Zoe Dubno did not expect her life to unravel. It was on a whim that the writer began taking St. John’s wort, an over-the-counter herbal supplement marketed as a gentle alternative to antidepressants. Trusting its natural origins, she started dosing herself twice daily without consulting a doctor. Four months later, the calm she sought gave way to chaos: sudden fainting spells, spiraling paranoia, and panic attacks so severe she feared she was losing her mind.1

Dubno’s experience encapsulates the societal and scientific fascination that surrounds St. John’s wort. On anonymous forums such as Reddit and Quora, some describe the supplement working wonders, while others warn of troubling side effects.2 Similarly, though some double-blind clinical trials have documented its successful depression treatment, others have found that the plant adds to mental health challenges.3 The plant’s controversial curative powers operate at the crux between traditional cures, health fads, and scientific approaches to treating depression. The history of St. John’s wort is inseparable from the transforming norms and knowledge of Western medicine, from its use as a repellent for evil spirits and treatment for melancholia to its invasion of California and current classification in the homeopathic section of the pharmacy.

The Devil’s Scourge

St. John’s wort (Hypericum perforatum L.) is an unassuming plant with the supposed power to fight demons. A native of Europe, western Asia, and northern Africa, St. John’s wort stands 1-3 feet off the ground, with five-petaled yellow flowers arriving at the end of June.4 Its leaves and petals, which appear perforated, have translucent oil glands that release bright red pigment when squeezed.5 The plant’s flowering tops and leaves contain high concentrations of hypericin and hyperforin — chemicals linked to its therapeutic properties. Once used to banish evil spirits, the plant was known in ancient Greece as “hypericum.”6

In the medieval period, hypericum’s bloom coincided with midsummer festivals, the time when evil spirits were considered most active. The plant played a critical role in these festivals as a means to ward off spirits and was sometimes even referred to as Fuga daemonum, a Latin phrase for “the devil’s scourge.”7 It was commonly burned in bonfires, placed over doors, kept beneath one’s pillow, or hung in wreaths around villages on the festival’s eve to drive out demons. Households hung the wort from their rafters to predict who would die soonest, and in Saxony, young women placed it above their beds to determine when they’d marry. Wrote one anonymous poet: “I must gather the mystic St. John’s-wort to-night; / The wonderful herb, whose leaf will decide / If the coming year shall make me a bride!”8 Later, Christianity integrated many of these pagan traditions into the feast of the Nativity of Saint John the Baptist.9 The plant’s red pigment became associated with the blood spilled at the saint’s beheading and led to hypericum’s more familiar name: St. John’s wort.10

Evolution of Psychiatric Medicine

Instead of seeing illness as caused by supernatural phenomena, ancient Greek physicians relied on physical observation of concrete symptoms. Following Hippocrates, a doctor and philosopher from the fifth century BCE, they understood health and disease in terms of humoral theory, based on four “cardinal humors” — blood, phlegm, yellow bile, and black bile — whose imbalances allegedly cause all maladies.11 Physicians used techniques such as bloodletting or laxatives to correct excessive humors, or by making changes in the patient’s diet.

Galen, a doctor in the second century CE who was a famous proponent of herbal remedies, was another herbal theorist. He associated each humor with a particular temperament, identifying the excess of black bile as a cause of melancholy.12 Thanks largely to Galen’s extensive writing on the subject, humoral theory spread across Europe and subsequently scaffolded centuries of Western medicine. Despite its later popularity as an antidepressant, St. John’s wort was not associated with the treatment of melancholy at that time; instead, physicians seemed to believe that the plant could expel excess yellow bile.13 It was thus used to treat nerve pain, to stimulate menstrual flow and after-birth, and as a salve for burns, spasms, and tetanus. Its mood boosting qualities would not be recognized for more than a millennium.

The first recorded use of St. John’s wort to treat depression comes from the sixteenth century and is associated with Paracelsus, a Swiss physician who renounced humoral theory and promoted alchemical cures.14 Other authors, including those who continued to support Galenic views, followed suit. London apothecary Nicholas Culpeper wrote in 1649 that a paste made from St. John’s wort was an “admirable remedy for melancholy.”15 This use of the plant reflected the broader evolving ideas about melancholy and humoral theory. In 1621, another Englishman, Robert Burton, published The Anatomy of Melancholy, an erudite treatise on depression that put forward a more nuanced understanding of how the imbalance among various humors (not just the excess of black bile) can produce mental illness. Burton suggested that melancholy was a part of normal life experience and identified a wide variety of possible symptoms, underscoring the complexity of mental illness which today can be captured by dozens of separate diagnoses.16 “Now go and brag of thy present happiness,” Burton told his reader, “thou seest in what a brittle state thou art, how soon thou mayest be dejected.”

