Fish Oil May Be Helpful Towards Cholesterol, Depression, Rheumatoid Arthritis Support and More!

Fish oil contains omega-3 fatty acids, one of the two main classes of essential fatty acids. ( Omega-6 fatty acids are the other main type.) Essential fatty acids are special fats that the body needs for optimum health.

Interest in the potential therapeutic benefits of omega-3 fatty acids began when studies of the Inuit (Eskimo) people found that, although their diets contain an enormous amount of fat from fish, seals, and whales, they seldom suffer heart attacks. This is presumably because those sources of fat are very high in omega-3 fatty acids.

Subsequent investigation found that the omega-3 fatty acids found in fish oil have various effects that tend to reduce risk of heart disease and strokes. However, research into whether use of fish oil actually prevents these diseases, while somewhat positive, remains incomplete and somewhat inconsistent. In recognition of this, the FDA has allowed supplements containing fish oil or its constituents to carry a label that states: “Supportive but not conclusive research shows that consumption of EPA and DHA omega-3 fatty acids may reduce the risk of coronary heart disease.”

In addition, a slightly modified form of fish oil (ethyl-omega-3 fatty acids) has been approved by the FDA as a treatment for hypertriglyceridemia (high triglycerides).²³⁷ This specially processed product, sold under the trade name Omacor, is widely advertised as more effective than ordinary fish oil. However, it should be noted that Omacor has undergone relatively little study itself; the physician prescribing information notes only two small trials to support its effectiveness for this use. This is a far lower level of evidence than usually required for drug approval and also substantially lower than the body of evidence supporting standard fish oil as a treatment for high triglycerides.

Fish oil has also shown promise as an anti-inflammatory treatment for conditions such as rheumatoid arthritis, menstrual pain, and lupus. In addition, it may be helpful for various psychiatric conditions.

Requirements/Sources

There is no daily requirement for fish oil. However, a healthy diet should provide at least 5 g of essential fatty acids daily.

Many grains, fruits, vegetables, sea vegetables, and vegetable oils contain significant amounts of essential omega-6 and/or omega-3 fatty acids, but oil from cold-water fish is the richest natural source of omega-3 fats. It is commonly stated that people require a certain optimum ratio of omega-3 to omega-6 fatty acids in the diet; however, there is no real evidence that this is true, and some evidence that it is false.²³¹

Therapeutic Dosages

Typical dosages of fish oil are 3 g to 9 g daily, but this is not the upper limit. In one study, participants ingested 60 g daily.

The most important omega-3 fatty acids found in fish oil are called eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). In order to match the dosage used in several major studies, you should take enough fish oil to supply about 2 g to 3 g of EPA (2,000 mg to 3,500 mg) and about 1.0 g to 2.5 g of DHA daily (1,000 mg to 2,500 mg). Far higher doses have been used in some studies; conversely, one study found blood-pressure lowering effects with a very low daily dosage of DHA—0.7 g.²³⁸

DHA and EPA are not identical and might not have identical effects. Some evidence hints that DHA may be more effective than EPA for thinning the blood ¹⁷⁶ and reducing blood pressure.¹⁰⁵ The reverse may be true for reducing triglyceride levels, but study results are conflicting.^{160-165, 235}

Some manufacturers add vitamin E to fish oil capsules to keep the oil from becoming rancid. Another method is to remove all the oxygen from the capsule.

If possible, purchase fish oil products certified as free of significant levels of mercury, toxic organochlorines, and PCBs (see Safety Issues).

Flaxseed oil also contains omega-3 fatty acids, although of a different kind. It has been suggested as a less smelly substitute for fish oil. However, it is far from clear whether flaxseed oil is therapeutically equivalent to fish oil.^1,200

Therapeutic Uses

Consumption of fish oil alters the body’s production of certain substances in the class of chemicals called prostaglandins. Some prostaglandins increase inflammation while others decrease it. The prostaglandins whose production is enhanced by fish oil fall into the anti-inflammatory category. Based on this, fish oil has been tried as a treatment for early stages of rheumatoid arthritis, with positive results. It is thought to significantly reduce symptoms without causing side effects and may magnify the benefits of standard arthritis drugs.^37,38,179 However, while some standard medications can slow the progression of the disease, there is no evidence that fish oil can do this. Much weaker evidence hints that fish oil might be helpful for the related disease ankylosing spondylitis.²³²

Fish oil’s apparent anti-inflammatory properties are the likely explanation for its apparent benefit in dysmenorrhea (menstrual pain), as seen in two studies.^39,40 Similarly, fish oil may be helpful for the autoimmune disease lupus.^137,191 (However, two studies failed to find fish oil helpful for kidney disease caused by lupus.^138,139) Evidence has been mixed regarding whether fish oil is beneficial for Crohn’s disease or ulcerative colitis, conditions in which parts of the digestive tract are highly inflamed.^{49-51,61-68, 159,201} More recently, however, two well-designed trials enrolling a total of 738 patients convincingly failed to find any benefit for omega-3 fatty acid supplementations in the prevention of Crohn’s disease relapse.²⁵⁴

Incomplete evidence hints but does not prove that fish or fish oil might help prevent death caused by heart disease.^152,202 This effect seems to result from several separate actions. The best documented involves reducing high triglyceride levels; studies enrolling more than 2,000 people have substantiated this use.1 In addition, fish oil might raise HDL (“good”) cholesterol levels, “thin” the blood, lower levels of homocysteine, prevent dangerous heart arrhythmias, slow heart rate, improve blood vessel tone, and decrease blood pressure. ^{14,15,51,90-94,96-105,151,160-165,174,177,189,190,203-204,238} These effects also support findings that fish oil may help prevent strokes.^20,178 However, results are conflicting on whether people with angina should take fish oil or increase intake of fatty fish; one large study actually found that fish oil increased risk of sudden death.²⁰⁶

For a number of theoretical reasons, it has been suggested that fish oil and its constituents (especially a slightly modified form of EPA called ethyl-EPA) might have positive effects on various psychiatric disorders, most notably depression. However, there is no convincing evidence that low levels of omega-3 fatty acids in the bloodstream leads to even mild depression.²⁵⁹ Moreover, larger trials have generally failed to demonstrate a beneficial effect of fish oil-related products in depressed patients.^{154,168,188,192,193,207,228,234,241,242,244} Preliminary, and not altogether consistent, evidence hints that high doses of fish oil may produce benefits in bipolar disorder (more commonly known as manic-depressive illness), reducing risk of relapse and improving emotional state.^41,205,242 Other preliminary, and again not altogether consistent, evidence hints that fish oil might enhance the effectiveness of standard drugs (such as phenothiazines) for schizophrenia.^{48,148,169,170,193,247} Fish oil has also shown a bit of promise for borderline personality disorder.¹⁸⁰ In one study, DHA failed to augment the effectiveness of standard therapy for attention deficit disorder (ADD).⁸⁹ However, two studies that evaluated the potential benefits of fish oil combined with omega-6 fatty acids found some evidence of benefit for this condition.^88,194 Finally, one small trial found evidence that use of fish oil might decrease anger and aggressiveness in people with a history of aggressive behaviors, substance abuse, and problems with the law.²⁴³

