St. John's Wort Review
A flowering plant with a long history of use for depression and anxiety that may help manage mood changes during smoking cessation.
Scientific Name
Hypericum perforatum
Available Forms
Capsules, Tablets, Tincture, Tea
Standard Dosage
300mg (0.3% hypericin) three times daily
Typical Cost
$15-30 per month
Table of Contents
Overview of St. John's Wort
St. John's Wort (Hypericum perforatum) is a flowering plant that has been used for medicinal purposes for thousands of years. Named for its tendency to flower around St. John's Day (June 24), this herb has a rich history in traditional medicine for treating various conditions, most notably depression, anxiety, and mood disorders.
St. John's Wort (Hypericum perforatum) with its distinctive yellow flowers
In the context of smoking cessation, St. John's Wort has gained attention for its potential to help manage the depression, anxiety, and mood changes that often accompany nicotine withdrawal. While not specifically approved for smoking cessation, its effects on mood regulation may indirectly support quit attempts.
Key Facts About St. John's Wort
- Active compounds: Hypericin, hyperforin, and flavonoids
- Traditional uses: Depression, anxiety, wound healing, nerve pain
- Modern applications: Mild to moderate depression, seasonal affective disorder
- Available forms: Capsules, tablets, tinctures, teas, topical preparations
- Standard dosage: 300mg (standardized to 0.3% hypericin) three times daily
- Regulation: Sold as a dietary supplement in the US, prescribed as medicine in some European countries
- Research status: Extensively studied for depression, limited research specifically for smoking cessation
St. John's Wort is one of the most well-studied herbal supplements, with substantial evidence supporting its effectiveness for mild to moderate depression. However, it's essential to note that the research specifically examining its role in smoking cessation is more limited.
Important Consideration
St. John's Wort is known for its significant interactions with many medications, including antidepressants, birth control pills, blood thinners, heart medications, and drugs used to treat HIV and cancer. These interactions can be serious and potentially life-threatening. Always consult with a healthcare provider before using St. John's Wort, especially if you're taking other medications.
This review examines the potential benefits, limitations, and safety considerations of using St. John's Wort as a complementary approach to smoking cessation, based on available scientific evidence and user experiences.
How St. John's Wort Works
St. John's Wort contains several bioactive compounds that affect brain chemistry in ways that may be beneficial during smoking cessation. Understanding these mechanisms helps explain both its potential benefits and limitations.
Active Compounds
The primary active compounds in St. John's Wort include:
- Hypericin: A naphthodianthrone compound that gives the red color when the plant is crushed
- Hyperforin: A phloroglucinol derivative believed to be primarily responsible for antidepressant effects
- Flavonoids: Including rutin, quercetin, and kaempferol, which have antioxidant properties
- Xanthones: Compounds with potential antidepressant and anti-inflammatory effects
Mechanism of Action
St. John's Wort appears to work through several mechanisms that affect neurotransmitters in the brain:
- Inhibition of neurotransmitter reuptake: Similar to some antidepressants, St. John's Wort appears to inhibit the reuptake of serotonin, dopamine, and norepinephrine, increasing their availability in the brain
- GABA receptor effects: Some components may bind to GABA receptors, potentially producing calming effects
- Modulation of cytokine production: May reduce inflammation-related depression by affecting cytokine levels
- Regulation of HPA axis: May help normalize stress hormone levels
Relevance to Smoking Cessation
These mechanisms may help with smoking cessation in several ways:
- Mood regulation: By affecting serotonin and other neurotransmitters, St. John's Wort may help manage the depression and mood changes that often occur during nicotine withdrawal
- Anxiety reduction: Its effects on GABA receptors may help reduce anxiety and irritability associated with quitting
- Stress management: Normalization of stress hormone levels may help individuals cope with stressors that might otherwise trigger smoking
- Sleep support: Some users report improved sleep quality, which can be disrupted during nicotine withdrawal
Scientific Perspective
While the mechanisms of St. John's Wort are well-studied for depression, it's crucial to note that its direct effects on nicotine cravings or withdrawal are less established. The potential benefits for smoking cessation are largely theoretical, based on its known effects on mood and anxiety rather than on specific anti-addiction properties.
Unlike prescription smoking cessation medications that directly target nicotine receptors (like varenicline) or specific neurotransmitter systems (like bupropion), St. John's Wort's potential benefit is more likely to be as a supportive therapy, helping to manage the psychological aspects of withdrawal rather than directly addressing the physical addiction to nicotine.
