I might be able to assist on this one.
St. John's Wort, like many herbs, affects multiple neurotransmitter systems in multiple brain regions.
This alone makes it HIGHLY complex to study and very difficult to draw conclusive findings from.
But 'clinical' research involves less raw data and more subjective reports.
And clinical data shows that SJW is only effective in severely depressed patients.
Funny - this is also true for SSRIs.
But SJW is actually MORE effective than SSRIs and has LESS side-effects.
I hate that fuzzy term - 'side effects'.
It completely ignores the fact that SSRIs actually damage higher cortical serotonin transmission.
So do other drugs/medications that increase serotonin...
So in severe depression SJW actually has a measurable effect.
It can be observed and repeated.
But how can we know what is happening, since more technical information on its effects are difficult to establish?
Here is what I remember from long ago...
SJW very mildly increases serotonin in the PFC, or prefrontal cortex.
This is critical to the function of SSRIs and MDMA, but SJW only has a 10% effect in the PFC.
However, dopamine is increased about 40% in the PFC.
That's more like it - because serotonin is actually targeting dopamine into higher brain regions with these other agents.
Perhaps it is the dopamine response that causes the real effectiveness of SJW.
Maybe the boost in dopamine occurs first, then a very mild increase in serotonin targets that extra dopamine into the right circuits.
But before the dopamine reaches the PFC it is FIRST increased in the amygdala, a lower brain region associated with the processing of emotions - especially fear and anger!
There is clinical evidence that it causes panic/anxiety in some people and is NOT recommended for people with anxiety disorders, bipolar disease, or schizophrenia. I actually believe that freaking out is one of the greatest causes of change, and healing, in people with mental disease...
SJW appears safe for plain old depression, but not in a LOT of other psychiatric conditions.
And since its exact mechanism of action is damned difficult to understand, many doctors will not recommend it.
There are fiber tracts that connect the PFC to the amygdala - hypothesized by some scientists to represent a higher brain control over the limbic system. It is the maturation of the frontal lobes that defines brain growth during adolescence.
As long as this frontal lobe dominance is still intact, SJW should be well tolerated.
And perhaps a little extra anger and fear is a GOOD thing for someone who is simply lacking motivation.
That 'spark' of life.
But if the connection between higher and lower brain regions is damaged, then pumping the amygdala full of dopamine might just have a catastrophic and unexpected result. Dominance of limbic structures over the frontal lobes is a defining feature of psychosis.
Allow me to recount my experience with Saint John's Wort.
The first night I took it - WOW.
I was DRUUUNK and happy.
For several hours I enjoyed the most fuzzy and pleasant feeling I had felt in EIGHT months of MDMA recovery.
I couldn't believe how dizzy and warm I felt.
I even enjoyed a burst in libido.
I did not expect to feel so slanted - so drunk.
And I enjoyed it enough to keep taking the stuff.
Never again did I feel the same way.
Over the following two weeks I took it almost DAILY, and the only result I got was either neutral or VERY negative emotional responses.
Anger and fear were certainly present.
But what is hard to communicate is how they boiled slowly....over hours.
No matter how intelligent and aware I was, the emotions still surprised me.
I kept taking it thinking it would just get better.
After about two weeks I just stopped taking it!
"Fuck that!" I would have said.
I haven't tried it since, although I will again one day.
I still can't believe the difference between the first time and every time after that.
It reminds me of trying Acetyl L-carnitine, vincopocetine, and Piracetam on the same day.
Now THAT was a transformation, no - a RESURRECTION of my former self.
Holy shit.
Amino acids and herbs can have amazing effects on the body and mind, but they must not be underestimated.
For the record - I recommend a potent version of SJW that has a higher concentration of Hyperforin.
Most will state their percentage of hypercin - which is most.
Research suggested that hyperforin, not hypercin, was the most relevant anti-depressant compound.
And that it what I chose to try.
And OH MY GOD was it strong.
I imagine that plain old hypercin would have had a fraction of the effect.
With many herbs it is found that only whole plant products that incorporate all compounds are effective, and isolating individual compounds does not impart the same effect.
Probably why Poppy Pod tea can be WAY stronger and longer lasting than most opiate and heroin users would expect.
If only I could get that stuff to work well for me....
Damned opiate receptors.
Back to the SJW.
If you decide to try it - take PARTIAL doses first.
I literally squeezed some of the goo out of the capsules before taking them.
There is no harm in this practice - you can always take more.
But you can NEVER take less.
Aside from vomiting quickly.
Yes, expect some stomach discomfort.
And mild anxiety at least.
But with ALL anti-depressants, from SJW to highly effective SSRIs, there is compelling evidence that NOTHING works as well as cognitive behavioral therapy and exercise.
Actually, FUCK therapy.
Exercise helps to increase dopamine supply and serotonin growth in the frontal lobes.
And it sends stem cells into many areas of the brain.
Nothing compares to pushups - not even St. John's Wort.
That much I guarantee.