How to Use St. John's Wort Therapeutically: The Health Uses You May Never Have Heard Of

St. John's wort has a rich history dating back centuries, revered for its medicinal properties and therapeutic benefits. The herb's ancient uses trace back to traditional medicine practices in various cultures, where it was believed to possess remarkable healing powers and aided in treating kidney and lung disease, insomnia, depression, and wounds. Historically, St. John's wort found its place in herbal remedies, with its name derived from the fact that it is often in full bloom on John the Baptist's birthday. In recent years, as the interest in complementary medicine has surged, St. John's wort has gained widespread recognition for its effectiveness in addressing various health concerns, particularly in managing depression and other mood-related conditions. Its enduring legacy as a medicinal herb continues to make it a subject of extensive research and a cornerstone in alternative therapies. (27)

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What is St. John's Wort?

St. John's wort boasts distinct botanical attributes that make it easily identifiable. This perennial plant, scientifically named Hypericum perforatum, features bright yellow flowers with five petals and numerous stamens. The leaves are characterized by small, translucent dots that resemble perforations when held against the light, a unique trait of this plant. St. John's wort typically grows in well-drained soils, favoring sunny, open spaces. It thrives in regions with temperate climates, often found in Europe, Asia, and North America. This hardy plant has been widely recognized for its therapeutic properties, especially in herbal medicine, due to the presence of hypericin and other active compounds. (27, 28) 

What Are The Active Components of St. John's Wort?

St. John's wort derives its medicinal prowess from its flowers and, to a lesser extent, its leaves, which are rich in active compounds called napthodianthrones (e.g., hypericin and pseudohypericin), phloroglucinols (e.g., hyperforin), and flavonoids (e.g., quercetin, kaempferol, and luteolin). Hypericin, pseudohypericin, and hyperforin have been best studied and believed to exert many of their therapeutic effects by regulating levels of neurotransmitters in circulation. However, the phenolic compounds found in St. John's wort likely act synergistically to combat oxidative stress and reduce inflammation, further contributing to the herb's medicinal properties. 

(17, 28)

Top Therapeutic Uses of St. John's Wort

St. John's wort has gained popularity for its diverse therapeutic applications. From its effectiveness in treating depression and anxiety to its potential in managing skin conditions, the herb's top therapeutic uses showcase its versatile and valuable contributions to natural medicine.

1. St. John's Wort for Depression

St. John's wort has gained significant attention in the realm of mental health, particularly for its ability to act as a natural antidepressant. The herb's constituents, hyperforin and adhyperforin, modulate the effects and inhibit the reuptake of neurotransmitters serotonin, dopamine, and norepinephrine. By preventing the rapid reabsorption of these neurotransmitters, the herb helps maintain higher levels in the brain, leading to improved mood. 

Numerous clinical studies have supported its efficacy in alleviating emotional and somatic depressive symptoms. These studies indicate that St. John's wort is superior to placebo and as effective as low-dose tricyclic and selective serotonin reuptake inhibitor (SSRI) antidepressants for treating mild to moderate depression. Additionally, findings show that St. John's wort is often better tolerated, resulting in fewer adverse effects than standard pharmacologic therapies. Furthermore, the positive benefits of St. John's wort may be longer-lasting than its pharmaceutical counterparts. One clinical trial concluded that 900 mg of St. John's wort extract resulted in increased response duration and reduced rates of relapse and recurrence compared to citalopram and placebo. (3, 9)

2. St. John's Wort for Menopausal Symptoms

SSRIs are a class of medications primarily used to treat depression and anxiety disorders; however, they have also been found to be effective in managing menopausal vasomotor symptoms, including hot flashes and night sweats. The exact mechanism through which SSRIs alleviate hot flashes is not fully understood, but it is believed to be related to their impact on neurotransmitter levels in the brain. Hot flashes are thought to be triggered, in part, by fluctuations in serotonin and norepinephrine. SSRIs work by blocking the reabsorption of serotonin in the brain, leading to increased serotonin levels. This alteration in serotonin levels may help regulate the body's temperature control system, reducing the frequency and intensity of hot flashes. (15) 

A meta-analysis of clinical trials in menopausal adults shows that taking 900 mg of St. John's wort for up to 16 weeks reduces the frequency and severity of hot flashes when compared to placebo. Other research also suggests the herb improves overall quality of life and psychological symptoms in menopausal adults (2, 10). St. John's wort is effective when used alone or with other botanicals. Black cohosh has been commonly studied in combination with St. John's wort.  

