St Johns Wort- safe use

St John’s Wort is probably one of the most researched and self-prescribed herbs around, so I thought I’d let people know some info for safe usage. These are some of the things I have to think about, as a professional, before prescribing:

Pregnancy and breastfeeding: while this herb appears to be safe so far given studies on both pregnancy and breastfeeding, I tend to err on the side of caution in pregnancy and use less or no herbs (or only miscarriage-prevention herbs), especially if there is any history of miscarriage.

There is a wonderful word we use in herbal medicine called ‘contraindicated’, which is the opposite to ‘indicated’. When someone says “St John’s Wort is indicated in ___”, this means “use this herb for this condition”. If a herb is contraindicated for a particular condition, it means DONT use it.

For example, St Johns Wort is contraindicated for people who have skin photosensitivity, and people taking high doses should be careful if they get a lot of sun exposure or artificial UVA irradiation.

St Johns Wort has been listed as contraindicated with the following drugs: warfarin, digoxin, cyclosporin, indinavir and related anti-HIV drugs, the contraceptive pill… and many others! This is because doctors are worried that something in SJWort may make the body metabolise prescribed drugs faster and thus reduce their effectiveness. It looks like the cause for this might be a specific phytochemical called hyperforin that is present in some subspecies of STWort and not others. Low SJW doses of no more than 2g per day, and/or a form containing less hyperforin (e.g. liquid herbal extract like the ones us herbalists use!) can make SJW safe to use with prescribed drugs, but it should still be done with professional supervision. I’ve certainly seen people get pregnant while on the pill due to taking SJW concurrently (at the same time). So basically, if you are on prescribed medication, don’t self-prescribe SJW- get professional guidance.

Another thing to think about is that yes, SJW is helpful in mild to moderate depression, but not in severe depression (esp if there is suicide risk) and it may be quite distinctly unhelpful for those with mania, hypomania, bipolar type patterns because it can trigger manic episodes. If you don’t have a diagnosed history of bipolar/mania type problems but you have an ‘over-stimulated’ type response to SJW you might be undiagnosed, or perhaps you are quite simply taking too strong a dose. Stop taking it, or at the very least reduce the dose, and seek professional guidance.

Lastly there is the issue of combining SJW with SSRI’s (anti-depressants). The concern here is something called seratonin-overload syndrome. It’s probably not as much of a problem as it’s made out to be… doctors for example, sometimes prescribe more than one SSRI at the same time. BUT if you are going to combine SJW with SSRI’s it’s a good idea to start with very low doses and to have a practitioner guiding you through the process i.e. have professional supervision. Better not to experiment on your own!

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