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Johns Hopkins Health Alert

Natural--but not Always Harmless--Remedies for Depression and Anxiety

Johns Hopkins Health Alerts | Depression and Anxiety | St. John's Wort for Depression

  • Recent reports have illustrated that St. John's wort, used by many people to relieve depression, may not be as benign as it appears.

Despite the availability of a full arsenal of medications proven to be effective for treating depression and anxiety, many people have turned to herbal remedies—which are classified as dietary supplements in the United States and so have not been tested or approved by the U.S. Food and Drug Administration (FDA). No one is sure how well they work as a treatment for depression and anxiety or how they may interact with prescription medications, nor is there any guarantee of the purity of any herbal product you buy.

In addition, one concern with any alternative treatment is that people tend to medicate themselves instead of being evaluated and monitored by a health professional. As a result, they may not recognize worsening symptoms.

St. John's wort, which is extracted from a yellow flowered plant called Hypericum perforatum, is the best known of the supplements purported to be natural antidepressants. The American College of Physicians and the American Society of Internal Medicine recently included St. John’s wort in their guidelines as a treatment option for mild depression, but two large studies published in the Journal of the American Medical Association in 2000 and 2001 found that St. John's wort was no more effective than a placebo for treating major depression.

Thus, the authors recommend that people with major depression not take St. John's wort until well-designed studies support its use. People with mild to moderate depression would be wise to follow the same advice and not take St. John's wort.

Recent reports have illustrated that St. John's wort may not be as benign as it appears. Researchers have shown that St. John's wort lowers blood levels of Crixivan (indinavir), a drug prescribed for HIV (human immunodeficiency virus) infection as well as Sandimmune (cyclosporine), a drug given to prevent organ rejection in transplant patients. Physicians suspect that St. John's wort might interfere with a range of medications, including those prescribed to treat depression, heart disease, seizures, and some cancers. St. John's wort may also cause increased sensitivity to the sun.

Kava, which is prepared from the crushed root of Piper methysticum (a shrub-like pepper plant), is marketed as a natural remedy for anxiety and stress. However, the FDA has issued a warning that the supplement can damage the liver. In addition, long-term use of kava may result in allergic reactions, visual disturbances, or difficulties maintaining. Kava should not be used if you are pregnant, breast feeding, or taking antidepressants.

Johns Hopkins Health Alerts | Depression and Anxiety | St. John's Wort for Depression

Posted in Depression and Anxiety on May 23, 2006
Reviewed June 2008

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Users and editors may post comments here at their own discretion. The views expressed do not constitute medical advice and do not represent the position of Johns Hopkins Medicine or University Health Publishing, which has no responsibility for its content.


When I feel upset and have trouble sleeping I take Valerian Root before bedtime. I've been buying it cheaply in powder form at my local "Food For Less" market; but I also started a couple plants in my garden. I plan to process this stinky weed myself.

This is the only drug I take for my insomnia. At age 68 I am in excellent health and do not take (or have any use for) any prescription medications. I do imbibe fish oil, and I eat a (nonstandard for Americans) healthy diet. Oh yes, and I make sure I get lots of regular exercise.

I take care of older people. Most didn't take decent care of themselves. Instead, they depended entirely on doctors and prescription medication to keep them healthy.

I welcome any comments, for or against, my ways of "self medicating," and "self therapy."

Posted by: Oregon Caregiver | August 20, 2006

I think that each individual should be responsible for their health and useing a health joural is a good way to do this. Doctors are already overburdened and have trouble remembering so many patients, time limits and ailments. Doctors are helpfull and many times fix the things we neglect but shouldnt be our only source for relying on optimal health. I love it that people now can check their own blood pressure, take some independent lab tests such as cholesterol and know some of the signs of health or sickness.

Posted by: Cherat51 | January 31, 2007

I dont like the wording that in the article about St Johns Wort, that the studies found it does work for mild depression, but not for moderate to severe as there is no studies to support this. So the conclusion of the author was not to ever take this herb even for mild depression? A round about way of saying "Herbs are bad"? Over the counter pain medications are sold every year and many times do not help pain or people get known problems such as bleeding ulcers or rebound migraines. Yet we dont tell people to stop taking all over the counter pain medications. Isnt this the same rationale?

Posted by: Cherat51 | January 31, 2007



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