St John's wort

St John’s wort is a plant with yellow flowers. Other names for this herb include hypericum, goatweed, klamath weed and tipton weed. The scientific name is Hypericum perforatum.

St John’s wort is a herbal remedy made from the flowers of the plant of the same name. It is a popular complementary therapy for mild to moderate depression. There is a lot of scientific evidence to show that St John’s wort can help to reduce mild or moderate depression. But there are also concerns about

• Possible side effects
• Whether it interferes with other drugs, such as chemotherapy

Scientists believe that chemicals in the brain (neurotransmitters) play a part in causing depression. We think that two of the active ingredients in St John’s wort - hypericin and hyperforin - change the activity of these neurotransmitters.

St John’s wort has been used for hundreds of years for other health conditions but there is currently no scientific evidence that it works for

• Anxiety
• Fatigue
• Pre menstrual symptoms
• Stomach problems
• Difficulty sleeping
• Malaria
• Kidney problems
• Skin wounds and burns (used as a balm)
• Nerve pain

About 25 out of every 100 people with cancer get depressed soon after they are diagnosed or after finishing their treatment.

It is quite normal to feel this way. It is not surprising that people who have cancer and feel low look for ways to help treat their depression. The press has often reported St John’s wort as a ‘wonder drug’ to treat depression and help people feel better.

Many people also see St John’s wort as a non toxic and natural therapy that is safe to use. People with cancer may also use St John’s wort rather than talk to their doctor about feeling sad or depressed. You can get it over the counter without a prescription. But you do need to be careful. Generally the side effects of St John’s wort are mild but it can interact with some other types of drugs so it is important to check with your doctor before taking it. You shouldn’t take St John’s wort with other antidepressants or with chemotherapy. It can also make the contraceptive pill work less well.

There is general information about the safety of herbal remedies in this section of CancerHelp UK.

If you have symptoms of depression, it might be hard to talk to your doctor. But they will be willing to listen and will want to help you through this difficult time. They can advise you about many ways of treating depression that don’t always involve taking drugs. We have information about treatment for depression in our section about coping physically with cancer.

Always check with your doctor before you start using any type of complementary or alternative treatment and try to find out all you can about the therapy before deciding to use it.

You may also find it helpful to read the following sections from our about complementary therapy section

• Why you should tell your doctor if you are using any type of therapy
• Why people with cancer use complementary therapies
• About the safety of using herbal remedies

St John’s wort comes as

• Capsules
• Tablets
• A powder
• Tinctures
• A liquid extract
• Tea bags

You can buy various St John’s wort products in health food stores, chemists and over the internet. They all contain different amounts and types of extracts of St John’s wort.

A clinical trial showed that many products labeled as containing specific amounts of St John’s wort, actually contained very varied amounts. Some didn’t contain any St John’s wort at all! There are hundreds of manufacturers trying to sell St John’s wort. Our advice is to buy with caution and only from a source that you trust, such as an established health food shop.

Several studies have looked at St John’s wort as a treatment for depression and compared it to other antidepressant drugs. This includes several large phase 3 clinical trials. Much of that research shows that certain extracts from St John’s wort can help treat mild to moderate depression. These studies suggest that it is

• More effective than a placebo
• As effective as standard antidepressant drugs

The Cochrane Collaboration carry out ‘systematic reviews’ of phase 3 trials. This means they pull all the results of related trials together. They looked at all the trials that have used St John’s wort as a treatment for depression. You can see this review on ‘St John’s wort and depression’ on The Cochrane Library website. It says that extracts of St. John's wort are prescribed widely to treat depression. They seem to work as well as standard antidepressants for treating mild to moderate depressive symptoms. Side effects are mild and not common. But it does not seem so helpful for treating major depression.

Herbal medicines are not controlled anywhere near as tightly as pharmaceutical medicines. The contents of a herbal remedy can vary a lot between different brands and sources. So remember to be cautious when thinking about the results of these trials. They can only apply to the particular St John’s wort preparations tested in these trials.

