Name: Hypericum perforatum , St. John’s wort
Active ingredients: Hypericin, Hyperforin
Number of scientific references: 42
Level of Evidence: Level I What is this?
Note: St. John’s wort helps in alcoholism by reducing alcohol intake. It regulates brain chemistry to reduce dependence on alcohol and can help minimise alcohol withdrawal symptoms. It seems to be a potential add-on therapy for alcohol addiction, but this is yet to be confirmed by human studies. Many studies have noted drug interactions with the herb; please consult a health practitioner before using St. John’s wort.
Alcohol dependence is a complex condition that involves neurochemistry, personality traits and even genetics. Social stigma, personal perceptions and lack of literacy regarding alcohol use and dependence impose treatment barriers.
Serotonin, dopamine and GABA (gamma-aminobutyric acid) are few of the neurotransmitters that regulate our mood and choices; dysregulation of these chemicals are observed in alcohol use disorder.
Researchers are investigating the use of antidepressants for mitigating alcohol withdrawal symptoms, reducing alcohol dependence and treating comorbid depression. There have been reports of successfully treating alcohol withdrawal associated insomnia with second-generation antidepressants.
Use of antidepressants seem to be an emerging treatment for alcoholism, but their efficacy is yet to be corroborated by adequate research data.
A herb that has already attracted researcher’s attention when it comes to treating depression and is now being investigated as a potential therapy for alcohol addiction is St. John’s wort.
St. John’s wort helps in alcoholism by reducing alcohol intake and lowering the motivation to consume alcohol (as evidenced by animal studies). It regulates our brain chemistry to relieve alcohol dependence and withdrawal symptoms. But these findings are yet to be proven in human studies.
Suggested St. John’s Wort Supplements For Peripheral Neuropathy
Please consult a health practitioner before taking any health supplements. St. John’s wort interacts with many drugs, please use with caution.
St. John’s wort supplements contain extracts from flower, leaf and stem. These are standardised to contain 0.3% hypericin.
WS 5570 is a patented extract of St. John’s wort that is standardized to 3% hyperforin. It is marketed by Nature’s Way as Perika St. John’s wort.
Please consult a suitable healthcare provider for the dosage.
|Nature’s Way St. John Wort herb||Nature’s Way Perika St. John Wort||Gaia Herbs St. John’s wort|
Image Credit:Nature’s Way
Image Credit:Nature’s Way
Image Credit: Gaia Herbs
|Contains 700mg St. John’s wort extract (full spectrum)||Contains 300mg St. John’s wort patented extract (WS-5570)||Contains 1350 mg St. John’s wort extract with 2.7mg hypericins (full spectrum)|
|Buy from Amazon||Buy from Amazon||Buy from Amazon|
5 Promising Benefits of St. John’s Wort For Alcoholism
St. John’s wort (Hypericum perforatum) is a leafy herb that is native to Europe but grows in temperate regions of Asia, Africa, America and Australia. It is listed as a noxious weed in some states in the US.
Table of Contents
- 1 Suggested St. John’s Wort Supplements For Peripheral Neuropathy
- 2 5 Promising Benefits of St. John’s Wort For Alcoholism
- 2.1 1.St. John’s wort reduces alcohol intake and alcohol cravings
- 2.2 2.It attenuates alcohol dependence and ameliorates alcohol withdrawal symptoms
- 2.3 3.St. John’s wort can help reduce depressive symptoms coexisting with alcohol abuse disorder
- 2.4 4.It may benefit from alcohol-induced neuropathy
- 2.5 5.St. John’s wort can protect brain health from alcohol toxicity
- 3 Dosage of St. John’s wort For Alcoholism
- 4 Precautions with St. John’s wort Use
- 5 Conclusion
The herb has yellow flowers which when crushed yield a blood red pigment. There are about seven classes of medicinally active compounds in the herb, but the two most important ones are hypericin (a naphthodianthrone) and hyperforin (phloroglucinol).
The herb has multiple pharmacological properties such as antimicrobial, anti-cancer, antidepressant, anti-inflammatory, antioxidant, neuroprotective etc.
Here are a few research-backed ways (animal studies) by which St. John’s wort may help in alcoholism.
1.St. John’s wort reduces alcohol intake and alcohol cravings
In 1999, De Vry and colleagues evaluated the efficacy of St. John’s wort in comparison to two antidepressants in an animal model of alcoholism.
Since genetic factors play an important role in alcohol dependence, the study involved ‘genetically selected alcohol-preferring rats’.
It was observed that the herb extract, imipramine and fluoxetine dose-dependently reduced alcohol intake. Both the herb and fluoxetine were equally effective in reducing alcohol intake and in creating an aversion to alcohol.
They concluded that Remotiv (Ze 117, a patented extract of St. John’s wort) could be a helpful adjunctive therapy for alcoholism.
