Rankings / Mood, Anxiety & Stress
St. John's wort (Hypericum perforatum)
Mood, Anxiety & Stress · Natural SSRI-SNRI-like
Tier B
Bottom line
Read Off Label grades St. John's wort (Hypericum perforatum) as B (6.4/10) based on strong evidence, moderate benefit magnitude, and a med-risk safety profile.
Drug-drug interactions are prominent; studies and labeling describe reduced efficacy of oral contraceptives, tacrolimus, warfarin, and many other medicines.
Studied, labeled, or reported-use context: 300 mg 3x/day standardized extract (0. — OTC (US); Rx in Germany; not individualized guidance.
What the evidence says
Drug-drug interactions are prominent; studies and labeling describe reduced efficacy of oral contraceptives, tacrolimus, warfarin, and many other medicines. Cochrane-era Linde reviews support efficacy in mild-moderate depression. CYP450 induction creates substantial interaction context.
Mechanism
Hypericin and hyperforin; hyperforin inhibits reuptake of serotonin, norepinephrine, dopamine, GABA, glutamate; strong CYP3A4 and P-gp induction → extensive drug interactions
Studied, labeled, or reported dose & route
300 mg 3x/day standardized extract (0.3% hypericin or 3% hyperforin; LI-160, WS 5570)
This records doses and routes described in studies, approved labeling, clinical practice, or documented use. It is not individualized guidance and does not establish safety; context changes with indication, formulation, health history, monitoring, and other medicines.
Citations
A link means the source informed this entry; it does not mean every claim on the page comes from that source. If a citation looks wrong or you want a claim re-checked, send a correction.
Common questions
- What does the evidence show about St. John's wort (Hypericum perforatum)'s effects?
- Read Off Label rates the evidence for St. John's wort (Hypericum perforatum) as Strong and the benefit magnitude as moderate, producing an overall grade of B (6.4/10). Drug-drug interactions are prominent; studies and labeling describe reduced efficacy of oral contraceptives, tacrolimus, warfarin, and many other medicines.
- What safety findings are reported for St. John's wort (Hypericum perforatum)?
- St. John's wort (Hypericum perforatum) has a med risk profile in the database. Med (massive drug interactions — reduces efficacy of oral contraceptives, immunosuppressants, chemotherapy, anticoagulants, many psychotropics; photosensitivity; serotonin syndrome risk with other serotonergics) Legal status: OTC (US); Rx in Germany (standardized).
- What doses or routes are reported for St. John's wort (Hypericum perforatum)?
- 300 mg 3x/day standardized extract (0.3% hypericin or 3% hyperforin; LI-160, WS 5570) This is context from studies, approved labeling, clinical practice, or documented use; it is not individualized guidance and does not establish safety.
- How does St. John's wort (Hypericum perforatum) work?
- Hypericin and hyperforin; hyperforin inhibits reuptake of serotonin, norepinephrine, dopamine, GABA, glutamate; strong CYP3A4 and P-gp induction → extensive drug interactions
This is an independent synthesis of published research by a non-clinician. Scores are opinions supported by citations, not prescriptions. See the full disclaimer and methodology for how this score was produced and what it does and doesn't mean.