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Nutritional Supplements

Depression, Anxiety & Insomnia: Is St. John’s Wort Effective?

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June 6, 2024

By Joie Meissner ND, BCB-L

ST. JOHN’S WORT SNAPSHOT

  • St. John’s wort is as effective as pharmaceutical antidepressants like Prozac for the treatment of mild-to-moderate depression. And it has fewer side-effects than the drugs. Compared to pharmaceutical antidepressants, a key drawback of St. John’s wort is its problematic interactions with numerous drugs.
  • There’s overwhelming evidence that it is effective for unipolar depression. But there’s not enough research to know if it is effective for insomnia or anxiety.
  • The safety profile of the herb looks good for short-term use. But the parade of potentially serious supplement-drug interactions limits its use.
  • St. John’s wort’s potential side effects include sun sensitivity, sexual dysfunction and supplement discontinuation symptoms.
  • It may cause fetal birth defects and it has caused unplanned pregnancies in women using oral contraceptives.
    Anyone considering taking St. John’s wort should consult with their physician before taking it.
  • Talk therapies used in counseling are as effective for treating depression as antidepressant medication. Even in the absence of studies comparing St. John’s wort to talk therapy, talk therapy is probably at least as effective as the botanical. The effects of talk therapy alter the brain in ways that are also more enduring than oral supplements or pharmaceuticals and without side effects.

St. John’s wort, a Backyard Weed as Potent as Prozac

St. John’s wort (hypericum perforatum) is an effective antidepressant botanical medicine with fewer side-effects than the pharmaceuticals. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13

Clinical guidelines from the American College of Physicians state that “St. John’s wort may be as effective and better tolerated than conventional antidepressants for mild to moderate depression,” according to a peer-review report from an expert panel at NatMed Pro14, 15

It’s licensed and widely prescribed for depression in many European countries and is among the most well-researched medicinal herbs on the planet. Use of this botanical dates back to the ancient Greeks or earlier. St. John’s wort is used to treat depression in traditional Chinese medicine.

In people with major depression, St. John’s wort improves mood and insomnia, and it decreases anxiety and physical symptoms of depression like fatigue and changes in body weight or appetite, studies show. 16, 17, 18 , 19, 20, 21, 22

But this herb should come with a warning label due to its risk of potentially serious interactions with numerous drugs.

The herb’s propensity to interact with numerous medications limits its use for many people who regularly take certain prescription or over-the-counter medications.

The focus of scientific research on this herb has been on the use of St. John’s wort for depression. There’s a lack of research on its use in anxiety and insomnia.

Is it effective for insomnia in people without depression?

The herb has been found to improve insomnia in people with major depression. But there’s a lack of studies on the use of St. John’s wort for sleep in people without depression. Paradoxically, it can cause in insomnia as well as sedation.

St. John’s wort seems to improve menopausal symptoms including hot flashes. 23, 24 And it seems to improve sleep in women in perimenopause. 25

St. John’s wort may improve sleep quality in older people, one small study found. 26

How might the herb impact emotions & sleep?

St. John’s wort inhibits the reuptake of several neurotransmitters, including glutamate, norepinephrine, dopamine and the mood-hormone serotonin. 27, 28, 29, 30, 31, 32 And it works on other stress-hormone receptors called catecholamine receptors. 33 These effects drive an upsurge in the stress-hormone cortisol. 34

With all these stimulating actions, one might expect that St. John’s wort would defeat one’s ability to sleep and maintain calm. And indeed, insomnia and anxiety are possible side-effects of St. John’s wort. But this complex herb also inhibits reuptake of the neurotransmitter gamma-aminobutyric acid (GABA). 35 By enhancing GABA, St. John’s wort may have more of a calming effect like anti-anxiety drugs such as Xanax, which also enhance GABA.

Like selective serotonin reuptake inhibitor (SSRI) antidepressants such as Prozac, St. John’s wort also works on the serotonin system, possibly by acting on serotonin receptors rather than inhibiting reuptake of serotonin like the drugs. 36 Serotonin is part of how the body regulates both mood and sleep. Increased serotonin activity is thought to boost mood. But too much serotonin can cause anxiety.

With so many brain modulating effects, it’s very hard to guess at how the herb ultimately impacts anxiety and sleep.

Though research is clear on its effectiveness for mild-to-moderate depression, there’s still not enough research to know how St. John’s wort affects sleep, much less if it works to reduce insomnia.

There’s limited evidence suggesting St. John’s wort might improve sleep in women approaching menopause, 37 as well as women in menopause. 38

A randomized pilot study reported that taking St. John’s wort for 12 weeks decreased sleep problems compared with placebo (inert pills) in perimenopausal women. 39 But because St. John’s wort has been shown to reduce frequency and severity of hot flashes when compared with placebo 40, 41 and because hot flashes keep women awake at night, we can’t say if sleep would be improved in people not in menopause or perimenopause who do not have hot flashes. 

The time we spend in deep sleep declines with age. St. John’s wort might improve deep sleep in older people. In a study of 12 older people, those who took St. John’s wort spent more time in deep, restorative sleep. But the study found the herb did not help people fall asleep or stay asleep.42 St. John’s wort could cause serious side effects in people with dementia.

Is it effective for anxiety?

The way St. John’s wort works is more complex than how drugs prescribed for anxiety like SSRI antidepressants and benzodiazepines drugs like Xanax work. But there is some overlap with how the pharmaceuticals work. Though St. John’s wort has an enhancing impact on gamma-aminobutyric acid (GABA)—the calming neurotransmitter—it also has very stimulating actions on stress hormones like cortisol and catecholamines. One of the side-effects of St. John’s wort is anxiety.

Though St. John’s wort helps improve anxiety in people with major depression, 43 taking this herb might not be helpful for those with social anxiety disorder who don’t have major depression.

St. John’s wort 600-1800 mg daily for 12 weeks did not improve social anxiety disorder or calm fears of social interactions when compared with placebo, a small study found. 44

More studies are needed to assess if this complex botanical medicine is helpful for anxiety.

To find out about St. John’s wort safety, drug interactions and side effects, click link below:

St. John’s Wort Safety

To find out how St. John’s wort stacks up against other supplements and pharmaceuticals, click link below:

St. John’s Wort: Backyard Weed as Potent as Prozac

To find out how to get the benefits of St. John’s wort, but avoid its side effects or drug interactions, click link below:

St. John’s Wort: Get Benefits without Tinctures or Tablets

Care informed by the understanding that emotional and physical wellbeing are deeply connected

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Citations

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