Effectiveness for Smoking Cessation
When evaluating St. John's Wort for smoking cessation, it's essential to distinguish between direct evidence for quitting smoking and evidence for managing symptoms that may support quit attempts.
Research Evidence
The scientific research on St. John's Wort specifically for smoking cessation is limited:
- Limited direct studies: Few clinical trials have directly examined St. John's Wort for smoking cessation
- Small pilot studies: Some small studies suggest modest benefits in reducing nicotine cravings and withdrawal symptoms
- Depression research: Extensive research supports its effectiveness for mild to moderate depression, which is relevant to smoking cessation
- Quality of evidence: The methodological quality of smoking-specific studies is generally low to moderate
Effectiveness for Related Symptoms
St. John's Wort has stronger evidence for conditions that often accompany smoking cessation:
| Condition | Level of Evidence | Relevance to Smoking Cessation |
|---|---|---|
| Mild to Moderate Depression | Strong | Depression often occurs during nicotine withdrawal and can trigger relapse |
| Anxiety | Moderate | Anxiety is a common withdrawal symptom that can lead to smoking |
| Sleep Disturbances | Limited | Sleep problems during withdrawal can increase irritability and cravings |
| Stress Reduction | Limited | Stress is a major trigger for smoking and relapse |
Comparison with Other Cessation Methods
How does St. John's Wort compare to other smoking cessation approaches?
| Method | Effectiveness for Quitting | Quality of Evidence |
|---|---|---|
| St. John's Wort | Low to Moderate | Limited |
| Prescription Medications (Varenicline, Bupropion) | High | Strong |
| Nicotine Replacement Therapy | Moderate to High | Strong |
| Other Herbal Supplements | Low | Limited |
Potential Role in Smoking Cessation
Based on current evidence, St. John's Wort may be most appropriate as:
- A complementary approach: Used alongside evidence-based cessation methods
- Support for mood symptoms: Particularly for those experiencing depression during quit attempts
- An alternative option: For those who cannot or prefer not to use prescription medications
- Part of a holistic approach: Combined with behavioral support and lifestyle changes
While St. John's Wort shows promise for supporting the psychological aspects of smoking cessation, it should not be considered a primary treatment. The strongest evidence-based approaches remain prescription medications, nicotine replacement therapy, and behavioral counseling. However, for individuals with mild depression during quit attempts who prefer natural approaches, St. John's Wort may be a reasonable supportive option when used under appropriate medical guidance.
Side Effects & Safety
While St. John's Wort is generally well-tolerated by many people, it can cause side effects and has significant safety considerations, particularly regarding drug interactions.
Common Side Effects
The following side effects occur in approximately 1-5% of users:
- Gastrointestinal symptoms: Upset stomach, nausea, diarrhea, constipation
- Skin reactions: Photosensitivity (increased sensitivity to sunlight), rash, itching
- Neurological effects: Dizziness, headache, restlessness, fatigue
- Sleep disturbances: Insomnia or vivid dreams
- Dry mouth: Reduced saliva production
Serious Side Effects
Though rare, more serious side effects can occur:
- Serotonin syndrome: Particularly when combined with other serotonergic medications
- Hypomania or mania: In individuals with bipolar disorder or predisposition to these conditions
- Severe photosensitivity reactions: Especially in fair-skinned individuals with high sun exposure
- Allergic reactions: Including skin rash, hives, or in rare cases, anaphylaxis
Critical Drug Interactions
St. John's Wort is known for its numerous and potentially serious drug interactions. It induces cytochrome P450 enzymes in the liver, which can significantly affect the metabolism of many medications.
Do not use St. John's Wort if you are taking:
- Antidepressants: SSRIs, SNRIs, MAOIs, tricyclics (risk of serotonin syndrome)
- Immunosuppressants: Cyclosporine, tacrolimus (reduced effectiveness)
- Anticoagulants: Warfarin (reduced effectiveness)
- Hormonal contraceptives: Birth control pills, patches, rings (reduced effectiveness, risk of unplanned pregnancy)
- Antiretrovirals: HIV medications (reduced effectiveness)
- Anticancer medications: Many chemotherapy drugs (reduced effectiveness)
- Antiepileptics: Seizure medications (reduced effectiveness)
- Digoxin: Heart medication (reduced blood levels)
- Statins: Cholesterol-lowering medications (reduced effectiveness)
Who Should Not Use St. John's Wort
St. John's Wort is contraindicated for:
- Individuals taking medications that interact with St. John's Wort
- People with bipolar disorder (may trigger manic episodes)
- Those with schizophrenia or other psychotic disorders
- Pregnant or breastfeeding women (insufficient safety data)
- People scheduled for surgery (may interact with anesthesia)
- Individuals with severe depression or suicidal thoughts
- Those with known allergies to plants in the Hypericaceae family
Special Considerations for Smoking Cessation
When using St. John's Wort specifically for smoking cessation:
- Interaction with cessation medications: May reduce the effectiveness of bupropion (Zyban)
- Photosensitivity: Smokers quitting often spend more time outdoors for exercise, increasing sun exposure risk
- Caffeine sensitivity: Many people increase caffeine consumption when quitting smoking; St. John's Wort may affect caffeine metabolism
- Alcohol interactions: May increase sedation when combined with alcohol, which some people use more during quit attempts
Quality and Standardization
As a dietary supplement, St. John's Wort products are not strictly regulated for quality or potency in the United States. Products can vary significantly in their content of active compounds. Look for products standardized to contain 0.3% hypericin or 3-5% hyperforin, and choose reputable brands that undergo third-party testing.
