Ask The Pharmacist: St. John’s wort, serotonin and depression

Suzy Cohen

St. John’s wort is a beautiful plant with yellow flowers known to ease depression. It’s banned in some countries though. 

For a long time, “hypericin,” a compound in the plant was thought to help with the blues, however scientists are noting that another compound in the plant called “hyperforin” plays an even bigger role.

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St. John’s wort increases the activity of serotonin. But serotonin isn’t the be-all, end-all of happy brain chemicals. Some research suggests that depression is really tied to dopamine deficiency. If you’d like to understand more about that brain chemical, read my other article posted at my website. It’s called, “Have you stopped enjoying life? It could be low dopamine.”

File: St. John’s wort is a beautiful plant with yellow flowers known to ease depression.

Selective Serotonin Reuptake Inhibitors are dubbed “SSRIs” and these medications increase serotonin activity in your brain. You know them as Prozac, Lexapro, Zoloft and others. Taking SSRI antidepressants along with St. John’s wort is dangerous and the combination should be avoided. 

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It’s fascinating that St. John’s wort has anti-inflammatory properties similar to a popular drug called Celebrex! This is fascinating. Research has demonstrated that inflammatory chemicals in the brain are high in depressed patients. In fact, some researchers even believe that brain inflammation is the primary cause of depression, with the neurotransmitter changes coming later. It’s possible that this anti-inflammatory action of St. John’s wort could help with depression in addition to its ability to increase serotonin activity. Which reminds me of a warning … 

If you combine prescription antidepressants with St. John’s wort, it can be dangerous and may lead to “Serotonin Syndrome,” which is a medical crisis. Serotonin has to be in balance with other brain chemicals, so the message here is “more is not always better.” Symptoms of the syndrome include increased heart rate and blood pressure, fever, diarrhea, and muscle rigidity. When severe, serotonin syndrome causes seizures, irregular heartbeat, faintness or unconsciousness, and even death.

St. John's wort can interact with many medications.

There are allergies associated with any herb including this one. Finally, due to changes in your liver enzymes, be extremely careful with this herb (or preferably avoid it) if you take any of the following: 

  • Oral Contraceptives
  • Warfarin
  • Digoxin
  • Theophylline
  • Indinavir
  • Cyclosporine

Treatment for severe depression is not as easy as popping a single pill, or an herbal remedy. St. John’s wort doesn’t even work well for severe cases. 

If you’re feeling depressed, make sure that you get professional help and make lifestyle or relationship changes if necessary. Depression can lead to fatal consequences and should be taken seriously by everyone in the family. It is fleeting for some of you, and life-long for others.

Anhedonia and suicide are linked to severe depression. A friend of a friend committed suicide this past month, and I knew and liked him. I’m sad about this, and so I’m prompted to write this article today. Be sure to tell your loved ones and friends just how much you need them in your life. Treat everyone, even new acquaintances with kindness, you have no idea what they’re suffering with. One kind word, or special text can make all the difference to a person who is empty inside. 

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Suzy Cohen is a registered pharmacist. The information presented here is not intended to treat, cure or diagnose any condition. Visit