Series by Kathleen Kendall-Tackett, Ph.D. (St. John’s Wort #5)

Part 5, Summary and References


St. John’s wort is another effective alternative to antidepressants that may be more acceptable for some women.  Its standard use is for mild-to-moderate depression, but it has also been used for major depression.  Some cautions are in order.  Even though St. John’s wort is a “natural” alternative to medications, it too is a medication and should be treated as such.  It should never be used with antidepressants. Mothers need to tell their health care providers that they are taking it, as it can interact with a number of different medications.  If used with safety concerns in mind, normal use of this medication does not appear to be harmful to mothers or babies.  Although hyperforin is excreted into breast milk, it appears in very low levels in infant plasma and in some cases was undetectable (Hale, 2006; Humphrey, 2007).




Abdel-Salam, O.M. (2005). Anti-inflammatory, antinociceptive, and gastric effects of Hypericum perforatum in rats. Scientific World Journal, 5, 586-595.

Bratman, S., & Girman, A.M. (2003). Handbook of herbs and supplements and their therapeutic uses. St Louis: Mosby.



Dell’Aica, I., Caniato, R., Biggin, S., & Garbisa, S. (2007). Matrix proteases, green tea, and St. John’s wort: Biomedical research catches up with folk medicine. Clinical Chimica Acta, 381, 69-77.


Ernst, E. (2002). The risk-benefit profile of commonly used herbal therapies: Ginkgo, St. John’s wort, ginseng, echinacea, saw palmetto, and kava. Annals of Internal Medicine, 136, 42-53.


Hale, T.W. (2006). Medications and mothers’ milk (Vol. 12). Amarillo, TX: Hale Publishing.

Harkness, R., & Bratman, S. (2003). Handbook of drug-herb and drug-supplement interactions. St. Louis, MO: Mosby.

Hu, Z.P., Yang, X.X., Chan, S.Y., Xu A.L., Duan, W., Zhu, Y.Z., et al. (2006). St. John’s wort attenuates irinotecan-induced diarrhea via down-regulation of intestinal pro-inflammatory cytokines and inhibition of intestinal epithelial apoptosis. Toxicology & Applied Pharmacology, 216, 225-237.

Humphrey, S. (2003). The nursing mother’s herbal. Minneapolis: Fairview Press.

Humphrey, S. (2007). Herbal therapeutics during lactation. In Hale, T.W. & Hartmann, P.E. (Eds.), Textbook of Human Lactation (pp. 629-654). Amarillo, TX: Hale Publishing.

Hypericum Depression Trial Study Group. (2002). Effect of Hypericum perforatum (St. John’s Wort) in major depressive disorder. Journal of the American Medical Association, 287, 1807-1814.


Klier, C.M., Schafer, M.R., Schmid-Siegel, B., Lenz, G., & Mannel, M. (2002). St. John’s wort (Hypericum Perforatum)—Is it safe during breastfeeding? Pharmacopsychiatry, 35, 29-30.

Klier, C.M., Schmid-Siegel, B., Schafer, M.R., Lenz, G., Saria, A., Lee, A., & Zernig, G. (2006). St. John’s wort (Hypericum perforatum) and breastfeeding: Plasma and breast milk concentrations of hyperforin for 5 mothers and 2 infants. Journal of Clinical Psychiatry, 67, 305-309.

Kuhn, M.A., & Winston, D. (2000). Herbal therapy and supplements: A scientific and traditional approach. Philadelphia, PA: Lippincott.


Lawvere, S., & Mahoney, M.C. (2005). St. John’s wort. American Family Physician, 72, 2249-2254.

Lecrubier, Y., Clerc, G., Didi, R., & Kieser, M. (2002). Efficacy of St. John’s wort extract WS 5570 in major depression: A double-blind, placebo-controlled trial. American Journal of Psychiatry, 159, 1361-1366.


Linde, K., Ramirez, G., Mulrow, C.D., Pauls, A., Weidenhammer, W., & Melchart, D. (1996). St. John’s wort for depression: An overview and meta-analysis of randomized clinical trials. British Medical Journal, 313, 253-258.



Muller, W.E. (2003). Current St. John’s wort research from mode of action to clinical efficacy. Pharmacology Research, 47, 101-109.

Philipp, M., Kohnen, R., & Hiller, K.O. (1999). Hypericum extract versus imipramine or placebo in patients with moderate depression: Randomized multicenter study of treatment for eight weeks. British Medical Journal, 319, 1534-1539.


Sarris, J. (2007). Herbal medicines in the treatment of psychiatric disorders: A systematic review. Phytotherapy Research, 21, 703-716.

Schultz, V. (2006). Safety of St. John’s wort extract compared to synthetic antidepressants. Phytomedicine, 13, 199-204.


Szegedi, A., Kohnen, R., Dienel, A., & Kieser, M. (2005). Acute treatment of moderate to severe depression with hypericum extract WS 5570 (St. John’s wort): Randomised controlled double blind non-inferiority trial versus paroxetine. British Medical Journal, 330, 503.


Van Gurp, G., Meterissian, G.B., Haiek, L.N., McCusker, J., & Bellavance, F. (2002). St. John’s wort or sertraline? Randomized controlled trial in primary care. Canadian Family Physician, 48, 905-912.


Whiskey, E., Werneke, U., & Taylor, D. (2001). A systematic review and meta-analysis of Hypericum perforatum in depression: A comprehensive clinical review. International Clinical Psychopharmacology, 16, 239-252.

Woelk, H. (2000). Comparison of St. John’s wort and imipramine for treating depression: Randomised controlled trial. British Medical Journal, 321, 536-539.

Wurglies, M., & Schubert-Zsilavecz, M. (2006). Hypericum perforatum: A “modern” herbal antidepressant: Pharmacokinetics of active ingredients. Clinical Pharmacokinetics, 45, 449-468. 

Zanoli, P. (2004). Role of hyperforin in the pharmacological activities of St. John’s wort. CNS, 10, 203-218.

Zhou, C., Tabb, M.M., Sadatrafiei, A., Grun, F., Sun, A., & Blumberg, B. (2004). Hyperforin, the active component of St. John’s wort, induces IL-8 expression in human intestinal epithelial cells via a MAPK-dependent, NF-kappaB-independent pathway.  Journal of Clinical Immunology, 24, 623-636.














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