3. St. John's Wort for Premenstrual Syndrome (PMS)

Women suffering from PMS often experience a range of emotional and physical symptoms, including mood swings, irritability, and fatigue. These symptoms may stem from chemical imbalances. Research shows that women with PMS have significantly lower serotonin levels during the last ten days of the menstrual cycle, accounting for the onset of changes to mood, energy, and sleep patterns associated with PMS. (5) 

Similar to depression and menopause, SSRIs can be used as a conventional and pharmacologic option for treating PMS symptoms. St. John's wort has been used as an alternative over-the-counter treatment for natural PMS symptom relief. One clinical study showed that taking St. John's wort extract 450 mg twice daily reduced physical and behavioral symptoms of PMS after two menstrual cycles. A published case study has also demonstrated St. John's wort as an effective option for ameliorating symptoms of premenstrual dysphoric disorder (PMDD), a more severe form of PMS. 

4. St. John's Wort for Skin Conditions

St. John's wort has antimicrobial properties and may help fight inflammation (28). Applied topically, these actions contribute to the herb's therapeutic potential in skin therapy, which is beneficial for inflammatory skin conditions and superficial wounds. Hypericin and hyperforin are responsible for inhibiting the epidermal inflammatory response and promoting the proliferation phase of the wound-healing cascade (20).  

The inflammatory cytokine tumor necrosis factor-alpha (TNF-alpha) is commonly elevated in psoriatic skin lesions. In a double-blind study, researchers found that applying a 5% topical St. John's wort ointment to the skin of patients with moderate psoriasis significantly reduced TNF-alpha and resulted in reduced redness, thickness, and scaling of psoriatic skin plaques.

A published case study also depicts that St. John's wort can improve the epithelialization of skin, improving the healing of pressure sores in an intensive care unit patient. A larger study, including 144 women undergoing childbirth via cesarean section, demonstrated the efficacy of topical St. John's wort in facilitating skin healing post-cesarean section, minimizing scar formation, and reducing pain and itching at the surgical site.

5. St. John's Wort for Neuropathic Pain

Neuropathic pain is a type of chronic pain that occurs as a result of damage or dysfunction in the nervous system. This type of pain affects an estimated 10% of the general population and can manifest in conditions including diabetic neuropathy, sciatica, shingles, and multiple sclerosis. Neuropathic pain is notoriously difficult to treat, and management usually involves a multifaceted approach involving a combination of medications, physical therapy, and psychological support.

St. John's wort has emerged as a natural remedy for neuropathic pain. By modulating neurotransmitters in the brain, St. John's wort may help regulate pain perception pathways and reduce neuropathic pain. Another theory for St. John's wort's analgesic effects is its ability to inhibit protein kinase C pathways, which are implicated in neuropathic pain. (1)  

6. St. John's Wort for Sleep Disorders

St. John's wort has shown potential therapeutic benefits in addressing sleep disorders, making it a subject of interest in the realm of sleep medicine. Most clinical studies of St. John's wort have focused on treating depression rather than insomnia specifically. However, sleep disturbances are a common clinical manifestation of depression, and studies have found that supplementing with St. John's wort results in reduced insomnia related to mild to severe major depression. (14, 18) 

Some evidence suggests St. John's wort may be beneficial for sleep by prolonging the duration of deep sleep rather than optimizing overall sleep quality. The time spent in deep sleep, without any other changes to sleep architecture, has been measured to be longer in patients taking supplemental St. John's wort. (23, 24) 

Potential Side Effects and Interactions with St. John's Wort

While St. John's Wort is considered a natural remedy with many therapeutic attributes, it is crucial to be aware of potential side effects and interactions associated with its use. Some individuals may experience mild side effects, such as gastrointestinal upset, dry mouth, dizziness, fatigue, or skin sensitivity to sunlight. (17) 

Because St. John's wort increases circulating levels of serotonin, taking it with other antidepressants or medications that also augment serotonin may cause serotonin syndrome, a potentially life-threatening situation characterized by flushed skin, nausea, vomiting, rapid heart rate, tremor, and altered mental status.

One significant concern with St. John's Wort is its potential to interact with various medications and supplements. The herb can induce certain liver enzymes responsible for drug metabolism, leading to reduced effectiveness of medications metabolized by these enzymes. This interaction can interfere with the potency of several prescription drugs, including birth control pills, anticoagulants, heart medications, antidepressants, chemotherapy agents, and immunosuppressants. (17, 27) 

It is crucial for anyone considering St. John's wort supplementation to consult a healthcare professional, especially if they are already taking medications or have existing health conditions. Healthcare providers can assess potential interactions and provide personalized recommendations to ensure the safe and effective use of St. John's wort as a complementary therapy.

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Summary

Embracing the healing properties of St. John's wort opens the door to a myriad of therapeutic benefits, ranging from its efficacy in managing depression to its potential in alleviating neuropathic pain and skin conditions. With a rich history rooted in ancient remedies, this medicinal herb has found its place in modern complementary medicine. However, it is crucial to approach its use with informed caution, understanding its potential drug-herb interactions and possible side effects. When used thoughtfully and under professional guidance, individuals can maximize the advantages offered by St. John's wort, tapping into its diverse healing potential.