Depression, Menopause, and St. John's Wort -- What's the connection?

St. John's Wort (also known as Hypericum perforatum) is a medicinal shrub plant native to Europe with star-shaped bright yellow flowers that is grown and available over-the-counter in the United States. The plant is named after John the Baptist from the Bible after the observation that the plant blooms on his birthday. The plant's flowers and leaves contain active ingredients that can be prepared as a supplement in teas, tablets, liquids, and topical preparations. It has been used for centuries to treat mental health conditions and is widely prescribed for depression in Europe. Some naturopathic providers and traditional healthcare providers recommend its use for certain patients in the United States. So, how does it work?

St. John's Wort increases the levels of serotonin, dopamine, and norepinephrine in the body, which is the same mechanism of action as many prescription antidepressants. This mechanism of action is also thought to help treat symptoms of menopause, especially vasomotor symptoms (hot flashes).

Clinical studies have mixed results, possibly due to the need for more regulation and standardization of commercially available St. John's Wort preparations. However, the following link is a systematic review showing that "there is a modest amount of data that suggests that hypericum extract is safe, well tolerated, and probably more effective than placebo in the treatment of mild to moderate depression."

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/485215

Additional clinical research, available in the link below, has shown that St. John's Wort can treat the symptoms of menopause by reducing the frequency and severity of hot flashes.

Effect of St John's wort on severity, frequency, and duratio... : Menopause (lww.com)

Given the low cost of St. John's Wort, this may be a good treatment option for patients with financial constraints. It is also a consideration for symptomatic menopausal patients who cannot take or who wish to avoid hormone replacement therapy. However, St. John's Wort must be taken with extreme caution and always under the supervision of a healthcare provider. St. John's Wort is usually well tolerated. Still, it may have side effects such as diarrhea, gastrointestinal discomfort, dizziness, dry mouth, fatigue, headache, insomnia, and sedation. The serious concern is that St. John's Wort interacts with many prescription and over-the-counter medications including, but not limited to, antidepressants, birth control pills, cough suppressants, allergy medications, cholesterol medications, warfarin and other blood thinners, digoxin (a heart medication), omeprazole, seizure medications, cyclosporine (for patients with transplants), indinavir and other HIV medications, and some chemotherapy medications. Taking St. John's Wort with other antidepressants could increase the body's level of serotonin too much, causing a life-threatening syndrome.

St. John's Wort may be a good treatment option for patients with depression, menopause, or both. Despite its over-the-counter availability, St. John's Wort should always be used in consultation with a healthcare professional due to its potential for multiple, serious drug-drug interactions. If St. John's Wort is an option that you would like to consider, discuss this possible treatment plan with your provider.