Friday, October 28th, 2011

St. John’s Wort for Postpartum Depression While Breastfeeding

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t. John’s Wort is one of the best choices to alleviate feelings of depression using herbs in the treatment of postpartum depression (but not for  severe depression.) There is a lot of conflicting information in general about the safety of herbs and breastfeeding, including St. John’s Wort. From what I can find, there are no large studies on the matter. However there have been several small studies that are very supportive of  St. John’s Wort during nursing.

Here is an excerpt from the article referring to the studies:

…case reports started trickling in from lactation specialists who were recommending St. John’s wort for postpartum depression and seeing positive results with no reports of any adverse effects on the nursing infant. The only study to address the  issue to date was a prospective, observational cohort study with 33 breastfeeding women with depression taking St. John’s wort compared to 101 disease-matched women and 33 parity-matched health control women.1 While no statistically significant differences were reported for maternal adverse events, colic was reported in one infant in each of the latter two groups while two cases of colic, two cases of drowsiness, and one case of “lethargy” were reported in the St. John’s wort group. The symptoms were not severe and specific medical treatment was not required. No differences were reported in milk production or infant weight over the first year of life. While a small study, the current data supports the findings of an earlier pharmacokinetic study which found that the milk/plasma ratio of hyperforin was very low indicating no accumulation in the breast milk.2 These limited data points to date suggest the need for larger safety data but also suggest, with precautions, that standardized St. John’s wort extracts may prove a safe alternative to SSRIs for post-partum depression.

References: 1. Lee A, Minhas R, Matsuda N, et al. The safety of St. John’s wort during breastfeeding. J Clin Psychiatry 2003;64:966-8. 2. Klier CM, Schafer MR, Schymid-Siegel B, et al. St. John’s wort (Hypercium perforatum): is it safe during breastfeeding? Pharmacopsychiatry 2002;35:

The amount that was used in the study was 300 mg of standardized St. John’s Wort. Most regular depression protocols for St.John’s Wort recommend 300mg three times per day. If you are considering trying St.John’s Wort here are some tips.

  • Take a product that is both standardized and preferably organic and from an excellent company that is GMP certified.
  • If you are not breastfeeding, you can start with 300 mg dose once per day for a few days, then increase to two per day until you reach three 300mg capsules per day. Some women take up to two weeks to notice a difference, but others can tell right away.
  • If you are breastfeeding, master herbalist Susan Weed recommends using a tincture to minimize all potential side effects. This form of the herb also allows you to increase your dosage easily.
  • Though it is unlikely, if your baby gets unusual symptoms like becoming colicy or drowsy, then stop entirely to be able to assess. It can be that the herb increases the let down reflex of the breast milk and  the baby can have trouble adjusting to it or that the baby is particularly sensitive to the herb. It may be entirely unrelated. Although babies go through lots of changes in their bodies all the time, it’s important to be safe.
  • When breastfeeding it is best with any herbal supplement to start gradually.  Find the lowest dose that  you feel benefits you.  Even a small dosage over months, as a part of a larger regimen, may be very beneficial to you.

I think St. John’s Wort as a very  important herb to alleviate the symptoms of depression and or postpartum depression, but don’t rely on it alone. It won’t restore the lost nutrients you may be needing, or any hormone imbalance issues, nor will it address any feelings of isolation or stress you may be having. Consult your physician and a lactation consultant for more information.

St. John’s Wort should not be taken if you are on prescription antidepressants, the birth control pill, or sensitive to the sun.

Mariana Kurko

Mariana Kurko

Mariana is a licensed practitioner of Chinese medicine, the owner of Mamashine, and a singer/songwriter. She shares her music as “Mariana and the Water.” She has a seven year old son and lives with her husband and mother. She is currently creating the “Natural Postpartum Depression Answers E-course” which is coming out this winter.
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