Given these considerations, it's essential to consult with a healthcare provider before using St. John's Wort, especially if you're taking other medications or have existing health conditions. The potential benefits should be carefully weighed against the risks of side effects and drug interactions.
Pros & Cons of St. John's Wort
Pros
- May help with depression and anxiety during nicotine withdrawal
- Generally well-tolerated by most people
- Long history of traditional use
- Available without prescription
- Relatively affordable compared to prescription medications
- Multiple forms available (capsules, tea, tincture)
- Some scientific evidence for mood regulation
Cons
- Limited specific research for smoking cessation
- Interacts with many medications including birth control and blood thinners
- May cause photosensitivity (increased sensitivity to sunlight)
- Effects may take 2-4 weeks to develop
- Quality and potency can vary between brands
- Not FDA-approved for any medical condition
- May cause side effects like digestive issues and headaches
St. John's Wort offers potential benefits for mood support during smoking cessation, but its significant drug interactions and limited specific evidence for quitting smoking are important limitations to consider. It may be most appropriate for individuals with mild depression symptoms during quit attempts who are not taking other medications and prefer natural approaches.
How to Use St. John's Wort
If you're considering using St. John's Wort to support your smoking cessation efforts, here's guidance on proper usage, dosage, and timing.
Forms and Preparations
St. John's Wort is available in several forms, each with different considerations:
| Form | Advantages | Disadvantages | Best For |
|---|---|---|---|
| Standardized Capsules/Tablets | Consistent dosage, most studied form | Less flexibility in dosing | Most users, especially beginners |
| Liquid Extract/Tincture | Faster absorption, adjustable dosing | Strong taste, contains alcohol | Those who need flexible dosing |
| Tea | Ritual aspect, may replace smoking ritual | Variable potency, less concentrated | Mild support, ritual replacement |
| Topical Preparations | Few systemic side effects | Not effective for mood or cessation | Not recommended for cessation |
Recommended Dosage
For supporting smoking cessation and mood:
- Standardized extract: 300mg (standardized to 0.3% hypericin) three times daily
- Liquid extract (1:1): 2-4mL three times daily
- Tea: 1-2 teaspoons of dried herb steeped in 8oz hot water for 5-10 minutes, three times daily
Note: Start with a lower dose and gradually increase to the recommended amount over 1-2 weeks to minimize side effects.
Timing and Duration
- When to start: Ideally 2-4 weeks before your quit date, as St. John's Wort typically takes this long to reach full effectiveness for mood support
- Time of day: Divide doses throughout the day (morning, afternoon, evening) for more consistent effects
- With food: Take with meals to reduce gastrointestinal side effects
- Duration: Typically used for 8-12 weeks during the quit attempt and early maintenance phase
- Discontinuation: Gradually taper off over 1-2 weeks rather than stopping abruptly
Important Usage Tips
- Consult a healthcare provider: Before starting St. John's Wort, especially if you take other medications
- Sun protection: Use sunscreen and protective clothing due to increased photosensitivity
- Consistent brand: Stick with the same brand throughout your treatment to ensure consistent potency
- Medication check: Review all medications with a pharmacist for potential interactions
- Monitor effects: Keep track of mood changes, side effects, and cravings to assess effectiveness
- Complementary approach: Use alongside evidence-based cessation methods rather than as a standalone treatment
Remember that St. John's Wort is not a quick fix for nicotine addiction. It works best as part of a comprehensive quit plan that includes behavioral strategies, social support, and possibly other cessation aids. The herb's primary benefit is likely to be in managing mood symptoms during withdrawal rather than directly reducing nicotine cravings.