Small studies also suggest that fish oil may be helpful in Raynaud’s phenomenon (a condition in which a person’s hands and feet show abnormal sensitivity to cold temperatures),^42,43 sickle-cell anemia,⁴⁵ and a form of kidney disease called IgA nephropathy.⁴⁷

According to some, but not all studies, fish oil may help treat the undesired weight loss often experienced by people with cancer.^181-182 In addition, highly preliminary evidence hints that DHA might enhance the effects of the cancer chemotherapy drug doxorubicin ¹⁵⁷ and decrease side effects of the chemotherapy drug irinotecan.¹⁵⁸

Use of fish oil by pregnant women might help prevent premature birth,^{184-185,208,236} although evidence is somewhat inconsistent. In addition, use of fish oil by pregnant women may support healthy brain function 183 and help prevent eczema and allergies in offspring.¹⁹⁵

Intriguing, but not yet at all reliable, evidence hints that fish oil, or its constituents, might be helpful for treating kidney stones or alleviating the symptoms of chronic fatigue syndrome, and reducing the risk of prostate cancer.^54,56,58,59 Results are inconsistent regarding whether the use of fish oil can decrease seizure frequency in people with epilepsy.^209,246

One study found that insulin metabolism in 278 young, overweight subjects improved on a calorie-restricted diet rich in fish oil from seafood or supplements compared to those on a diet low in fish oil, suggesting that fish oil may help delay the onset of diabetes in susceptible individuals.²⁵⁸ Fish oil has also been proposed as a treatment for many other conditions, including diabetic neuropathy,⁶⁰ allergies, and gout, but there has been little real scientific investigation of these uses.

Some, but not all, studies suggest that fish oil combined with omega-6 essential fatty acids may augment the effectiveness of calcium in the treatment of osteoporosis.^86,87 One promising, but highly preliminary, double-blind, placebo-controlled study suggests that the same combination therapy may improve symptoms of the severe neurological illness called Huntington’s disease.¹⁵⁵

Use of a fish oil product as part of a total parenteral nutrition regimen (intravenous feeding) may help speed recovery after major abdominal surgery.²³³

For several other conditions, the current balance of the evidence suggests that fish oil is not effective.

For example, despite widely publicized claims that fish oil helps asthma, most preliminary studies have failed to provide evidence that it is effective, and one study found that fish oil can actually worsen aspirin-related asthma.^{69-77,171,271} However, there is some evidence that use of fish oil could help prevent exercise-induced asthma in athletes.^196,212 And, in an interesting randomized, controlled trial with long-term follow-up, mothers who take fish-oil during late pregnancy reduced the risk of asthma in their children up to 16 years later.²⁶³

One study found that fish oil did not benefit the lung function of patients with cystic fibrosis.²⁵¹

Similarly, a 16-week, double-blind, placebo-controlled study of 167 individuals with recurrent migraine headaches found that fish oil did not significantly reduce headache frequency or severity.¹⁴⁹ Conflicting results have been seen in other, much smaller trials of fish oil for migraines.^172,173

One study found weak evidence that use of fish oil might decrease aggressive behavior in young girls (but, in this study, not in young boys).²¹³ Another study found benefit in developmental coordination disorder (a condition in which children suffer from lack of physical coordination as well as problems with learning and behavior).²¹⁴

Fish oil is also sometimes recommended for enhancing immunity in HIV infection. However, one 6-month, double-blind study found that a combination of the omega-3 fatty acids in fish oil plus the amino acid arginine was no more effective than placebo in improving immune function in people with HIV.⁷⁸ Fish oil, however, might help individuals with HIV gain weight.⁷⁹

In one large, randomized, controlled trial, diets rich in fish and omega-3 fatty acids from fish were associated with a significant reduction in the risk of developing colorectal cancer among men over a 22-year period.²⁵⁵ Another study provides preliminary evidence for the benefits of fish oil in reducing the risk of prostate cancer.⁵⁷ On balance, however, there is still relatively little evidence that the consumption of fish oil reduces cancer risk.²¹⁵

Preliminary studies have suggested that fish oil could help symptoms of multiple sclerosis; however, the largest double-blind study on the subject found no difference between people taking fish oil and those taking olive oil (used as a placebo).^80-84,216

Although one study found fish oil somewhat helpful in psoriasis,¹³³ a much larger study found no benefit.¹³⁴

DHA has been evaluated as a possible treatment for male infertility, but a double-blind trial of 28 men with impaired sperm activity found no benefit.⁸⁵

Combination therapy with GLA and fish oil has failed to prove effective for cyclic breast pain.¹⁸⁶

One study failed to find fish oil more effective than placebo for treating stress.²¹⁷ DHA has also been tried for slowing the progression of retinitis pigmentosa (a condition in which the retina gradually degenerates), but without much success.^210-211 In observational studies, people who happen to consume a diet rich in omega-3 fatty acids seem to lower their risk of age-related macular degeneration (the most common cause of blindness in the elderly). However, in the absence of randomized controlled trials, it is not possible to say whether or not it is omega-3 that produces this benefit.²⁶⁰

Studies of fish oil have failed to find it helpful for Alzheimer’s disease, whether for slowing its progression or improving symptoms.^230,240 And, one well-designed study failed to find any benefit of fish oil for enhancing memory and mental function in older adults without dementia over a 26 week period.²⁶⁵

Use of essential fatty acids in the omega-3 family has also shown some promise for the treatment of non-alcoholic fatty liver.^245,270

What Is the Scientific Evidence for Fish Oil?