Multiple animal studies have confirmed that Hypericum perforatum extracts inhibit alcohol intake. This alcohol intake suppression activity, however, did not suppress food or sugar intake in the studies.
Perfumi et al., via an animal study, demonstrated that St. John’s wort reduces the motivation to consume alcohol. Moderate to high doses of the herb reduced alcohol self-administration and also abolished alcohol intake during withdrawal.
This suggests the potential of the herb to inhibit alcohol cravings and promote sobriety during withdrawal.
Our natural opioid system is actively involved in alcohol dependence, and its dysregulation plays an important role in the disease process.
Opioid antagonists are drugs that bind to opioid receptors but do not activate them. They block their activity. They are prescribed to reduce alcohol dependence and relapse.
St. John’s wort is found to act synergistically with opioid antagonists in reducing alcohol intake in animal models. Combination of a low dose of the herb and naltrexone (opioid antagonist) is found to be more effective than high doses of individual therapeutic agents.
The safety of this combination needs to be validated by human studies.
The herb’s potential to suppress alcohol intake and reduce alcohol cravings is attributed to the hyperforin content rather than hypericin content. An extract rich in hyperforin is found to be more effective than standard extracts.
Quick Gist: Multiple animal studies have confirmed that St. John’s wort extract is effective in reducing alcohol intake, lowering alcohol cravings and in reducing preference and motivation for alcohol.
The hyperforin content of the herb contributes to its therapeutic action in alcoholism. Further research in human studies is warranted.
2.It attenuates alcohol dependence and ameliorates alcohol withdrawal symptoms
The brain’s reward, as well as stress system, are dysregulated during alcohol dependence. Multiple neurotransmitter (chemicals that support brain function) systems are disturbed in this state.
Dopaminergic reward system (regulated by neurotransmitter dopamine) facilitates learning and stimulates self-reinforcement or motivation to repeat activities which in the past felt rewarding or sought pleasure.
This process leads to habit formation which is regulated based on our experiences and behavioural traits. Substances such as alcohol disrupt this dopaminergic reward system as well as other neurotransmitter systems leading to addiction.
St. John’s wort extract is proven to inhibit dopamine reuptake, and researchers hypothesise that this effect may be beneficial in the treatment of addiction.
Inhibiting reuptake of neurotransmitters is a classic mechanism by which antidepressants sort of ‘save’ or ‘prevent depletion’ of our brain chemicals and recycle them to produce better mood and cognition.
When it comes to regulating our brain’s chemistry, St. John’s wort mediates its antidepressant effect partially by affecting serotonin levels. Would it be suppressing alcohol intake by altering serotonin levels?
A study published in Alcohol and Alcoholism, 2008 comparing different serotonergic antidepressants for alcohol withdrawal symptoms reported that fluoxetine and tianeptine might be effective in treating alcohol withdrawal in humans. The third most effective serotonergic antidepressant was Hypericum perforatum.
Further, the researchers commented that apart from affecting the serotonergic system, these therapeutic agents may even affect other neurotransmitter systems such as nitrergic, glutamatergic, and adenosinergic systems.
GABA or gamma-aminobutyric acid is a neurotransmitter, and its receptors (proteins that facilitate GABA’s activity) play an important role in mediating the deleterious effects of alcohol on the central nervous system.
Variations in genes regulating GABA receptors has been associated with increased risk of alcoholism.
Benzodiazepines are prescribed during alcohol withdrawal to assist in detoxification while maintaining GABA function. Certain variations in the receptors may even confer benzodiazepine insensitivity.
Interestingly, results of an animal study showed that ‘alcohol intake reduction’ effect mediated by St. John’s wort is not mediated by altering the GABAergic system alone.
This indicates the possibility of utilising St. John’s wort for treating alcohol dependence in individuals that do not respond to benzodiazepines.
St. John’s wort is proven to inhibit alcohol withdrawal symptoms such as tremors and seizures in an animal model. This needs to be confirmed by adequate human studies.
Quick Gist: St. John’s wort reduces alcohol dependence and alcohol withdrawal symptoms by regulating multiple neurotransmitter systems in the brain. Animal studies suggest that it may be as effective as or even better than some conventional antidepressants in reducing alcohol withdrawal symptoms.
3.St. John’s wort can help reduce depressive symptoms coexisting with alcohol abuse disorder
Depression and related disorders frequently co-occur with alcohol use disorders. Untreated alcoholism increases the risk of depression and suicide and reduces response to conventional treatment.
Antidepressants are used to treat depressive symptoms in patients with alcohol use disorders. Some studies show that treating patients with SSRIs at a dose higher than what is prescribed for depression can help influence drinking pattern positively in addition to reducing depressive symptoms.
St. John’s wort mediates antidepressant effects by regulating various neurotransmitters. A recent review study published in Systematic Reviews, 2016 reported that monotherapy with St. John’s wort is superior to placebo for mild to moderate depression and as effective as conventional antidepressants.
