ENT: Possibly useful for tinnitus (ringing in the ears)

Gastrointestinal: Burning mouth syndrome

Genitourinary/hormonal: Menopausal symptoms (especially in combination with black cohosh), PMS (mood problems related to hormones)

Musculoskeletal: Myalgias (topical)

Skin: Improves wound healing, 1st degree burns (topical), eczema, acne

Neurologic: Neuropathy, vertigo/dizziness

Mental Health: Mild to moderate depression (not severe), anxiety, fatigue, insomnia, somatization, ADD, OCD, SAD (seasonal affective disorder). Among other neurotransmitter effects, St Johns Wort has effects that are similar to SSRI medication used to treat depression and anxiety (selective serotonin reuptake inhibitors).

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SIDE EFFECTS: Sun sensitivity, insomnia, vivid dreams, irritability, stomach upset, diarrhea, fatigue, dizziness, headache, dry mouth, dermatitis (rash), may induce mania/hypomania or worsen bipolar disorder or schizophrenia/schizoaffective disorder.

CAUTION/CONTRAINDICATIONS: Large doses (severe photosensitivity/skin reaction). Caution in dementia/Alzheimers, ADHD, and bipolar disorder (can increase manic symptoms). Caution in Schizophrenia (may worsen). Caution in surgery. Many potential interactions with other medications because of their effects on the P450 3A4 enzymes and P450 2C19 enzyme system (see link): It increases the breakdown of certain medications so that those other medications you are taking may not be as effective as they should be. Also, should not be taken with Xanax, Elavil (amitriptyline), theophylline, birth control pills, cyclosporine, Digoxin, Fenfluramine/Pondimin, methylphenidate, ketamine, blood thinners and others. They should not be taken with SSRIs (medications that increase your serotonin levels) because they can cause your serotonin levels more to become too high - resulting in major side effects. COMMON SSRIs include Zoloft, Prozac, Paxil, and others. Possible cardiac complications with surgery. Possible decrease in fertility. May increase seizure activity. May alter the effects of birth control.

Notes: Many potential interactions with other medications.

FORMS: Capsules, tablets, powder, tinctures, extract, tea, skin creams

RECOMMENDED BRANDS

Be careful with your product choice, they vary from product to product in the amount of active ingredient they contain; in fact, more than half contain less than 50% of the active ingredients hypericin or hyperforum. Additionally, a few products contain lead and/or cadmium. Many of the tested quality brands are not currently available.

DOSAGES: 

As directed on the product label. Some clinical and consumer sources describe a wide range of herbal amounts, and many are not supported by strong evidence. Always follow the manufacturer’s instructions.

Amounts used in studies vary widely depending on the formulation and purpose. These study amounts are not clinical recommendations and may not apply to consumer products.

Commonly reported amounts from the public domain include:

• 300 mg by mouth for up to 3 times daily for up to 6 weeks or 450 mg twice daily 

• Acne and skin inflammation: Apply (0.5% extract, gel or cream) to the affected area once daily for 10 minutes (avoid before sun exposure)

• Seasonal affective disorder and Mood Support: 300 mg by mouth 3 times daily or 450 mg twice daily

For more information on herbal doses, see herbal references in Epocrates ($).

*Disclaimer: The material above is for informational purposes only. This information is not intended to diagnose, treat or cure a condition. The uses listed above are tentative; some have or are undergoing research trials, but many are not FDA-approved. It is essential that you investigate these supplements further before deciding to use them. Check interactions and contraindications on sites like Drugs.com or WebMD. Do not attempt to treat a serious condition like liver, kidney problems, high blood pressure, heart, cancer, diabetes, or thyroid issues without discussing it with a healthcare provider first. If you are pregnant or nursing a baby, please do not use supplements without discussing it with your healthcare provider.