Heart Disease Prevention

• Studies on fish or fish oil for preventing cardiovascular disease, slowing the progression of cardiovascular disease, and preventing heart-related death have returned somewhat contradictory results.^{106-125,150,156} A major review published in 2004 failed to find trustworthy evidence of benefit,²¹⁸ and a subsequent study actually found that use of fish oil increases risk of sudden death in people with stable heart disease.²¹⁹ A 2008 systematic review found that fish oil was associated with modestly reduced cardiac mortality, but not sudden cardiac death, in 11 studies totally over 32,000 patients. The reliability of these results, however, is limited by the inclusion of mostly low-to-moderate quality trials.²⁷² Though not entirely consistent, on balance the evidence does suggest that regulalry consuming oily fish or taking omega-3 fatty acid supplements can reduce the risk of cardiovascular events (eg, heart attacks) and deaths.²⁶¹ A 2009 review pooled data from 8 trials examining the effect of omega-3 fatty acids on prevention of cardiac death in almost 21,000 patients with coronary heart disease.²⁷⁴ This review separated patients into two general groups (those with previous myocardial infarction versus those with angina history) and found that omega-3 supplementation reduced risk of sudden cardiac death in patients with previous myocardial infarction, but increased risk in patients with angina. Though compelling, this finding may be limited since it was derived from a retrospective analysis of original data reorganized into subgroups.
• A gigantic study (over 18,000 participants) published in 2007 was widely described in the media as finally proving beyond a shadow of a doubt that fish oil helps prevent heart problems.²³⁹ Unfortunately, this study lacked a placebo group, and therefore failed to provide reliable evidence.
• As noted earlier, fish oil is hypothesized to exert several separate effects that act together to help protect the heart. The most important action of fish oil may be its apparent ability to reduce high triglyceride levels. Like cholesterol, triglycerides are a type of fat in the blood that tends to damage the arteries, leading to heart disease. According to most, though not all, studies, fish oil supplements can reduce triglycerides by as much as 25% to 30%.^{90-93,151,256} In a detailed review of 47 randomized trials, researchers concluded that fish oil is capable of significantly reducing triglyceride levels with no change in total cholesterol levels and only slight increases in HDL (“good”) cholesterol and LDL (“bad”) cholesterol.²⁶⁸ A slightly modified form of fish oil (ethyl-omega-3 fatty acids) has been approved by the FDA as a treatment for elevated triglycerides. However, in some studies, use of fish oil has markedly raised LDL cholesterol, which might offset some of the benefit. A 2009 review of 30 trials involving about 1,500 patients with type 2 diabetes demonstrated that marine-derived omega-3 polyunsaturated fatty acids (mean dose 2.4 g per day) lowered triglyceride levels about 15 mg/dL but increased LDL cholesterol by about 3 mg/dL after an average 24 weeks of treatment.²⁷⁵
• Stanols and sterols (or phytosterols) are naturally occurring substances found in various plants that can help to lower cholesterol in individuals with normal or mildly to moderately elevated levels. A study investigating the possible benefit of combining a phytosterol with fish oil found that together they significantly lowered total cholesterol, LDL-cholesterol and triglycerides, and raised HDL (“good”) cholesterol in subjects with undesirable cholesterol profiles.²⁵⁷
• Fish oil has been specifically studied for reducing triglyceride levels in people with diabetes, and it appears to do so safely and effectively.^3,262 It also seems to remain effective in individuals who are already using statin drugs to control lipid levels (both people with and without diabetes).^14,15,197 However, one study found that the standard drug gemfibrozil is more effective than fish oil for reducing triglycerides.⁹⁴
• Some but not all studies suggest that fish, fish oil, or EPA or DHA separately may additionally raise the level of HDL (“good”) cholesterol and possibly improve other aspects of cholesterol profile as well.^{96,97,151,164,165,197} This too should help prevent heart disease.
• Additionally, fish oil may help the heart by “thinning” the blood and by reducing blood levels of homocysteine,^98,176,190 although not all studies have found a positive effect.¹⁹⁸
• Studies contradict one another on whether fish oil can lower blood pressure,^{99-104,177,264} but on balance the supplement does seem to exert a modest positive effect.¹⁷⁴ A 6-week, double-blind, placebo-controlled study of 59 overweight men suggests that the DHA in fish oil, but not the EPA, is responsible for this benefit.¹⁰⁵
• Evidence is conflicting on whether fish oil helps prevent heart arrhythmias.^220-224,248 A large Italian trial involving almost 7,000 subjects found that fish oil may modestly reduce the risk of death or admission to the hospital for cardiovascular reasons in patients suffering from congestive heart failure.²⁶⁶
• Fish oil may slightly reduce heart rate.²²⁵ This effect could contribute to preventing heart attacks and other heart problems.

Rheumatoid Arthritis

• The results of numerous small double-blind trials indicate that omega-3 fatty acids in fish oil can help reduce the symptoms of rheumatoid arthritis.^{126,127,179,187} At least one small study suggests that it may help rheumatoid arthritis patients lower their dose of nonsteroidal anti-inflammatory medication (eg, ibuprofen).²⁵³ The benefits of the fish oil effect may be enhanced by a vegetarian diet.¹⁸⁷ Simultaneous supplementation with olive oil (about two teaspoons daily) may further increase the benefits.²²⁶ However, unlike some conventional treatments, fish oil probably does not slow the progression of rheumatoid arthritis.

Menstrual Pain

• Regular use of fish oil may reduce the pain of menstrual cramps.
• In a 4-month study of 42 young women aged 15 to 18, half the participants received a daily dose of 6 g of fish oil, providing 1,080 mg of EPA and 720 mg of DHA daily.¹²⁸ After 2 months, they were switched to placebo for another 2 months. The other group received the same treatments in reverse order. The results showed that these young women experienced significantly less menstrual pain while they were taking fish oil.
• Another double-blind study followed 78 women, who received either fish oil, seal oil, fish oil with vitamin B 12 (7.5 mcg daily), or placebo for three full menstrual periods.¹²⁹ Significant improvements were seen in all treatment groups, but the fish oil plus vitamin B 12 proved most effective, and its benefits continued for the longest time after treatment was stopped (3 months). The researchers offered no explanation why vitamin B 12 should be helpful.