User Experiences & Testimonials
While scientific studies provide important data, personal experiences can offer valuable insights into how St. John's Wort may help with smoking cessation. Here are some representative testimonials from users who have tried this supplement during their quit attempts.
Michael T.
"I tried quitting cold turkey several times and always got hit with depression around day 3 or 4, which sent me back to cigarettes. My therapist suggested St. John's Wort to help with the mood issues. I started taking it two weeks before my quit date, and while I still had cravings, the depression was much more manageable. It didn't eliminate withdrawal symptoms, but it made them bearable enough that I could stick with my quit plan. I'm now 6 months smoke-free."
Sarah K.
"I used St. John's Wort tea as part of my quit plan, mainly as a replacement ritual for smoking. The act of brewing and drinking the tea gave me something to do with my hands and mouth. I can't say for sure if the herb itself helped chemically, but the ritual aspect was valuable. I did notice I was less anxious overall, though I was also doing meditation and exercise. The tea has a pleasant, slightly bitter taste that I came to enjoy."
David L.
"After trying prescription medications with severe side effects, I wanted something gentler. I used St. John's Wort alongside nicotine patches. The combination worked well for me - the patches handled the physical addiction while the St. John's Wort seemed to help with the irritability and low mood I experienced in previous quit attempts. I did experience some increased sensitivity to sun, so I had to be careful about sunscreen. Overall, it was a positive experience and I've been smoke-free for over a year now."
Jennifer M.
"I had high hopes for St. John's Wort based on reviews, but my experience wasn't great. It did seem to help a bit with my mood, but I experienced digestive issues and headaches. The biggest problem was that it interfered with my birth control pills, which my doctor hadn't warned me about. I had to stop taking it and switch to a different approach. I eventually quit smoking using behavioral therapy and nicotine gum, but St. John's Wort wasn't right for me."
Patterns in User Experiences
Based on collected testimonials and reviews, several patterns emerge:
- Most effective for mood symptoms: Users consistently report better results for mood management than for physical cravings
- Complementary approach: Many successful users combine St. John's Wort with other cessation methods
- Variable results: Effectiveness varies significantly between individuals
- Timing matters: Those who start 2-4 weeks before quitting report better results than those who start at their quit date
- Side effects: Photosensitivity and digestive issues are commonly reported
- Ritual value: Some users, especially those using the tea form, value the ritual replacement aspect
These testimonials highlight the varied experiences people have with St. John's Wort during smoking cessation. They underscore that while it may be helpful for some individuals, particularly for managing mood-related withdrawal symptoms, it's not a universal solution and works best as part of a comprehensive quit plan.
Frequently Asked Questions
How long does it take for St. John's Wort to start working for smoking cessation?
St. John's Wort typically takes 2-4 weeks to reach its full effectiveness for mood regulation. For this reason, it's recommended to start taking it several weeks before your planned quit date. The effects build gradually, and some people may not notice significant benefits until after consistent use for a month. This is different from prescription cessation medications like varenicline, which can begin working more quickly.
Can St. John's Wort be used alongside nicotine replacement therapy?
Yes, St. John's Wort can generally be used alongside nicotine replacement therapies (NRT) like patches, gum, or lozenges. There are no known direct interactions between St. John's Wort and nicotine. In fact, this combination may be beneficial, with NRT addressing the physical addiction while St. John's Wort potentially helps with mood-related withdrawal symptoms. However, you should consult with a healthcare provider before combining treatments.
Is St. John's Wort safe to use with prescription cessation medications like Chantix or Zyban?
No, St. John's Wort should not be used alongside prescription smoking cessation medications without medical supervision. It may reduce the effectiveness of bupropion (Zyban/Wellbutrin) through liver enzyme induction. While direct interactions with varenicline (Chantix) are less well-documented, combining multiple treatments that affect brain chemistry could potentially lead to adverse effects. Always consult your doctor before combining any supplements with prescription medications.
What's the difference between using St. John's Wort for smoking cessation versus depression?
The mechanism is similar in both cases, as St. John's Wort affects neurotransmitters like serotonin that influence mood. For smoking cessation, the benefit comes from managing the depression and mood changes that often accompany nicotine withdrawal. The dosage is typically the same for both uses. The key difference is that for smoking cessation, St. John's Wort is used as a supportive therapy rather than a primary treatment, and it's often used for a shorter duration (typically during the withdrawal period) compared to longer-term use for chronic depression.
Will St. John's Wort help with nicotine cravings?
