mood swings and suicidal feelings. To use in combination with antidepressants, work with your doctor to control the dosage of both. You can gradually lower your antidepressant dose by one half and then use 50 percent of the usual St. John’s Wort dosage (see label guidelines), so you maintain a 50-50 balance. Never abruptly cut your drug intake—you need to wean yourself off the antidepressants or SSRIs as you bump up your dosage of St. John’s Wort. Do not make any changes to your medical prescription without first seeing your doctor.

Know when to avoid it. St. John’s Wort affects pathways in the liver, so it can interfere with infection-fighting drugs like indinavir (used to treat HIV) and cyclosporine (used to prevent organ transplant rejection). Skip St. John’s Wort if you’re pregnant or breast-feeding. The herb can also interact with fermented foods, like cheese and wine, and cause headaches for those prone to migraines.

Experience fewer side effects. Studies have found that 900 to 1,200 mg of St. John’s Wort a day can be just as effective in treating mild to moderate depression as tricyclic antidepressants and SSRIs, but without side effects like weight gain, decreased sex drive, fatigue, and insomnia. There are potential side effects like sensitivity to light and headaches. Drink it. The best way to take St. John’s Wort is as a tincture, an alcohol-based liquid, which can get the herb into your bloodstream quickly. Try Herb Pharm or Gaia Herbs. —Karen Vaughan, M.S.T.O.M., American Herbalists Guild