St. John's Wort for Managing Nicotine and Alcohol Withdrawal

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The limited effectiveness of conventional pharmacologic treatments of alcohol and nicotine withdrawal calls for research on promising natural supplements and other complementary and alternative medicine (CAM) approaches.

This short piece is the second in a series of posts on CAM and integrative treatments of alcohol and drug abuse. In the previous post, I summarized the findings of a study on Red Ginseng for reducing alcohol withdrawal and craving. In this post, I review studies investigating St. John’s wort (Hypericum perforatum) as a potential treatment of alcohol and nicotine withdrawal.

Serotonin: the common link between depressed mood and alcohol withdrawal

St. John’s wort is known to increase brain levels of serotonin and is widely used to treat depressed mood. Reduced functioning of the brain’s serotonergic neurons is believed to play a central role in alcohol dependence and withdrawal. Many individuals who are depressed also abuse alcohol and smoke.

Antidepressants, such as fluoxetine and other serotonin reuptake inhibitors, have been shown to be effective in reducing alcohol withdrawal in rats, suggesting that depressed mood and alcohol abuse may be mediated by one or more common neurobiological mechanisms. H. perforatum is believed to attenuate nicotine withdrawal by reducing brain serotonin levels and by stimulating the increased synthesis of nitric oxide, a neurotransmitter that may also play a role in reducing withdrawal symptoms.

Emerging research findings on St. John's wort for managing alcohol and nicotine withdrawal

Results of animal studies support that St. John’s wort may reduce alcohol intake and mitigate symptoms of withdrawal from nicotine and alcohol; however, the findings are inconsistent. Mice treated with a standardized extract of St. John's wort were observed to be significantly less agitated and had fewer seizures following acute withdrawal from alcohol.

In a placebo-controlled study, 45 adult smokers were randomized to an oral spray containing St. John's wort vs. a placebo. Following one month of treatment, both groups reported similar abstinence rates; however, the group treated with St. John's wort reported less intense nicotine cravings, less anxiety, and improved sleep compared to the control group. However, a small pilot study found no differences in abstinence rates in individuals taking St. John's wort or a placebo.

Safety issues

St. John’s wort is generally well tolerated when taken alone; however, the herbal should not be taken with oral contraceptives, anti-HIV drugs, antidepressants, or other medications, because the active ingredients in St. John’s wort decrease the blood levels of these drugs, interfering with their efficacy. St. John’s wort should not be used in combination with prescription antidepressants, because the combination can potentially result in increased brain levels of serotonin, causing "serotonin syndrome," an unpleasant and potentially serious condition associated with agitation, anxiety, increased heart rate, and increased blood pressure.

Closing remarks

St. John’s wort is widely used to treat depressed mood. Emerging findings from animal studies and a few small human clinical trials suggest that St. John's wort may help reduce symptoms of alcohol and nicotine withdrawal. Because of common neurobiological mechanisms in depressed mood and alcohol and nicotine abuse, taking St. John's wort may be especially beneficial for depressed individuals who smoke or drink heavily.

The findings discussed above should be viewed as preliminary pending confirmation by large placebo-controlled studies. If you are taking a medication, it is prudent to consult with a physician or other health care provider before taking St. John’s wort to avoid potentially unsafe interactions. The reader can find more detailed information about St. John's wort for the management of alcohol and nicotine withdrawal in a review article published in Phytotherapy Research.