Herb
St John's Wort
St John's Wort shows solid evidence for mild to moderate depression, performing comparably to prescription antidepressants in multiple trials. Some smaller studies suggest it may help mood symptoms during menopause specifically. However, it interacts with numerous critical medications including birth control, blood thinners, and antidepressants. If you're considering this herb, medical supervision is essential to navigate potential interactions safely.
30-second summary
St John's Wort shows solid evidence for mild to moderate depression, performing comparably to prescription antidepressants in multiple trials. Some smaller studies suggest it may help mood symptoms during menopause specifically. However, it interacts with numerous critical medications including birth control, blood thinners, and antidepressants. If you're considering this herb, medical supervision is essential to navigate potential interactions safely.
depression — strongmood swings — mixedanxiety — weak
Overall: Mixed evidence
Randomised controlled trials
Multiple randomized trials show St John's Wort performs similarly to standard antidepressants for mild to moderate depression.
Observational studies show variable results, with some populations reporting benefits and others showing no difference from placebo.
Meta-analyses confirm effectiveness for depression but highlight significant variation between studies and preparations.
Menopause-specific trials
Three small studies suggest benefits for menopausal mood symptoms, but sample sizes were under 100 women each.
What we do not know
We don't know the optimal dose specifically for menopausal mood symptoms versus general depression. Long-term safety data beyond 12 weeks is limited. Most menopause studies included only small numbers of women (under 100 participants). We lack studies comparing St John's Wort to hormone therapy for mood symptoms. The exact mechanism for how it affects serotonin remains unclear.
How it is used
Common dose range
300mg standardised extract three times daily
Notes on dosing
Do not combine with antidepressants, oral contraceptives, blood thinners, or HIV medications. Causes photosensitivity in some people.
Get it from food first
Food sources are better absorbed than most supplements and come with co-factors that support the same pathways. If you eat two or three of these consistently, you may not need a supplement at all.
St John's Wort tea
1-2 cups daily
Much weaker than standardized extracts, unlikely to provide therapeutic effects
Fresh St John's Wort flowers
Variable preparation
Traditional preparation but potency is unpredictable and not recommended
Anti-inflammatory eating
May support mood stability by reducing inflammation that can worsen depression
Omega-3 rich foods
Fish and walnuts provide compounds that support brain function and mood regulation
What depletes St John's Wort
Alcohol can worsen depression and may interfere with St John's Wort effectiveness. High sugar intake creates blood sugar swings that destabilize mood. Excessive caffeine can increase anxiety in sensitive individuals.
Interactions and cautions
No significant interactions noted at recommended doses.
Rose bottom line
"St John's Wort isn't something to try casually — the medication interactions are real and potentially serious. If your doctor confirms it's safe with your current medications, it could be worth exploring for mild mood dips. Just know that addressing sleep, stress, and inflammation often helps mood symptoms too, sometimes more reliably than any single supplement."