Question: One of my patients with postpartum depression would like to use St. John’s wort to treat her depression. Is it safe to use St. John’s wort when breastfeeding?

Answer from Ruta Nonacs, MD PhD: St. John’s wort (Hypericum perforatum) contains hypericin and hyperforin and has been used to treat depression in adults. While some treaters recommend St. John’s wort for the treatment of postpartum depression, it should be noted that there are no clinical trials supporting its effectiveness in this setting.

According to the Drug and Lactation Database (Lactmed), hypericin and hyperforin are poorly excreted into breastmilk. One study noted a slightly increased frequency of colic, drowsiness and lethargy among breastfed infants whose mothers were taking St. John’s wort. Reassuringly, in all cases, adverse events were mild and did not require specific treatment. Most exposures occurred in older infants rather than during the first 1-2 months postpartum when infants are more vulnerable to adverse reactions. Most reports have related to breastfeeding older infants, rather than during the first 2 months postpartum when infants are more susceptible to adverse reactions. 

Conflicting information exists as to whether St. John’s wort affects serum prolactin levels or the maternal milk supply. 

Because there is so little published data on the use of St. John’s wort during breastfeeding and because we lack data on the effectiveness of SJW for the treatment of PPD, we would typically recommend using a conventional antidepressant, such as an SSRI or SNRI. 

References
St. John’s Wort (LactMed)

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