Bipolar Disorder

• A 4-month, double-blind, placebo-controlled study of 30 individuals suggests that fish oil can enhance the effects of standard treatments for bipolar disorder, reducing risk of relapse and improving emotional state.¹³⁰ Eleven of the 14 individuals who took fish oil improved or remained well during the course of the study, while only 6 out of the 16 given placebo responded similarly.
• Another small study found that ethyl-EPA (a modified form of EPA) is helpful for the depressive phase of bipolar disease.²²⁷

Depression

• A 4-week, double-blind, placebo-controlled trial evaluated the potential benefits of fish oil in 20 individuals with depression.¹⁵⁴ All but one participant were also taking standard antidepressants and had been taking them for at least 3 months. By week 3, the level of depression had improved to a significantly greater extent in the fish oil group than in placebo group. Six of 10 participants given fish oil, but only one of 10 given placebo, showed at least a 50% reduction in depression scores by the end of the trial. (A reduction of this magnitude is considered a “cure.”)
• A double-blind, placebo-controlled study of 70 people who were still depressed despite standard therapy (such as SSRIs) found that additional treatment with ethyl-EPA (a modified form of EPA) improved symptoms.¹⁷⁵ Similar add-on benefits were also seen in other double-blind studies of ethyl-EPA or mixed essential fatty acids.^{192-193,228,250} However, one study failed to find benefit with fish-oil as an add-on treatment.²²⁹ Another double-blind study failed to find DHA alone helpful for depression.¹⁸⁸ A third relatively large placebo-controlled study found no benefit for fish oil in improving “mental well-being” among 320 older adults without a diagnosis of depression.²⁶⁷
• The effectiveness of fish oil supplementation in treating or preventing peripartum depression is, as of yet, unclear. A small preliminary study of women found that fish oil was significantly more effective than placebo at alleviating post-partum depression.²⁵² However, another small, placebo-controlled study was unable to show a benefit in women suffering from depression whether before or after delivery.²⁴⁹ In addition, a 2009 trial of 182 pregnant women with suspected low intake of docosahexaenoic acid (DHA) found that daily DHA supplementation (with or without arachidonic acid) did not reduce risk of postpartum depression compared to placebo.273

Raynaud’s Phenomenon

• In small, double-blind studies, fish oil has been found to reduce the severe finger and toe responses to cold temperatures that occur in Raynaud’s phenomenon.^131,132 However, these studies suggest that a higher than usual dosage must be used to get results, perhaps 12 g daily.

Osteoporosis

• There is some evidence that essential fatty acids may enhance the effectiveness of calcium in osteoporosis. In one study, 65 postmenopausal women were given calcium along with either placebo or a combination of omega-6 fatty acids (from evening primrose oil) and omega-3 fatty acids (from fish oil) for a period of 18 months. At the end of the study period, the group receiving essential fatty acids had higher bone density and fewer fractures than the placebo group.¹³⁵
• However, a 12-month, double-blind trial of 42 postmenopausal women found no benefit.¹³⁶
• The explanation for the discrepancy may lie in the differences between the women studied. The first study involved women living in nursing homes, while the second studied healthier women living on their own. The latter group of women may have been better nourished and already received enough essential fatty acids in their diet.

Lupus

• Lupus is a serious autoimmune disease that can cause numerous problems, including fatigue, joint pain, and kidney disease. One small, 34-week, double-blind, placebo-controlled crossover study compared placebo against daily doses of EPA (20 g) from fish oil.¹³⁷ A total of 17 individuals completed the trial. Of these, 14 showed improvement when taking EPA, while only 4 did so when treated with placebo. Another small study found similar benefits with fish oil over a 24-week period.¹⁹¹ However, two small studies failed to find fish oil helpful for lupus nephritis (kidney damage caused by lupus).^138,139

Attention Deficit and Hyperactivity Disorder (ADHD)

• Based on evidence that essential fatty acids are necessary for the proper development of brain function in growing children, EFAs have been tried for the treatment of ADHD and related conditions.
• A preliminary double-blind, placebo-controlled trial found some evidence that a supplement containing fish oil and evening primrose oil might improve ADHD symptoms.140 However, a high dropout rate makes the results of this trial somewhat unreliable. Another small study examined fish oil in children with ADHD who had thirst and skin problems. Benefits were seen with fish oil, but they also occurred with placebo and to about the same extent.¹⁹⁴
• In a double-blind, placebo-controlled trial of children already using stimulant therapy, addition of DHA for 4 months failed to further improve symptoms.¹⁴¹

Safety Issues

Fish oil appears to be generally safe. The most common problem is fishy burps. However, there are some safety concerns to consider.

For example, it has been suggested that some fish oil products contain excessive levels of toxic substances such as organochlorines and PCBs.¹⁶⁶ If possible, try to purchase fish oil products certified not to contain significant levels of these contaminants. Note: Various types of fish contain mercury, but this has not been a problem with fish oil supplements, according to reports on Consumerlab.com.

Fish oil has a mild blood-thinning effect;269 in one case report, it increased the effect of the blood-thinning medication warfarin (Coumadin).¹⁹⁹ Fish oil does not seem to cause bleeding problems when it is taken by itself ¹⁴² or with aspirin.¹⁴³ Nonetheless, people who are at risk of bleeding complications for any reason should consult a physician before taking fish oil.

Fish oil does not appear to raise blood sugar levels in people with diabetes.^144,145 Nonetheless, if you have diabetes, you should not take any supplement except on the advice of a physician.

Fish oil may modestly increase weight and lower total cholesterol and HDL (“good”) cholesterol levels.269 It may also raise the level of LDL (“bad”) cholesterol; however, this effect may be short-lived.^146,147

If you decide to use cod liver oil as your fish oil supplement, make sure you do not exceed the safe maximum intake of vitamin A and vitamin D. These vitamins are fat soluble, which means that excess amounts tend to build up in your body, possibly reaching toxic levels. The official maximum daily intake of vitamin A is 3,000 mcg for pregnant women as well as other adults. Look at the bottle label to determine how much vitamin A you are receiving. (It is less likely that you will get enough vitamin D to produce toxic effects.)

Interactions You Should Know About

If you are taking warfarin (Coumadin) or heparin, do not take fish oil except on the advice of a physician.

If you’d like to see iHerb’s selection of Fish Oil products, click here. Use Coupon Code WOW123 to get $5 off any first time order.

Click here to review the References for this article at the iHerb Health Library.

5-HTP for Depression, Migraines, Weight Loss and Fibromyalgia Symptoms

Many antidepressant drugs work, at least in part, by raising serotonin levels. The supplement 5-hydroxytryptophan (5-HTP) has been tried in cases of depression for a similar reason: the body uses 5-HTP to make serotonin, so providing the body with 5-HTP might, therefore, raise serotonin levels.

As a supplement, 5-HTP has also been proposed for all the same uses as other antidepressants, including aiding weight loss, preventing migraine headaches, decreasing the discomfort of fibromyalgia, improving sleep quality, and reducing anxiety.

Sources

5-HTP is not found in foods to any appreciable extent. For use as a supplement, it is manufactured from the seeds of an African plant (Griffonia simplicifolia).

Therapeutic Dosages

A typical dosage of 5-HTP is 100 to 300 mg 3 times daily. Once 5-HTP starts to work, it may be possible to reduce the dosage significantly and still maintain good results.