This view of melancholy as part of the human experience, and St. John’s wort’s role as its potential treatment, lasted into the Victorian era, as evidenced by an 1852 poem by Alfred Lear Huxford:

“So then about her brow They bound Hypericum, whose potent leaves Have sovereign power o’er all the sullen fits And cheerless fancies that besiege the mind; Banishing ever, to their native night, Dark thoughts, and causing to spring up within The heart distress’d, a glow of gladdening hope, And rainbow visions of kind destiny.”17

Taking Root Across America

Although native to Europe, Western Asia, and North Africa, St. John’s wort has naturalized itself in the Americas.18 It is possible that the plant first arrived with the proponents of a doomsday cult who disembarked in Philadelphia on Midsummer’s Eve in 1694, carrying herbs to cultivate as they awaited the world’s end.19 The first documented record of St. John’s wort in North America, however, came from a German missionary in 1793 Philadelphia, and the plant soon gained a reputation as a “pernicious weed.”20 The plant spread westward with Oregon Trail pioneers, gaining the nickname “Klamath weed” when it began growing on the banks of California’s Klamath River. By 1945, St. John’s wort had claimed some 2.5 million acres of California alone, choking out native plants.21 Agricultural research suggests that the plant had “replaced most of the herbaceous plant cover” in certain areas, causing “enormous losses in grazing capacity.”22

The plant’s abundance on grazing land was especially problematic due to its toxicity to cattle. When sheep, cows, and horses consume it in large quantities, they develop painful facial sores and scabs. The plant causes extreme light sensitivity in livestock, and eventually, the poisoned animals could die. St. John’s wort was described as “the cause of the heaviest financial losses found on pasture and range lands of California.”23

To counter these issues, in 1944, the U.S. government imported two species of beetle that feed on St. John’s wort. Beginning with nine sites in California, tens of thousands of these insects were released, successfully reducing the presence of St. John’s wort in the state to one percent of its previous spread.24 Humboldt County — which includes about 60 miles of the Klamath River and was the site of the largest release of beetles — dedicated a monument to the “Klamath weed beetle” in 1958.25 Now, St. John’s wort is successfully contained to localized patches.

The Little Beetle that KO’d Klamath Weed, University of California Agricultural Extension Service, Rohner Park, Fortuna, California, July 12, 1958.

From Petals to Prescriptions

With the rise of germ theory and anatomical pathology, once-prominent narratives about why St. John’s wort was effective no longer held medical significance. As humoral theory gradually fell out of favor, modernized physicians criticized “quack” traditional herbalists for their imprecise preparations, impure ingredients, and outdated conceptions of health and disease.26 They scorned herbal remedies as make-believe drugs.27 Becoming a doctor, however, required university training and certification, raising the cost of treatment. As a result, poor families and rural communities still relied on the traditional methods and cures that they could readily access. The 1858 Medical Act in Britain further separated these professions, establishing a legally unified medical profession that excluded herbalist practice.28

Chemically-produced pharmaceuticals were becoming the standard treatment in medicine in the second half of the 19th century. Synthetic drugs were developed and refined, undergoing extensive trials for safety and effectiveness. In the United States, the Food and Drug Administration, founded in 1906, monitored this process, usually removing herbal remedies from medical spaces. In 1994, the FDA legalized the sale of herbal remedies on pharmacy shelves as “dietary supplements,” so long as their packaging did not “diagnose, mitigate, treat, cure, or prevent a specific disease or class of diseases.”29 For St. John’s wort, this requirement meant that it could only be advertised as a positive mood supplement, not a depression cure. Under the FDA rules, such dietary supplements are not required to specify a safe dosage or demonstrate their safety and efficacy prior to sale, providing unregulated access to such remedies, unlike doctor-approved medication.30

In some places such as Germany, however, the connection to herbal medicine was not entirely lost.31 When, in 1984, the German Federal Health Agency included St. John’s wort in a report of local herbal remedies, it considered the plant safe and effective.32 This endorsement caught the attention of physicians, sparking a flurry of German trials, which produced the first empirical evidence that the plant could improve the symptoms of those with mild to moderate depression. A pharmaceutical company Lichtwer Pharma introduced a high strength pill, much more convenient to use than infusion or oil.33 This further boosted the popularity of the supplement. German doctors began prescribing St. John’s wort in earnest, distributing some 130 million prescriptions annually.34 The hype reached the English-speaking world when the British Medical Journal compiled a 1996 meta-analysis of twenty-three German trials of St. John’s wort.35