St. John's Wort is not likely to directly reduce nicotine cravings. Its primary benefit in smoking cessation appears to be in managing mood-related withdrawal symptoms like depression, irritability, and anxiety, which can trigger cravings and relapse. For directly addressing nicotine cravings, nicotine replacement therapies or prescription medications specifically designed for smoking cessation are more effective. St. John's Wort works best as part of a comprehensive approach that includes strategies specifically targeting cravings.
Are there any withdrawal symptoms when stopping St. John's Wort?
Some people report mild withdrawal symptoms when stopping St. John's Wort, particularly if they've been taking it for an extended period. These may include temporary mood changes, sleep disturbances, irritability, or fatigue. To minimize these effects, it's recommended to gradually taper the dose over 1-2 weeks rather than stopping abruptly. These withdrawal effects are generally milder than those associated with prescription antidepressants.
How do I choose a high-quality St. John's Wort supplement?
Look for products standardized to contain 0.3% hypericin or 3-5% hyperforin, which are the active compounds. Choose brands that undergo third-party testing and display quality certifications (like USP, NSF, or ConsumerLab). Reputable manufacturers will provide clear information about sourcing, testing, and standardization. Consider products that specify the extraction method and plant parts used. Avoid extremely cheap products, as they may contain lower-quality ingredients or insufficient active compounds. Capsules and tablets typically provide more consistent dosing than teas or unstandardized preparations.
Conclusion & Recommendations
St. John's Wort offers a potential complementary approach for individuals seeking natural support during smoking cessation, particularly for managing the mood-related aspects of nicotine withdrawal. However, it comes with important limitations and considerations.
Summary of Key Points
- Potential benefits: May help manage depression, anxiety, and mood changes during nicotine withdrawal
- Limitations: Limited direct evidence for smoking cessation, significant drug interactions, variable quality of supplements
- Safety profile: Generally well-tolerated but can cause side effects including photosensitivity and digestive issues
- Best use: As a complementary approach alongside evidence-based cessation methods, particularly for those experiencing mood symptoms
- Timing: Most effective when started 2-4 weeks before quit date and continued through the withdrawal period
Who Might Consider St. John's Wort
St. John's Wort may be most appropriate for:
- Individuals who experience depression or significant mood changes during quit attempts
- Those who prefer natural approaches or have had adverse reactions to prescription medications
- People who are not taking medications that interact with St. John's Wort
- Individuals looking for a complementary approach to use alongside behavioral strategies or nicotine replacement
- Those who have experienced mood-related relapse triggers in previous quit attempts
Who Should Avoid St. John's Wort
St. John's Wort is not recommended for:
- People taking medications that interact with St. John's Wort (including many antidepressants, birth control, blood thinners, and others)
- Individuals with bipolar disorder, schizophrenia, or other serious mental health conditions
- Pregnant or breastfeeding women
- Those with severe depression or suicidal thoughts
- People who primarily need help with physical nicotine cravings rather than mood symptoms
- Individuals with a history of photosensitivity or who take medications that increase sun sensitivity
Recommendations for Effective Use
- Consult a healthcare provider before starting St. John's Wort, especially if you take other medications
- Start 2-4 weeks before your quit date to allow the supplement to reach full effectiveness
- Use a standardized product (0.3% hypericin) from a reputable manufacturer
- Combine with evidence-based cessation methods like behavioral counseling or nicotine replacement therapy
- Monitor for side effects, particularly increased sun sensitivity
- Keep expectations realistic - St. John's Wort may help with mood symptoms but is unlikely to eliminate cravings
- Consider a comprehensive quit plan that addresses physical, psychological, and social aspects of smoking
Alternative Approaches
If St. John's Wort isn't suitable for you, consider these alternatives:
- Evidence-based cessation medications: Varenicline (Chantix), bupropion (Zyban), or nicotine replacement therapies
- Other natural approaches: Mindfulness meditation, acupuncture, or exercise for mood management
- Behavioral support: Counseling, support groups, or quit-smoking apps
- Other herbs: Though evidence is limited, some people report benefits from rhodiola, ashwagandha, or valerian for stress and anxiety during cessation
In conclusion, St. John's Wort represents one option in the toolkit for smoking cessation, with specific benefits for mood-related withdrawal symptoms. While not a standalone solution for quitting smoking, it may provide valuable support for some individuals when used appropriately as part of a comprehensive quit plan. As with any supplement, individual responses vary, and consultation with healthcare providers is essential, particularly given St. John's Wort's significant interaction profile.
Disclaimer: This review is for informational purposes only and does not constitute medical advice. Always consult with a healthcare provider before starting any supplement or smoking cessation program. St. John's Wort can interact with many medications and may not be suitable for everyone.