Mood

St John's Wort

Herbal extract used for mild to moderate low mood, with antidepressant-like effects and unusually important drug interactions.

St John's Wort

Herbal extract used for mild to moderate low mood, with antidepressant-like effects and unusually important drug interactions.

score

evidence

Caution

risk

Proven Benefits

01Reduces depressive symptoms

02May reduce anxiety symptoms

03May improve sleep in low mood

04May improve quality of life

05May ease PMS low mood

06May ease menopausal low mood

Chemical Forms

Recommended

Standardized St John's wort extract (0.3% total hypericins)
Low-hyperforin standardized extract

Avoid

Whole-herb powder (unstandardized potency)
High-hyperforin extracts if you use medications (greater interaction risk)

Expert Note

Most clinical trials used standardized extracts rather than raw powder, so standardization matters. Hypericin and hyperforin content can vary widely across products; raw whole-herb capsules are less predictable. Lower-hyperforin extracts may reduce interaction burden, while very high-hyperforin products are more likely to induce drug metabolism.

Protocol

Amount

900 mg

Frequency

Split into 2-3 doses daily

When

With food to reduce GI upset; take earlier in the day if it feels activating.

Condition-Based Dosing

Standardized extract with 0.3% total hypericins

300 mg three times daily— This is the classic regimen used in many mood trials.

Once-daily clinically studied extract

600-900 mg once daily— Match the label directions to the studied extract; standardization matters more than milligrams alone.

Safety & Limits

Upper Safe Limit

No official UL; up to 1800 mg/day standardized extract has been studied short term in adults, but interaction risk is the main practical limit.

Cycling

Safe for continuous use

Contraindications

SSRIs, SNRIs, MAOIs, trazodone, triptans, tramadol, or other serotonergic drugs — serotonin excess risk

Bipolar disorder — may trigger mania or hypomania

Oral contraceptives — can lower hormone levels and reduce contraceptive reliability

Warfarin, DOACs, or clopidogrel — clinically important interaction risk

Cyclosporine, tacrolimus, or other transplant drugs — can sharply lower drug levels

HIV antivirals — can reduce antiviral exposure

Many chemotherapy drugs — may alter drug metabolism and reduce treatment effectiveness

Digoxin, anticonvulsants, or certain heart medications — can reduce circulating drug levels

Pregnancy or breastfeeding — insufficient safety data, avoid unless specifically advised

Upcoming surgery — stop 1-2 weeks before due to interaction and anesthesia concerns

Avoid Combining With

✕Hormonal contraceptives (St John's wort induces CYP3A4 and can reduce effectiveness)
✕CYP3A4 or P-gp substrate drugs such as cyclosporine, tacrolimus, digoxin, and some antivirals (can lower drug levels)

Updated Invalid Date