Frequently asked questions about St. John's Wort
Q: I work all day. Sometimes I forget to take my SJW
A: Given that one of the main actives in hypericum (Hypericin) has a 26.5 hour half life, in all of the significant studies, patients were administered 300 mgs 3 times per day, every day. The other main active in SJW (Hyperforin) is much less stable and has a much faster half life (approximately 9 hours) so it
Q. My doctor suggested that I might take St. John's wort with my Zoloft.
A. St. John's wort in combination with antidepressants such as Prozac, Paxil or Zoloft could potentially lead to a buildup of the brain chemical serotonin. Symptoms may include nausea, anxiety, agitation, confusion, dizziness and uncontrollable muscle twitching.
January 10, 2005
Q: I am a menopausal woman who chooses not to take estrogen therapy. My mother died of breast cancer, so I don't want to take any more risks than necessary. I am wondering if St. John's wort is effective in smoothing the sometimes wild mood swings that can happen at this stage of life.
I continue to have hot flashes that are very troublesome, and my doctor is concerned about the possibility of osteoporosis. I would appreciate information on any therapies other than estrogen that would be effective for these problems.
A: St. John's wort appears to be as effective as standard prescription drugs for relieving mild to moderate depression. Herbal approaches to menopausal symptoms include black cohosh, dong quai. chaste tea berry. ginseng. or soy.
Q: After being on Prozac for several years for PMS, I pulled myself off because of weight gain and loss of libido. We also lost our prescription benefit and had to pay the high cost out of pocket. I am occasionally a little depressed but not like I was a few years ago with four teenagers in the house, a full time job plus helping my husband run his business. Now the kids are grown, the business is sold and I still work full time, but pressures are few. How long must I wait before the drug is out of my system? It's been almost two months, but my sex drive hasn't come back yet. I would like to supplement my diet with St. John's wort but the two times I've tried it for 4 or 5 days I got overly aggressive, sensitive and just bitchy. Any information you can send me would be deeply appreciated.
A: The negative sexual side effects associated with Prozac should begin to disappear shortly. Like the Prozac, St. John's takes at least 5 to six weeks to ramp up. You must take a high quality, high hyperforin, research-grade formulation and be patient. Your PMS may be helped with a variety of natural remedies including vitamin B6, magnesium, vitamin E, chaste tree berry, black cohosh, dong quai or licorice.
Q: My mother recently saw her doctor about sharp chest pains and heart palpitations. Her doctor said the symptoms might be caused by sudden withdrawal from the St. John's wort she had stopped six weeks earlier. Have you ever heard of this?
A: No, never. We have heard of withdrawal difficulties with valerian, but not St. John's wort. Anecdotally, the most common experience is a gradual return to the prior state over a period of three weeks or so. On the other hand antidepressants such as Effexor, Paxil or Zoloft may trigger withdrawal symptoms such as headaches, agitation or dizziness if discontinued suddenly. Paxil withdrawal symptoms, being the most aggressive
Q: Herbal preparations using St. John's wort have become so popular that many people probably do not know of or care about cautions in taking it. In one book I have read, the author warns that this herb acts as an MAO inhibitor and that people taking it should therefore avoid foods such as "cheeses, beer, wine, pickled herring, yeast, etc." I looked up MAO inhibitors and found that people taking such drugs who eat these foods may develop "severe hypertension, headache, palpitations, and perhaps intracranial hemorrhage." This is scary stuff but the word "may" could be significant. If I were to take St. John's wort and eat a cheese sandwich would I experience any of these reactions?
A: Only inferior St. John's Wort formulations may contain MAO inhibitors as they don't use an extract of the top flowering portion of the plant but the whole plant, stems included, which contain zanthrones which contain MAO. Once again you must take a proven, alcohol extracted formulation. Not "Grind" an industry term for a product that has been harvested at the base, ground up and put in a capsule.
Q. I was astonished to read in the paper that St. John's wort doesn't work for depression. I have been taking it for almost a year and it has helped me a lot. Is the research for real or does my response to St. John's wort mean that I am susceptible to suggestion? Now I don't know whether to keep taking it or ask my doctor for a drug like Prozac.
A: There have been dozens of placebo-controlled studies demonstrating that St. John's wort is helpful in treating mild to moderate depression. Some compared the herb to traditional prescription antidepressants and found it equal in effectiveness. The data I think you are referring to was published in the Journal of the American Medical Association (April 18, 2001). These investigators targeted patients with severe depression, which makes their study different from most of the previous research. No one has been recommending St. John's wort for major depression. It should be noted that this study has been criticized on several dimensions (Parker-Pope, 2001). As one example, the study only included the herbal remedy and a placebo and did NOT include a proven antidepressant as well. Other criticisms include a possibility of low expectations on the part of the researchers for both the herb and the placebo; the low expectations may have biased the results.
If you have achieved relief from your depression, we see no reason
for you to stop taking St. John's wort or switch to a drug like Prozac,
Paxil or Zoloft. You should stay in touch with your doctor about
your condition. Keep in mind that St. John's wort can interact with
a number of other medications, as well as with sunlight
Q: I work with breast cancer survivors. Many of the women are taking tamoxifen and will be doing so for at least five years.
Many of them also have problems with depression and have had relief using St. John's wort. Are you aware of any interactions between St. John's wort and tamoxifen?
A: We haven't seen any clinical studies proving that St. John's wort lowers circulating levels of tamoxifen. But, until the research is done, we would discourage women on tamoxifen from taking St. John's wort. It might make this drug less effective and increase the risk of a cancer recurrence. They might look into 5-htp and or SAMe as natural solutions.