Therapeutic Uses

The primary use of 5-HTP is for depression. Several small short-term studies have found that it may be as effective as standard antidepressant drugs.^1,2 Since standard antidepressants are also used for insomnia and anxiety, 5-HTP has also been suggested as a treatment for those conditions, but there is only very preliminary evidence as yet that it works.³

Similarly, antidepressant drugs are often used for migraine headaches. Some, but not all, studies suggest that regular use of 5-HTP may help reduce the frequency and severity of migraines, as well as help other types of headaches.^4-10 Additionally, preliminary evidence suggests that 5-HTP can reduce symptoms of fibromyalgia¹¹ and perhaps help you lose weight.^12-15

What Is the Scientific Evidence for 5-Hydroxytryptophan?

Depression

• Several small studies have compared 5-HTP to standard antidepressants.¹⁶ The best one was a 6-week study of 63 people given either 5-HTP (100 mg 3 times daily) or an antidepressant in the Prozac family (fluvoxamine, 50 mg 3 times daily).¹⁷ Researchers found equal benefit between the supplement and the drug. However, 5-HTP caused fewer and less severe side effects.

Migraine and Other Headaches

• There is some evidence that 5-HTP may help prevent migraines when taken at a dosage of 400 to 600 mg daily. Lower doses may not be effective.
• In a 6-month trial of 124 people, 5-HTP (600 mg daily) proved equally effective as the standard drug methysergide.¹⁸ The most dramatic benefits observed were reductions in the intensity and duration of migraines. Since methysergide has been proven better than placebo for migraine headaches in earlier studies, the study results provide meaningful, although not airtight, evidence that 5-HTP is also effective.
• Similarly good results were seen in another comparative study, using a different medication and 5-HTP (at a dose of 400 mg daily).¹⁹
• However, in one study, 5-HTP (up to 300 mg daily) was less effective than the drug propranolol.²⁰ Also, in a study involving children, 5-HTP failed to demonstrate benefit.²¹ Other studies that are sometimes quoted as evidence that 5-HTP is effective for migraines actually enrolled adults or children with many different types of headaches (including migraines).^22,23,24
• Putting all this evidence together, it appears likely that 5-HTP can help people with frequent migraine headaches if taken in sufficient doses, but further research needs to be done. In particular, we need a large double-blind study that compares 5-HTP against placebo over a period of several months.
• Finally, an 8-week, double-blind, placebo-controlled trial of 65 individuals (mostly women) with tension headaches found that 5-HTP at a dose of 100 mg 3 times daily did not significantly reduce the number of headaches experienced; however, it did reduce participants’ need to use other pain-relieving medications.²⁵

Obesity (Weight Loss)

• The drug fenfluramine was one member of the now infamous phen-fen treatment for weight loss. Although very successful, fenfluramine was later associated with damage to the valves of the heart and was removed from the market. Because fenfluramine raises serotonin levels, it seems reasonable to believe that other substances that affect serotonin might also be useful for weight reduction.
• Four small double-blind, placebo-controlled clinical trials examined whether 5-HTP can aid weight loss. The first, a double-blind crossover study, found that use of 5-HTP (at a daily dose of 8 mg per kilogram body weight) reduced caloric intake despite the fact that the 19 participants made no conscious effort to eat less.²⁶ Participants given placebo consumed about 2,300 calories per day, while those taking 5-HTP ate only 1,800 calories daily. Use of 5-HTP appeared to lead to a significantly enhanced sense of satiety after eating. Over the course of 5 weeks, women taking 5-HTP effortlessly lost more than 3 lbs.
• A follow-up study by the same research group enrolled 20 overweight women who were trying to lose weight.²⁷ Participants received either 5-HTP (900 mg per day) or placebo for two consecutive 6-week periods. During the first period, there was no dietary restriction, while during the second period participants were encouraged to follow a defined diet expected to lead to weight loss. Participants receiving placebo did not lose weight during either period. However, those receiving 5-HTP lost about 2% of their initial body weight during the no-diet period and an additional 3% while on the diet. Thus, a woman with an initial weight of 170 lbs lost about 3-1/2 lbs after 6 weeks of using 5-HTP without dieting and another 5 lbs while dieting. Once again, participants taking 5-HTP experienced quicker satiety.
• Similar benefits were seen in a double-blind study of 14 overweight women given 900 mg of 5-HTP daily.²⁸
• Finally, a double-blind, placebo-controlled study of 20 overweight individuals with adult-onset diabetes found that use of 5-HTP (750 mg per day) without intentional dieting resulted in about a 4-1/2 lb weight loss over a 2-week period.²⁹ Use of 5-HTP reduced carbohydrate intake by 75% and fat intake to a lesser extent.

Fibromyalgia

• Antidepressants are the primary conventional treatment for fibromyalgia, a little-understood disease characterized by aching, tender muscles, fatigue, and disturbed sleep. One study suggests that 5-HTP may be helpful as well. In this double-blind trial, 50 subjects with fibromyalgia were given either 100 mg of 5-HTP or placebo 3 times daily for a month.³⁰ Those receiving 5-HTP experienced significant improvements in all symptom categories, including pain, stiffness, sleep patterns, anxiety, and fatigue.

Anxiety

• An 8-week, double-blind, placebo-controlled study compared 5-HTP and the drug clomipramine in 45 individuals suffering from anxiety disorders.³¹ The results showed that 5-HTP was effective, but clomipramine was more effective.

Safety Issues

No significant adverse effects have been reported in clinical trials of 5-HTP. Side effects appear to be generally limited to short-term, mild digestive distress and possible allergic reactions.

One potential safety issue with 5-HTP involves an interaction with a medication used for Parkinson’s disease: carbidopa. Several reports suggest that the combination can create skin changes similar to those that occur in the disease scleroderma.^32,33,34

According to several reports, when dogs have consumed excessive amounts of 5-HTP, they developed signs of excess serotonin.³⁹ In humans, this so-called serotonin syndrome includes such symptoms as confusion, agitation, rapid heart rate, high blood pressure, muscle jerks, loss of coordination, sweating, shivering, and fever; rapid breathing, coma, and death are possible. Serotonin syndrome might also occur if 5-HTP is combined with drugs that raise serotonin levels, such as SSRIs (such as, Prozac), other antidepressants, or the pain medication tramadol.

There are some reasons for concern that 5-HTP could increase the risk of “infantile spasms” (technically, massive myoclonic seizure disorder) in developmentally disabled children.^35,40

Although safety in children has not been proven, children have been given 5-HTP in studies without any apparent harmful effects.^36,37,38 Safety in pregnant or nursing women and those with liver or kidney disease has not been established.