Hypericum Goes Mainstream

Although many scientists and doctors in the U.S. warned that the initial German studies of St. John’s wort did not meet the FDA’s standards for approved medications, public interest spread faster than the appropriate trials could be conducted.36 Between 1996 and 1999, nearly a dozen books were published that championed the plant and provided evidence of patients cured by St. John’s wort. These publications encouraged readers to talk to their doctor before taking the supplement; however, many of them also included guidance for seeking out new doctors who may support alternative remedies, instructions for self-medication, and even advice for growing St. John’s wort.37

News outlets both captured and advanced the growing interest in St. John’s wort. After its effects were highlighted in an episode of the ABC show 20/20, the market for the supplement blossomed overnight.38 “Suddenly, St. John’s wort is hot,” reported TIME magazine in 1997.39 “The cult of St. John’s wort just keeps winning converts,” chimed in the first line of a New York Times article.40 Armed with such newspaper cutouts and booming pro-supplement books, Americans purchased St. John’s wort en masse, with its annual U.S. sales peaking at $315 million in the course of a single year.41 In 1998, the plant was the second highest selling herbal product in the mass market and had the fastest growth rate.42 “This thing has caught us so fast that we’re scrambling to catch up,” Bob Bidlingmeye, vice president of the U.S. branch of Lichtwer Pharma, told The Washington Post.43

Public Appeal

One reason the supplement gained so much momentum was its perceived absence of side effects compared to synthetic antidepressants such as Prozac. Treating depression can be a daunting challenge. Antidepressants are notorious for causing side effects such as weight gain, nausea, insomnia, dry mouth, and sexual dysfunction, so patients with mild or moderate depression symptoms sometimes decided against such treatments.44 St. John’s wort attracted those who had suffered from such synthetic treatments and became a symbol of mental health returning to the control, and judgment, of the individual. Although the form of the plant itself faded into obscurity, its existence as a supplement became its own cultural phenomenon thanks to the pill’s heavily marketed “natural” association.

The pharmacological effects of *Hypericum perforatum* in '*Hypericum perforatum*: Traditional uses, clinical trials, and drug interactions'. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC9526892/.

As a result, St. John’s wort became not only a treatment for diagnosed depression, but rather a supplement for anything that ranged from the death of a loved one to a stressful situation at work.45 As one of the plant’s most vocal advocates, Norman Rosenthal, put it, “if, after reflection, you feel that you are not clinically depressed, but simply overstressed or mildly down in the dumps, you may also benefit from a trial of St. John’s wort.”46

Rise is cases of depression, by socio-demographic index regions, from 1990 to 2017. From 'Changes in the global burden of depression from 1990 to 2017: Findings from the Global Burden of Disease study' by Qingqing Liu et al. Retrieved from https://www.sciencedirect.com/science/article/pii/S0022395619307381?via%3Dihub.
Rise is cases of depression, by socio-demographic index regions, from 1990 to 2017. From 'Changes in the global burden of depression from 1990 to 2017: Findings from the Global Burden of Disease study' by Qingqing Liu et al. Retrieved from https://www.sciencedirect.com/science/article/pii/S0022395619307381?via%3Dihub.

Rather than remaining a purely medical cure, St. John’s wort became an attractive choice for proponents of an alternative lifestyle, resonating with a “natural health” movement that swept the American middle-class. Organic foods, yoga, and connection to nature were fashionable, and alternative medicines were increasingly seen as a way of opposing the greed of pharmaceutical companies.47 “Natural health” treatments found their champions on cable television programs, billboards, and even daytime talk shows. Herbal remedies were suddenly back in vogue, and St. John’s wort stood to benefit. “Now, for the first time, the worlds of conventional medicine and alternative healing have at last come together to embrace St. John’s wort’s exceptional powers,” wrote Rosenthal in 1996.48 The plant’s enthusiasts were confident that owing to its natural healing qualities, it “beats Prozac hands down.”49

Too Good to Be True?

The first blow to the plant’s credibility came in 2001, when physician-scientist Richard Shelton conducted research that compared Lichtwer Pharma’s 300mg St. John’s wort tablet against a placebo, concluding that the supplement was not effective for treating patients with clinical major depression.50 Shelton’s study was met with suspicion from many members of the scientific community because of a potential conflict of interest, since Pfizer, the company that sells the prescription antidepressant Zoloft, was involved in its funding and design.51 Still, this new research created fissures in the medical support for the plant, especially when a year later, a larger NIH-funded trial led by Jonathan Davidson found a “complete absence of trends suggestive of efficacy” for the same Lichtwer extract of St. John’s wort.52

Supplement supporters pounced on Davidson. Because his study had screened participants for moderately severe depression, detractors argued that it “misled the public” by publishing results that did not reflect the supplement’s effectiveness in treating mild symptoms.53 The study’s credibility was also called into question because its positive control, a proven antidepressant, had not been more effective than the placebo. Still, the damage was significant. “America has not been kind to St. John’s Wort,” wrote the author of one editorial.54 By 2006, annual sales of St. John’s wort had dropped by over 80% to around $60 million.55 Physicians lost interest in prescribing the supplement, even after subsequent studies partially reaffirmed its effectiveness for treating mild depression and sadness.