Scientists are also looking at using St John’s wort for other mental conditions such as anxiety and obsessive compulsive disorder. There is also research into the safety of St John’s wort, and how it interacts with other drugs. You can see a list of the current trials investigating St John’s wort on the National Centre for Complementary and Alternative Medicine (NCCAM) website.

Side effects aren’t common but it may cause

• Stomach upsets
• Increased sensitivity to sunlight
• Tiredness
• Dizziness
• Headache
• Constipation
• Sleep disturbances
• Dry mouth

We don’t know whether any of these side effects are long or short term. Side effects are usually mild. But as extracts of St. John's wort can influence the effects of other drugs, you should talk to your doctor before using St. John's wort.

If you are taking St John’s wort, avoid going out in strong sunlight, and don’t use tanning beds. There are a few reports of people developing a skin rash while taking St John’s wort.

St John’s wort can change how well some drugs work, making them either stronger or weaker. You can have some very serious side effects if you take St John’s wort with these drugs. If you are planning to take St John’s wort, it is very important to talk to your doctor first.

 St John’s wort can interact with other types of antidepressants. It can increase the activity of a chemical called serotonin in your brain. This can cause confusion, hallucinations, sweating, feeling and being sick and a high temperature (fever).

St John’s wort can make you feel very drowsy if you take it with alcohol, drugs to help you sleep, strong painkillers or some sedatives.

We know that St Johns Wort can interact with these groups of drugs and may affect how well they work

• Birth control pills
• Cancer drugs such as irinotecan and imatinib
• Some HIV drugs
• Some epilepsy drugs
• Blood thinning drugs such as warfarin
• Heart medications such as digoxin
• Drugs to treat diarrhoea, such as loperamide hydrochloride
• An asthma medicine called theophylline
• Ciclosporin - a drug to prevent organ transplant rejection

Research is also being done to find out if St John’s wort interacts with other drugs, such as strong opioid painkillers.

You shouldn’t take St John’s wort if you

• Take other types of antidepressant medications
• Have manic depression (bipolar disorder)
• Are taking any of the medicines listed in the section on the drugs St John’s wort may affect

You should not take St John’s wort if you are pregnant as it can increase womb contractions and may increase the risk of miscarriage. You should not take St John’s wort if you are breastfeeding as it can pass into your breast milk.

If you are having an anaesthetic you need to stop taking St John’s wort at least a week before your surgery.

If you are taking any medications that are not mentioned in the list above you should talk to your doctor before you start using St John’s wort.

This varies depending on

• The dosage
• The amount you buy
• Where you buy it (health food shops, chemist or online)

Generally it isn’t very expensive (between £3 and £7 for 60 capsules). If you buy online the prices can vary quite a lot. We recommend that you speak to your doctor before taking St John’s wort. It may interact with other medicines that you are taking, and could harm you.

For more information about the safety of using St John’s wort, contact

Penny Brohn Cancer Care (formerly the Bristol Cancer Help Centre )
Chapel Pill Lane
Pill
Bristol
BS20 OHH
Tel: 0845 123 23 10
Website: http://pennybrohncancercare.org
Email: helpline@pennybrohn.org

This centre is staffed by doctors, nurses and therapists working in complementary medicine. They can provide information on complementary treatments, alternative diets, holistic medicine, counselling and relaxation.

The European Herbal Therapists’ Association
45a Corsica Street
London
N5 1JT
Tel: 0207354 5067
Website: http://www.euroherb.com

This is a group of organisations working together to develop a minimum set of practice and training standards for herbal medicine. A list of their current member organisations on their website.

The Institute for Complementary Medicine (ICM)
PO Box 194
London 
SE16 1QZ
Phone: 0207 237 5165
Fax: 0207 237 5175
Email: icm@icmedicine.co.uk
Website: www.icmedicine.co.uk

Can give information about herbal medicines and has a list of practitioners on their website.