St. John's Wort For Anxiety

Medically reviewed by Nikki Ciletti, M.Ed, LPC
Updated October 8, 2024by BetterHelp Editorial Team

Although the pharmaceutical industry can provide many options that may support the treatment experience of those who live with anxiety disorders, many of these anxiety medicines can cause side effects or have a prolonged period of adjustment. In either case, patients may opt for natural anxiety treatment alternatives — which has prompted the medical community to explore the efficacy of supplements like St. John's wort for anxiety.

Below, we’re exploring what St. John’s wort is, possible efficacy it may have for anxiety, and scientific support that is currently available for this form of anxiety treatment and support. 

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What is St. John’s wort? 

St. John's wort, otherwise known as hypericum perforatum, is classified as an herbaceous plant that is generally identified by many via its bright yellow flowers and shrublike appearance. St. John’s wort (Hypericum perforatum) is technically a flowering plant in the Hypericaceae family. St. John’s wort has been used in a medicinal capacity for centuries — offering a historical use for many as a tool to support conditions such as depression and insomnia, and externally as an aid in healing wounds.

St. John’s wort may be used to treat various ailments as a capsule, tincture, or paste.

St. John's wort is not generally classified as a pharmaceutical drug, as St. John’s wort does not require a prescription or evaluation from a healthcare professional. We do want to note, however, that you may find more safety and benefit from seeking a professional medical opinion before beginning any course of treatment or supplementation, including St. John's wort for anxiety. 

St. John’s wort for anxiety and depression

St. John's (hypericum perforatum) wort may be used as a supplement to support those who live with depression, as well as those with anxiety disorders. These may include: 

  • Somatic symptom disorder 
  • Social anxiety disorder 
  • Generalized anxiety disorder 

Systematic reviews have demonstrated the efficacy of St. John’s wort (versus placebo) for treating mild to moderate depression. However, studies are still proving St. John’s wort's effectiveness for severe depression. A systematic review shows that there is currently a lack of research and evidence to support the use of St. John’s wort for severe depression. Researchers in one review found that St. John’s wort produces similar effects to antidepressant medications, concluding that St. John’s wort is not only as effective as but also safer than prescription medications used for depression. However, according to practice guidelines developed by the American College of Physicians—and published in the Annals of Internal Medicine—cognitive behavioral therapy and second-generation antidepressants are still considered primary treatment modalities for anxiety, over complementary and alternative medicine options like St. John’s wort for anxiety. 

In addition to being used for mild to moderate depression, St. John's wort may help those living with insomnia, seasonal affective disorder, and obsessive compulsive disorder better manage their mental and physical symptoms. St. John's wort has also historically been used for supportive therapeutic supplement for some experiencing menopause. Typically, St. John’s wort for menopause is used to alleviate hot flashes and mood swings. St. John's Wort has been clinically suggested as an effective supportive therapy to address menopausal symptoms. St. John’s wort can also be of use for some individuals experiencing symptoms of anxiety disorder as a result of menopause by treating the bodily changes brought on by menopause. 

Overall, though, research into the efficacy of St. John’s wort when treating anxiety has produced mixed results. There is evidence that St. John’s wort can relieve symptoms of anxiety that arise out of a depressive disorder. However, there is limited proof of its effectiveness for individuals living with anxiety disorders alone. For example, in a placebo-controlled pilot study, researchers found that St. John’s wort failed to improve symptoms of social phobia. Additional research continues to be done on St. John’s wort for anxiety, though. 

There is also evidence that St. John’s wort can improve mood for people who aren’t living with a mental health challenge. In one study, researchers found that healthy volunteers experienced a positive shift in emotional processing when taking St. John’s wort.

Can you use St. John’s wort as an anxiety treatment method?

While a successful and helpful treatment protocol looks different for each patient based on their own unique experience, St. John's wort (hypericum perforatum) can be used by many for a helpful addition to other types of treatment methods, such as talk therapy or pharmaceutical intervention. Speaking with a clinician may help you to determine if St. John’s wort is an appropriate form of intervention to be used exclusively for anxiety or if you may benefit from pairing it with other supportive therapy types. 