Peak X

One report in 1998 raised a potential safety concern with 5-HTP. Researchers discovered evidence of an unidentified substance called peak X in a limited number of 5-HTP products.⁴¹

Peak X has a frightening history involving a supplement related to 5-HTP: tryptophan. The body turns tryptophan into 5-HTP, and the two supplements have similar effects in the body. Until the late 1980s, tryptophan was widely used as a sleep aid. However, it was taken off the market when thousands of people using tryptophan developed a disabling and sometimes fatal blood disorder called eosinophilia myalgia. Peak X, introduced through a manufacturer’s mistake, is thought to have been the cause, although not all experts agree.^42-50

Despite this one report, it seems unlikely that 5-HTP could present the same risk as tryptophan.⁵¹ It is manufactured completely differently; peak X has not been seen again in 5-HTP samples, and no epidemic of eosinophilia myalgia has occurred with 5-HTP use.

Interactions You Should Know About

If you are taking:

• Prescription antidepressants (including SSRIs, MAO inhibitors, or tricyclics), the pain drug tramadol, or migraine drugs in the triptan family (such as sumatriptan): Do not take 5-HTP in addition, except on a physician’s advice.
• The Parkinson’s disease medication carbidopa: Taking 5-HTP at the same time might cause skin changes similar to those that develop in the disease scleroderma.

If you’d like to see iHerb’s selection of 5-HTP products, click here. Use Coupon Code WOW123 to get $5 off any first time order.

Click here to review the References for this article at the iHerb Health Library.

St. John’s Wort for Mild to Moderate Depression

St. John’s wort is a common perennial herb of many branches and bright yellow flowers that grows wild in much of the world. Its name derives from the herb’s tendency to flower around the feast of St. John. (A wort simply means plant in Old English.) The species name perforatum derives from the watermarking of translucent dots that can be seen when the leaf is held up to the sun.

St. John’s wort has a long history of use in treating emotional disorders. During the Middle Ages, St. John’s wort was popular for “casting out demons.” In the 1800s, the herb was classified as a nervine, or a treatment for “nervous disorders.” When pharmaceutical antidepressants were invented, German researchers began to look for similar properties in St. John’s wort.

What Is St. John’s Wort Used for Today?

Today, St. John’s wort is a widely used treatment for depression in Germany, other parts of Europe, and the United States. The evidence-base for its use approaches that of many modern prescription drugs at the time of their first approval.

Most studies of St. John’s wort have evaluated individuals with major depression of mild to moderate intensity. This contradictory-sounding language indicates that the level of depression is more severe than simply feeling “blue.” However, it is not as severe as the most severe forms of depression. Typical symptoms include depressed mood, lack of energy, sleep problems, anxiety, appetite disturbance, difficulty concentrating, and poor stress tolerance. Irritability can also be a sign of depression.

Taken as a whole, research suggests that St. John’s wort is more effective than placebo and approximately as effective as standard drugs. Furthermore, St. John’s wort appears to cause fewer side effects than many antidepressants. However, the herb does present one significant safety risk: it interacts harmfully with a great many standard medications. (See Safety Issues for details.)

St. John’s wort has also shown promise for treatment of severe major depression.^107,126 Note: St. John’s wort alone should never be relied on for the treatment of severe depression. If you or a loved one feels suicidal, unable to cope with daily life, paralyzed by anxiety, incapable of getting out of bed, unable to sleep, or uninterested in eating, see a physician at once. Professional care may be lifesaving.

Besides depression, St. John’s wort has also been tried for many other conditions in which prescription antidepressants are thought useful, such as attention deficit disorder,¹³¹ anxiety, insomnia,¹⁵ menopausal symptoms,²⁰ premenstrual syndrome (PMS),^19,102 seasonal affective disorder (SAD),^98,99 and social phobia.¹⁰³ However, there is as yet no convincing evidence that it offers any benefit for these conditions. One substantial double-blind study did find St. John’s wort potentially helpful for somatoform disorders (commonly called psychosomatic illnesses).¹⁰⁴

Standard antidepressants are also often used for diabetic neuropathy and other forms of neuropathy (nerve pain). However, a small double-blind, placebo-controlled trial failed to find St. John’s wort effective for this purpose.¹⁶ Another study failed to find St. John’s wort helpful for obsessive-compulsive disorder.¹¹⁵

St. John’s wort contains, among other ingredients, the substances hypericin and hyperforin. Early reports suggested that St. John’s wort or synthetic hypericin might be useful against viruses such as HIV, but these haven’t panned out.¹⁷ However, there is some evidence hyperforin may be able to fight certain bacteria, including some that are resistant to antibiotics.¹⁸ Note: This evidence is far too preliminary to count St. John’s wort as an effective antibiotic.

Based on weak evidence that hypericin might have anti-inflammatory properties, St. John’s wort cream has been tried as a treatment for eczema, with some promising results.¹⁰⁰

One interesting double-blind study evaluated a combination therapy containing St. John’s wort and black cohosh in 301 women with general menopausal symptoms as well as depression.¹¹⁶ The results showed that use of the combination treatment was significantly more effective than placebo for both problems.

In a small placebo-controlled trial, hypericin extract showed no benefit for burning mouth syndrome, a poorly understood condition in which a person experiences ongoing moderate to severe pain in the tongue and/or mouth.¹²⁹

What Is the Scientific Evidence for St. John’s Wort?

Depression

There have been two main kinds of studies: those that compared St. John’s wort to placebo, and others that compared it to prescription antidepressants. A 2008 detailed review of 29 randomized, placebo controlled trials found that St. Johns wort was consistently more effective than placebo and equally effective to standard antidepressants.¹³³

St. John’s Wort Versus Placebo

• Studies of St. John’s wort (and other antidepressants) use a set of questions called the Hamilton Depression Index (HAM-D). This scale rates the extent of depression, with higher numbers indicating more serious symptoms.
• Double-blind, placebo-controlled trials involving a total of more than 1,500 participants with major depression of mild to moderate severity have generally found that use of St. John’s wort can significantly reduce HAM-D scores as compared to placebo.^{21-28,89,105,123} In addition, continued treatment with St. Johns Wort over 6 months may be effective at preventing a relapse of moderate depression in patients who recover from an initial acute episode.¹³²
• For example, in a 6-week trial, 375 individuals with average 17-item HAM-D scores of about 22 (indicating major depression of moderate severity) were given either St. John’s wort or placebo.⁸⁹ Individuals taking St. John’s wort showed significantly greater improvement than those taking placebo.
• Three double-blind, placebo-controlled trials evaluating individuals with a similar level of depression have failed to find St. John’s wort more effective than placebo.^27,85,106 However, three studies cannot overturn a body of positive research. Keep in mind that 35% of double-blind studies involving pharmaceutical antidepressants have also failed to find the active agent significantly more effective than placebo.⁸⁵ As if to illustrate this, in two of the three studies in which St. John’s wort failed to prove effective, a conventional drug (Zoloft in one case, Prozac in the other) also failed to prove effective. The reason for these negative outcomes is not that Zoloft or Prozac does not work. Rather, statistical effects can easily hide the benefits of a drug, especially in a condition like depression where there is as a high placebo effect and no really precise method of measuring symptoms. Thus, unless a whole series of studies find St. John’s wort ineffective, especially trials in which a comparison drug treatment does prove effective, St. John’s wort should still be regarded as probably effective for major depression of mild to moderate severity.