In subsequent years, scientists uncovered an even larger problem with St. John’s wort: drug interactions. The active chemical hyperforin negatively impacts the work of many prescription drugs, making medications such as birth control, immunosuppressants, anti-HIV, and anti-cancer drugs less effective.56 If combined with other depression medications, it can block their functionality, which can even lead to a lethal build-up of serotonin. Moreover, a series of recent cases demonstrate that St. John’s wort can be particularly hazardous to those with other psychiatric disorders. For someone with psychosis, schizophrenia, or bipolar disorder, the supplement might trigger delusions and hallucinations.57 The danger of the supplements’ side effects — or at least of its mythical renown — came to public attention with the case of Charlene Dorcy, who had been taking an anti-psychotic for schizophrenia but decided to switch to St. John’s wort, unaware that the herb was known to exacerbate psychosis. As no doctor oversaw these treatment changes, Dorcy began behaving erratically, and, on the morning of June 12, 2004, she shot and killed her two daughters.[^58]

A Modern Lens

Despite scientists’ concerns about St. John’s wort, its cultural presence as a natural, side-effect-free mood supplement has led to its continued popularity. Though Zoe Dubno did not believe she had clinical depression and saw her reoccurring bad moods as a combination of personality traits, bad weather, and a frustrating job, she “just wanted to be in a positive mood all the time.”[^59] Although a therapist confirmed that she was not depressed, Dubno still decided to give St. John’s wort a try. While St. John’s wort might be valuable for addressing long-term dejection that may not be captured by diagnosis criteria, it may also be an appealing way to avoid uncomfortable emotions. That the plant is evoked as a “mood booster” on a pharmacy shelf suggests escapism rather than facing the challenge of lifestyle changes and self-discovery. St. John’s wort in its modern supplement form blurs the distinction between pathology and naturally occurring sadness.

“I figured the supplements could only help. And if they did nothing, then I’d at least enjoy the positive placebo effect of participating in self-care,” Dubno wrote.50 Misguided reasons for believing St. John’s wort is safe — that it is natural, sold over the counter, or just another pseudoscientific supplement — increases the likelihood of irresponsible self-administration, such as Dubno’s choice to abruptly stop taking St. John’s wort instead of weaning as one would with an antidepressant. Moreover, because Dubno didn’t recognize the potential danger, and because she presumed medical professionals just held bias against the use of supplements, failing to acknowledge the connection between her symptoms and the supplement delayed effective treatment.51

In summary, despite their popular appeal, such unregulated substances can ultimately prove dangerous. As recently as 2025, the United States Secretary of Health and Human Services Robert F. Kennedy Jr. has argued against the “aggressive suppression” of the 1994 FDA law that authorized such controversial cures as dietary supplements, encouraging their manufacturers to make bolder claims about the effectiveness of these drugs to receive government subsidies.52 Yet for supplements such as St. John’s wort, which can lead to extreme mental and physical effects if improperly administered, less regulation can only increase potential risks for people in search of mental support. By contrast, standardized dosages across brands and mandatory warning labels listing drug interactions could go a long way toward improving the supplement’s safety.53

The use of herbal medicines is complicated by their chemical effects and nuanced cultural history. St. John’s wort epitomizes what has been lost in the schism between traditional and contemporary medicine: its benefits are not fully utilized, while its dangers go unacknowledged. Medicine is historically rooted in plants as materia medica, and severing today’s treatments from traditional medicine means rejecting thousands of years of traditional knowledge. The effectiveness of St. John’s wort is only known due to its pagan significance, and although doctors no longer treat evil spirits, they rely on the curative discoveries of historical rituals and folklore. Still, for the treatment of patients suffering from depression, modern scientific standards are unquestionably necessary.54 Despite its “natural” properties compared to synthetic drugs, St. John’s wort should be held to the same standard of treatment and be recognized for its legitimate biological impacts. The history of the plant suggests that safe and effective mental health treatments will have to come from a close dialogue between traditional wisdom and laboratory expertise — and between medical agency and institutional regulation.55

  1. Zoe Dubno, “Supplements Made Me Lose My Mind,” The Cut, May 15, 2025. https://www.thecut.com/article/supplements-made-me-lose-my-mind.html. ↩︎

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