Using St. John's Wort for Depression and Anxiety

A practical guide to choosing a product, dosing it correctly, and using it safely alongside (or instead of) other treatments.

Choosing a standardized product

Pick an extract standardized to at least 3% hyperforin, the main active ingredient.
A 900 mg daily dose at that strength delivers a minimum of about 27 mg of hyperforin.
Choose dark or amber bottles — hyperforin degrades with heat and light.

Recommended dosing

900 mgtotal per day

300 mg ×3one 300 mg capsule, three times daily

450 mg ×2or one 450 mg capsule, twice daily

How long until it works

Effects typically begin after about a month, with maximum benefit around 6–8 weeks. Expect meaningful results after roughly two months of consistent use, though some people notice a change within two weeks.

Side effects

Most users have none. When they occur, possibilities include headaches, upset stomach, fatigue, vivid dreams, sun sensitivity and a possible initial increase in anxiety. These are generally milder than with prescription antidepressants and usually fade within a few weeks.

Important interactions: St. John's Wort affects liver enzymes that metabolize more than half of all prescription and over-the-counter drugs. Do not combine it with SSRIs, SNRIs, tricyclics or other antidepressants without medical advice (risk of serotonin syndrome), and do not take it within 14 days of stopping an MAO inhibitor. Oral-contraceptive users should consult a gynecologist, as effectiveness may be reduced.

Severe depression

More than 27 published clinical studies support its use for mild-to-moderate depression, but the evidence for severe depression is insufficient (even though one study found it more effective than a prescription drug for moderate-to-severe cases). Anyone who is severely depressed or having suicidal thoughts should seek immediate medical care.

Who should be cautious

Bipolar disorder: not recommended — the mood-elevating effect may trigger mania.
Pregnancy and nursing: not recommended; consult an OB/GYN before use when planning conception.
Children: considered appropriate for ages 12 and up under parental supervision; insufficient data for under 12.
Chronic conditions: schizophrenia, seizure disorders and other serious conditions require a physician's guidance first.