St. John’s Wort Versus Medications

• At least 8 double-blind trials enrolling a total of more than 1,200 people have compared St. John’s wort to fluoxetine (Prozac), citalopram (Celexa), paroxetine (Paxil) or sertraline (Zoloft).^{31-33,90,91,107,108,117-118} In all of these studies, the herb proved as effective as the drug and generally caused fewer side effects.
• In the largest of these trials, a 6-week study of 388 people with major depression of mild-to-moderate severity, St. John’s wort proved equally effective as the drug citalopram (Celexa) and more effective than placebo.¹¹⁸ Additionally, Celexa caused a significantly higher rate of side effects than St. John’s wort. There were also significantly more side effects in the placebo group than in the St. John’s wort group—presumably because treatment of depression reduces physical symptoms of psychological origin.
• St. John’s wort has also been compared to older antidepressants, with generally favorable results.^34-38

How Does St. John’s Wort Work for Depression?

• Like pharmaceutical antidepressants, St. John’s wort is thought to raise levels of neurotransmitters in the brain, such as serotonin, norepinephrine, and dopamine.^6,7
• The active ingredient of St. John’s wort is not known. Extracts of St. John’s wort are most often standardized to the substance hypericin, which has led to the widespread misconception that hypericin is the active ingredient. However, there is no evidence that hypericin itself is an antidepressant. Another ingredient of St. John’s wort named hyperforin has shown considerable promise as the most important ingredient. Hyperforin was first identified as a constituent of Hypericum perforatum in 1971 by Russian researchers, but it was incorrectly believed to be too unstable to play a major role in the herb’s action.¹ However, subsequent evidence corrected this view. It now appears that standard St. John’s wort extract contains about 1% to 6% hyperforin.² Evidence from animal and human studies suggests that it is the hyperforin in St. John’s wort that raises the levels of neurotransmitters.^8-10 Nonetheless, there may be other active ingredients in St. John’s wort also at work.^11,12 In fact, 2 double-blind trials using a form of St. John’s wort with low hyperforin content found it effective.^13,14 The bottom line remains that more research is necessary to discover just how St. John’s wort acts against depression.

Polyneuropathy

• A double-blind, placebo-controlled trial of 54 people with diabetic neuropathy or other forms of neuropathy (pain, numbness and/or tingling caused by injury to nerves) did not find St. John’s wort effective for this purpose.⁴⁰

Dosage

The typical dosage of St. John’s wort is 300 mg 3 times a day of an extract standardized to contain 0.3% hypericin. Some products are standardized to hyperforin content (usually 2% to 3%) instead of hypericin. These are usually taken at the same dosage. Two studies found benefits with a single daily dose of 900 mg.^118-119

Yet another form of St. John’s wort has shown effectiveness in double-blind studies. This form contains little hyperforin and is taken at a dose of 250 mg twice daily.^41,42 There is some evidence that this form of St. John’s wort may be less likely to interact with medications. (See Drug Interactions.)

If the herb bothers your stomach, take it with food.

Remember that the full effect takes 4 weeks to develop. Don’t give up too soon!

Safety Issues

St. John’s wort taken alone usually does not cause immediate side effects. In a study designed to look for side effects, 3,250 people took St. John’s wort for 4 weeks.⁴³ Overall, about 2.4% reported problems. The most common complaints were mild stomach discomfort (0.6%), allergic reactions—primarily rash—(0.5%), tiredness (0.4%), and restlessness (0.3%). Another study followed 313 individuals treated with St. John’s wort for 1 year.⁴⁴ The results showed a similarly low incidence of adverse effects.

In the extensive German experience with St. John’s wort as a treatment for depression, there have been no published reports of serious adverse consequences from taking the herb alone.⁴⁵ Animal studies involving enormous doses of St. John’s wort extracts for 26 weeks have not shown any serious effects.⁴⁶

However, there are a number of potential safety risks with St. John’s wort that should be considered. These are outlined in the following sections.

Photosensitivity

Cows and sheep grazing on St. John’s wort have sometimes developed severe and even fatal sensitivity to the sun. In one study, highly sun-sensitive people were given twice the normal dose of the herb.⁴⁷ The results showed a mild but measurable increase in reaction to ultraviolet radiation. Another trial found that a one-time dose of St. John’s wort containing 2 or 6 times the normal daily dose did not cause an increased tendency to burn, nor did 7 days of treatment at the normal dose.⁸³ However, there is a case report of severe and unexpected burning in an individual who used St. John’s wort and then received ultraviolet therapy for psoriasis.⁴⁸ In addition, two individuals using topical St. John’s wort experienced severe reactions to sun exposure.⁸⁴

The morals of the story are as follows: if you are especially sensitive to the sun, don’t exceed the recommended dose of St. John’s wort, and continue to take your usual precautions against burning. If you are receiving UV treatment, do not use St. John’s wort at all; and if you apply St. John’s wort to your skin, keep that part of your body away from the sun.

In addition, you might get into problems if you combine St. John’s wort with other medications that cause increased sun sensitivity, such as sulfa drugs and the anti-inflammatory medication piroxicam (Feldene). The medications omeprazole (Prilosec) and lansoprazole (Prevacid) may also increase the tendency of St. John’s wort to cause photosensitivity.⁴⁹

Finally, a report suggests that regular use of St. John’s wort might also increase the risk of sun-induced cataracts.⁵⁰ While this is preliminary information, it may make sense to wear sunglasses when outdoors if you are taking this herb on a long-term basis.

Drug Interactions

Herbal experts have warned for some time that combining St. John’s wort with drugs in the Prozac family (SSRIs) might raise serotonin too much and cause a number of serious problems. Recently, case reports of such events have begun to trickle in.^51-53 This is a potentially serious risk. Do not combine St. John’s wort with prescription antidepressants except on the specific advice of a physician. Since some antidepressants, such as Prozac, linger in the blood for quite some time, you also need to exercise caution when switching from a drug to St. John’s wort.