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How does St. John’s wort work? 

St. John's Wort's (hypericum perforatum) active components can increase your brain's ability to send and receive messages, which can elevate the presence of serotonin, dopamine, and noradrenaline. 

Having a lack of these critical neurotransmitters can be linked to anxiety, depression, and insomnia. Also, low levels of certain transmitters like serotonin are correlated with bipolar disorder, which is considered an affective disorder, characterized by intense shifts in emotions. 
Supporting your brain's ability to communicate and more effectively support the production of these neurotransmitters can elevate your mood, may increase your body's ability to both fall and stay asleep and may create greater stability in mood as a whole. 

How much St. Johns wort should I take for anxiety?

Cleveland Clinic’s study suggests that an effective dose of St. John’s wort for many ranges, and can be taken as a tablet, tincture, ointment, or oil. Before attempting any sort of supplementation or therapeutic regimen, however, you may consider seeking professional medical care and support to determine if supplementation is a good choice for your personal health needs. 

It might not be right for everyone 

St. John's wort can negatively interact with numerous pharmaceutical medications, including antidepressants, contraceptive drugs, some heart medications, photosensitizing drugs, organ transplant medications, drugs that treat HIV (e.g., protease inhibitors), and blood thinners. Misuse of this herbal supplement can result in life-threatening conditions or complications, which is why you may benefit from the diagnosis and support of a medical professional prior to starting any form of treatment or supplementation with St. John’s wort or similar natural medicines. 
Taking St. Johns’s wort with prescribed pharmaceutical medications like selective serotonin reuptake inhibitors can increase side effects. When combined with antidepressants like selective serotonin reuptake inhibitors, St.John’s wort can lead to serotonin levels being too high. Therefore, doctors generally advise patients to avoid St. John’s wort if they’ve already been prescribed selective seretonin reuptake inhibitors or other antidepressants. 
Because of its antidepressant properties, St. John’s wort might exacerbate or cause manic symptoms. Additionally, according to an article published by the National Institutes of Health, using St. John’s wort with other drugs for depression can cause serotonin syndrome, which is a serious condition that occurs due to elevated neurotransmitter levels. Drugs used to treat migraines can also cause serotonin syndrome when taken alongside St. John’s wort.  

What are the benefits of online therapy for anxiety?

For those experiencing the symptoms of anxiety disorders, stepping outside the home or being in an unfamiliar location can feel overwhelming. These feelings of overwhelm may limit the therapeutic benefit of a therapy session or heighten other somatic experiences and psychological symptoms of anxiety. With online therapy, however, patients can minimize this risk, holding therapy sessions in the comfort of a familiar space and their own environment(s). They will also be able to connect directly with therapists via convenient in-app messaging, which can help them to have a better overall experience where they may feel supported than in traditional therapeutic models.

Is online therapy effective for anxiety?

In a meta-analysis of over 20 quantitative studies, online therapy was shown to be comparably beneficial when compared to in-person methods of therapeutic intervention. The test groups across the many studies reviewed showed improvement in function and quality of life, which suggests that online therapy may be an effective method of support for those experiencing the symptoms of anxiety disorder. 
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Takeaway

St. John’s Wort has been scientifically suggested to offer efficacy and support to those experiencing symptoms of anxiety disorders, insomnia, and depressive disorders. However, St. John's Wort is not usually intended to fulfill the role of a full treatment regimen. Your clinician may choose to recommend or oversee your usage of St. John’s Wort concurrently with regular therapy, and potentially even other medication sources, dietary changes, and lifestyle habits.

Because St. John's Wort formulations do not currently have a baseline test process to determine purity, composition, or other key elements of the supplement formation process, purchasing this supplement from a legitimate source is crucial. 

Although there are many retailers offering tinctures, capsules, and even creams made with St. John's Wort, asking questions before purchasing and speaking about reputable sources and use with your physician can help you to have a better overall experience.

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