St. John's Wort contains hypericin that inhibits monoamine oxidase, a bodily chemical associated with depression. It appears that hypericin does not act alone. Like many herbal medicines, St. John's Wort relies on the complex interplay of many constituents for its antidepressant actions. Patients suffering from depression received relief, increased appetite, more interest in life, greater self-esteem and restoration of normal sleeping patterns. Plant Description St. John's wort is a shrubby plant with clusters of yellow flowers that have oval, elongate petals. The plant gets its name because it is often in full bloom around June 24, the day traditionally celebrated as the birthday of John the Baptist. Both the flowers and leaves are used for medicinal purposes. Available Forms St. John's wort can be obtained in many forms: capsules, tablets, tinctures, teas, and oil-based skin lotions. Chopped or powdered forms of the dried herb are also available. St. John's wort products should be standardized to contain 0.3% hypericin. Adult Dry herb (in capsules or tablets): The usual dose for mild depression and mood disorders is 300 to 500 mg (standardized to 0.3% hypericin extract), three times per day, with meals. Liquid extract (1:1): 40 to 60 drops, two times per day. Tea: Pour one cup of boiling water over 1 to 2 tsp of dried St. John's wort and steep for 10 minutes. Drink up to 2 cups per day for four to six weeks. Oil or cream: To treat inflammation, as in wounds, burns or hemorrhoids, an oil-based preparation of St. John's wort can be applied topically. Internal dosages generally require at least eight weeks to get the full therapeutic effect     Potential side effects from St. John's wort are generally mild. They include stomach upset, hives or other skin rash, fatigue, restlessness, headache, dry mouth, and feelings of dizziness or mental confusion. Although not common, St. John's wort can also make the skin overly sensitive to sunlight (called photodermatitis). Those with light skin who are taking St. John's wort in large doses or over a long period of time should be particularly careful about sun exposure. The use of sunscreen with a skin protection factor (SPF) of at least 15, and the avoidance of sunlamps, tanning booths, or tanning beds is recommended while taking St. John's wort. Because of the potential for serious interaction with medications used during surgery, patients should discontinue the use of St. John's wort at least 5 days prior to surgery and should avoid taking it post surgery. See Possible Interactions for more information about mixing St. John's wort and medications. St. John's wort should not be taken by women who are pregnant, trying to become pregnant, or breastfeeding. Possible Interactions St. John's wort interacts with a range of medications. In most cases, this interactions leads to reduced the effectiveness of the medication in question; in other cases, however, St. John's wort may increase the effects of a medication. If you are currently being treated with any of the following medications, you should not use St. John's wort without first talking to your healthcare provider: Antidepressants St. John's wort may interact with antidepressant medications that are used to treat depression or other mood disorders, including tricyclics, SSRIs (see earlier discussion), and monoamine oxidase inhibitors (MAOIs) such as phenelzine. How St. John's wort works is not entirely clear, but is believed to be similar to how SSRIs work. Therefore, using St. John's wort with this class of antidepressants in particular can lead to exacerbation of side effects including headache, dizziness, nausea, agitation, anxiety, lethargy, and lack of coherence. Digoxin St. John's wort should not be taken by those on digoxin because the herb may decrease levels of the medication and reduce its effectiveness. Immunosuppressive medications St. John's wort should not be taken by those on immunosuppressive medications such as cyclosporine because it may reduce the effectiveness of these medications. In fact, there have been many reports of cyclosporin blood levels dropping in those with a heart or kidney transplant, even leading to rejection of the transplanted organ. Indinavir and other protease inhibitors The Food and Drug Administration (FDA) issued a public health advisory in February 2000 concerning the probable interaction between indinavir and St. John's wort that resulted in significantly decreased blood levels of this protease inhibitor, a class of medications used to treat HIV or AIDS. The FDA recommends that St. John's wort not be used with any type of antiretroviral medication used to treat HIV or AIDS. Loperamide There has been a report of a possible interaction between St. John's wort and the antidiarrheal medication, loperamide leading to delirium in an otherwise healthy woman. Oral contraceptives There have been reports of breakthough bleeding in women on birth control pills who were also taking St. John's wort. Reserpine Based on animal studies, St. John's wort may interfere with the intended action of this medication used to treat high blood pressure. Theophylline St. John's wort can reduce levels of this medication in the blood leading. Theophylline is used to open the airways in those suffering from asthma, emphysema, or chronic bronchitis. Warfarin St. John's wort interferes with the anticoagulant medication, warfarin, by reducing blood levels as well as the effectiveness. This leads to the need to for adjustments in doses of this medication.