Antimigraine drugs in the triptan family (such as sumatriptan, or Imitrex) and the pain-killing drug tramadol also raise serotonin levels and might interact similarly with St. John’s wort.^54,55

However, perhaps the biggest concern with St. John’s wort is that it appears to decrease the effectiveness of numerous medications, including protease inhibitors and reverse transcriptase inhibitors (for HIV infection), cyclosporine and tacrolimus (for organ transplants), digoxin (for heart disease), statin drugs (used for high cholesterol), warfarin (Coumadin) (a blood thinner), chemotherapy drugs, oral contraceptives, tricyclic antidepressants, protein pump inhibitors (like Prilosec), atypical antipsychotics like olanzapine or clozapine (for schizophrenia), anesthetics, and the new heart disease drug ivabradine.^{56-67,80,82,87,88,92,93,95,101,109-113,124,125,127,128} In fact, there are theoretical reasons to believe that this herb might reduce the effectiveness or otherwise interact with about 50% of all medications.114 Furthermore, suppose you are taking St. John’s wort while your physician is adjusting the dosage of one of your medications to obtain an optimum balance of efficacy and side effects. A problem may then occur if you subsequently stop taking the herb: blood levels of the drug may then rise, with potentially dangerous consequences.

Note that these proposed interactions are not purely academic: they could lead to catastrophic consequences. Indeed, St. John’s wort appears to have caused several cases of heart, kidney, and liver transplant rejection by interfering with the action of cyclosporine.

The herb also appears to decrease the effectiveness of oral contraceptives¹²⁰ and by doing so is thought to have caused unwanted pregnancies.^68,88

On a less dramatic level, one study showed that among people taking a cholesterol-lowering medication in the statin family, use of St. John’s wort caused cholesterol levels to rise.¹²⁷ (The same would be expected to occur if you are using red yeast rice to treat high cholesterol, as red yeast rice supplies naturally-occurring statin drugs.)

Finally, some people with HIV take St. John’s wort in the false belief that the herb will fight AIDS. The unintended result may be to reduce the potency of standard anti-HIV drugs.

There is some evidence that low-hyperforin St. John’s wort may have less potential for drug interactions than other forms of St. John’s wort.^121-122,125 Nonetheless, we recommend that people taking any oral or injected medication that is critical to their health or wellbeing should entirely avoid using any form of St. John’s wort until more is known; if you are already taking the herb, you should not stop taking it until you can simultaneously have your drug levels monitored. On general principles, we also advise avoid using the herb prior to undergoing general anesthesia.

Safety in Special Circumstances

One animal study found no ill effects on the offspring of pregnant mice.⁶⁹ However, these findings alone are not sufficient to establish St. John’s wort as safe for use during pregnancy. Furthermore, the St. John’s wort constituent hypericin can accumulate in the nucleus of cells and directly bind to DNA.⁷⁰ For this reason, pregnant or nursing women should avoid St. John’s wort. Furthermore, safety for use by young children or people with severe liver or kidney disease has not been established.

Like other antidepressants, case reports suggest that St. John’s wort can cause episodes of mania in individuals with bipolar disorder (manic-depressive disease).^71,72

There is also one report of St. John’s wort causing temporary psychosis in a person with Alzheimer’s disease.⁷⁹

Other Concerns

Certain foods contain a substance named tyramine. These foods include aged cheeses, aged or cured meat, sauerkraut, soy sauce, other soy condiments, beer (especially beer on tap). and wine. Drugs in the MAO inhibitor family interact adversely with tyramine, causing severe side effects such as high blood pressure, rapid heart rate, and delirium. One case report suggests that St. John’s might present this risk as well.⁹⁶ However, other studies suggest that normal doses of St. John’s should not cause MAO-like effects.^4,5,97 Until this issue is sorted out, we recommend that individuals taking St. John’s wort avoid tyramine-containing foods. Since MAO inhibitors react adversely with stimulant drugs such as Ritalin, ephedrine (found in the herb ephedra), and caffeine, we also recommend that you avoid combining St. John’s wort with them.

One small study suggests that high doses of St. John’s wort might slightly impair mental function.⁷³

One case report associates use of St. John’s wort with hair loss.⁷⁴ The authors note that standard antidepressants may also cause hair loss at times.

One study raised questions about possible antifertility effects of St. John’s wort. When high concentrations of St. John’s wort were placed in a test tube with hamster sperm and ova, the sperm were damaged and less able to penetrate the ova.⁷⁵ However, since it is unlikely that this much St. John’s wort can actually come in contact with sperm and ova when they are in the body rather than in a test tube, these results may not be meaningful in real life.

In one reported case, St. John’s Wort may have interacted with the menopause drug tibolone to produce severe liver damage.¹³⁰

Transitioning from Medications to St. John’s Wort

If you are taking a prescription drug for mild to moderate depression, switching to St. John’s wort may be a reasonable idea if you would prefer taking an herb. To avoid overlapping treatments, the safest approach is to stop taking the drug and allow it to wash out of your system before starting St. John’s wort. Consult with your doctor on how much time is necessary.

However, if you are taking medication for severe depression, switching over to St. John’s wort is not a good idea. The herb probably won’t work well enough, and you may sink into a dangerous depression.

Interactions You Should Know About

If you are taking:

• Antidepressant drugs, including MAO inhibitors, SSRIs, and tricyclics, or possibly the drugs tramadol or sumatriptan (Imitrex): Do not take St. John’s wort at the same time. Actually, you need to let the medication flush out of your system for a while (perhaps weeks, depending on the drug) before you start the herb.
• Digoxin, cyclosporine and tacrolimus, protease inhibitors or reverse transcriptase inhibitors, oral contraceptives, tricyclic antidepressants, warfarin (Coumadin), statin drugs, theophylline, chemotherapy drugs, newer antipsychotic medications (such as olanzapine and clozapine), anesthetics, or, indeed, any critical medication: St. John’s wort might cause the drug to be less effective. Furthermore, if you are already taking St. John’s wort and your physician adjusts your medication dosage to achieve proper blood levels, suddenly stopping St. John’s wort could cause the level of the drug in your body to rebound to dangerously high levels.
• Medications that cause sun sensitivity such as sulfa drugs and the anti-inflammatory medication piroxicam (Feldene), as well as omeprazole (Prilosec) or lansoprazole (Prevacid): Keep in mind that St. John’s wort might have an additive effect.
• Stimulant drugs or herbs such as Ritalin, caffeine, or ephedrine ( ephedra): It is possible that St. John’s wort might interact adversely with them.

Click here to review the References for this article at the iHerb Health Library.

If you’d like to see iHerb’s selection of St. John’s Wort products, click here. Use Coupon Code WOW123 to get $5 off any first time order.