Hypericum perforatum extracts are found to be as effective as and safer than SSRIs in treating mild to moderate depression (Neuropsychiatric Disease and Treatment, 2016)
The herb’s antidepressant effect may be beneficial in reducing depressive symptoms in alcoholism and relieving alcohol withdrawal symptoms.
Quick Gist: St. John’s wort has the natural antidepressant property that may help reduce depressive disorders co-existing with alcohol addiction disorder.
4.It may benefit from alcohol-induced neuropathy
Peripheral neuropathy is a serious complication of alcoholism that can arise due to the toxicity caused by excess alcohol or due to nutritional deficiencies.
Neuropathic pain or nerve pain arising from alcohol-induced neuropathy is one of the most debilitating symptoms of the disorder. It is characterised by numbness, tingling, burning pain, abnormal sensations and pain in response to stimuli that do not cause pain.
St. John’s wort helps in peripheral neuropathy by regulating various brain chemicals that are responsible for pain transmission. Despite the theoretical hypothesis, practical research on this benefit of the herb is limited.
Quick Gist: Serotonin apart from regulating our mood is also involved in pain transmission. The ability of Hypericum perforatum extracts to regulate our brain chemistry may help attenuate neuropathic pain in alcohol-induced neuropathy.
Topical application of St. John’s wort oil may help relieve nerve pain. This ignored potential of the herb is yet to be validated by clinical trials.
5.St. John’s wort can protect brain health from alcohol toxicity
Chronic or binge alcohol consumption causes neurotoxicity or toxicity in the brain and nervous tissue. It initiates inflammation and oxidative stress which leads to neurodegeneration or death of brain cells.
Hypericum perforatum extracts have anti-inflammatory property; they target genes involved in inflammatory pathways to reduce inflammation.
Active compounds present in the herb such as flavonoids, hyperforin and pseudohypericin mediate anti-inflammatory activity.
The herb also possesses neuroprotective (brain protective) property. It inhibits the activity of molecular agents that cause neuronal cell death (neurons are brain cells or cells of the nervous system), reduces the level of harmful reactive oxygen species and promotes survival of neurons.
Thus, add-on therapy with St. John’s wort may support regeneration and recovery of the brain from alcohol abuse.
Quick Gist: St. John’s wort holds therapeutic benefits in alcoholism beyond reducing alcohol intake and alcohol dependence.
Its neuroprotective property may protect brain health from alcohol-induced neurodegeneration and support recovery.
Dosage of St. John’s wort For Alcoholism
St. John’s wort is available in the form of supplements, teas, tinctures and extracts.
There is no specific dosage of St. John’s wort prescribed for alcoholism; human studies are awaited. The recommended dose range of standardised extracts (0.12 to 0.3 hypericin or 2-5% hyperforin) is 300-1200mg per day.
Doses higher than 900 mg may increase susceptibility to photodermatitis.
Please consult your doctor or a herbalist before taking St. John’s Wort supplements.
Precautions with St. John’s wort Use
The most common side effects of St. John’s wort are gastrointestinal symptoms, mouth dryness, confusion, lethargy, restlessness, dizziness and allergic reactions. These events are mild and mostly transient.
Hypericin has a phototoxic effect that may cause photodermatitis when taken at high doses.
As a precaution, individuals should stick to normal doses since they have not been reported to cause phototoxicity under normal settings. Also, adequate care should be taken to protect eyes from excess sunlight when taking the herb.
As a standalone supplement, St. John’s wort is safe, but when taking other medications, there is a risk for potential drug interactions. The herb interacts with multiple drug metabolising enzymes.
Not much is known about the drug interactions between the herb and drugs used to treat alcohol addiction.
Few drugs that Hypericum perforatum may interact with are fexofenadine, digoxin, anti-cancer drugs, warfarin, immunosuppressive agents, ivabradine, oral contraceptives, anti-HIV drugs, anti-fungal agents, antidepressants and other drugs for psychiatric conditions, benzodiazepines etc.
It may also interact with herbs and dietary supplements that have sedative property.
Please consult a health practitioner before taking St. John’s Wort supplements.
In pre-clinical studies, St. John’s wort demonstrates the potential to serve as an add-on therapy for alcoholism. It suppresses alcohol intake and reduces the motivation or craving to consume alcohol.
It regulates brain chemistry to reduce alcohol dependence and can help ameliorate alcohol withdrawal symptoms.
Additionally, it may protect brain health and support its regeneration while recovering from alcohol addiction.
However, there is quite a bit of evidence that suggests that the herb has a strong potential for drug interaction. Further research in the form of human studies must be conducted to ascertain its effectiveness and safety for treating alcohol addiction.
Alcohol addiction and withdrawal, at a biochemical level, is a very complex process. Please consult a health practitioner before taking St. John’s wort supplements for treating alcohol addiction or withdrawal.