St. John's wort (Hypericum perforatum)
Mental Health · Natural SSRI-SNRI-like
Tier B
What this is
Drug-drug interactions are the real problem — can reduce efficacy of oral contraceptives (pregnancy risk), tacrolimus (transplant rejection), warfarin, and many others. Cochrane-era Linde reviews support efficacy in mild-moderate depression. Not a casual choice due to CYP450 impact.
Mechanism
Hypericin and hyperforin; hyperforin inhibits reuptake of serotonin, norepinephrine, dopamine, GABA, glutamate; strong CYP3A4 and P-gp induction → extensive drug interactions
Dose & route
300 mg 3x/day standardized extract (0.3% hypericin or 3% hyperforin; LI-160, WS 5570)
Citations
- https://pubmed.ncbi.nlm.nih.gov/18843608/
- https://pubmed.ncbi.nlm.nih.gov/31752066/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC6947184/
Links go to the source. If a link is dead or you want something re-checked, let me know.
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.