by Neil Bauman, Ph.D.
Updated January, 2022
A man wrote:
I read an article on Dr. Jeffrey Dach’s website referring to the natural mood improving qualities of St. John’s Wort [“Beating Depression Naturally“], which also should have little or no side-effects when taking the recommended daily dosage (anywhere from 300mg-900mg).
I have been feeling “down” for the last year and a half, and thought I’d give it a try (mostly due to my hearing loss and adjusting to the new me). I also suffer from severe tinnitus and recruitment.
My question is this: “Is St. John’s Wort a non-ototoxic drug/herb? Is it safe to take?” I want to improve my mood, and would prefer to find a natural method; but don’t want to make my hearing loss any worse.
St. John’s Wort is very mildly ototoxic. It has far fewer side effects than prescription drugs. Furthermore, it is not reported to cause hearing loss, and only a handful of people have reported getting tinnitus from taking it.
Over 40 studies (so far) have reported it to be just as effective for mild to moderate depression as the drugs doctors typically prescribe. St. John’s Wort really works. D_______ takes it as needed and has never had any ototoxic (or other) side effects like she had with prescription drugs. I know a number of others that have had the same experience.
Consequently, you can take it for as long as you need to without being unduly concerned that it will cause hearing loss, aggravate your tinnitus, make your hyperacusis worse or wreck your balance.
However you still have to be prudent because you may be particularly sensitive to St. John’s Wort. For example, one man wrote,
The St. John’s Wort I’m taking has made my tinnitus incredibly worse. I’ve been taking it for almost 2 weeks and my tinnitus is now unbearable. I’ve been taking 2,000 mg each morning and I’m wondering if I should lower my dosage or drop it all together.
This man is taking a very high dose once a day rather than breaking it up and taking it morning, noon and night. I wouldn’t be surprised if he’d find his tinnitus going away if he dropped the dose to 300 to 600 mg a day which is in the recommended range.
I’ve suggested to a good number of people that they ask their doctors to switch them to St. John’s Wort rather than the ototoxic prescription drugs they originally took in order to prevent further ototoxic damage to their ears.
You can get St. John’s Wort at almost any drug store or health food store, or on the Internet. Just be sure that the packaging explicitly states that the active ingredient—hypericin—is standardized to a given level somewhere between 0.3% and 0.7%—typically 0.3%. This is very important. Some formulations don’t mention this at all. As a result, you don’t know whether you are even getting any of the active ingredient or not.
However, don’t just start taking St. John’s Wort on your own if you are taking any other medications. You don’t want to cause problems due to interactions between St. John’s Wort and any other medications you might be taking. For example, St. John’s Wort can speed up the breakdown of many drugs and thereby reduce these drugs’ effectiveness This can happen if you are taking antidepressants or birth control pills–and you don’t want an “oops” to occur) .
Also, note that taking St. John’s Wort can make your skin sensitive to sunlight. If this occurs, you know that St. John’s Wort is not for you. However, the vast majority of people taking St. John’s Wort don’t have any side effects.
To learn which drugs and herbs are (or can be) ototoxic, see “Ototoxic Drugs Exposed“. This book contains information on the ototoxicity of 877 drugs, 35 herbs and 148 chemicals.
I felt good taking St. John’s Wort a couple years ago, but then switched to Mertazapine because my ENT said it helped with hearing loss. And my audiograms improved when I was on it. But now I want to switch back to St. John’s Wort. Does SJW have the same effect on hearing loss as Mertazapine?
Thanks much!
Hi Sheila:
I’ve never heard of Mirtazapine helping hearing loss, but it is listed as CAUSING hearing loss and hyperacusis, and I’ve received reports of people getting tinnitus from taking it. Mirtazapine is a tetracyclic antidepressant. Taking it may make it so you don’t worry about your hearing loss, or anything else, but I don’t see how it can help it.
St. John’s Wort is not ototoxic so it should not affect your hearing or tinnitus.
Regards
Neil
https://news.ohsu.edu/2017/08/22/study-suggests-serotonin-may-worsen-tinnitus
I admire your work.
Since recent research suggests that it is actually serotonin that exacerbates tinnitus (a good reason to avoid SSRIs) I am concerned about taking St. John’s Wort for my debilitating tinnitus since it works by increasing serotonin. Is there no medication out there for tinnitus sufferers that can help with depression resulting from chronic tinnitus? I am just getting off gabapentin which helped for a week then increased my tinnitus tenfold
Peter
Hi Peter:
As far as I know, St. John’s Wort has not been implicated in increasing tinnitus, no matter what any studies may say about serotonin. If I had come across a connection, it would be in my book, “Ototoxic Drugs Exposed” and its not.
Furthermore, I have suggested to many people that they try St. John’s Wort rather than prescription drugs and no one has come back to me complaining of tinnitus from taking the SJW. Thus, I don’t think you have to worry about it making your tinnitus worse. You could try it and see what happens. St. John’s Wort is not an SSRI drug so probably has a completely different (and less harsh) action on our bodies as that is the way herbals work.
Gabapentin is known to cause tinnitus. Hundreds upon hundreds of people have reported to the FDA of getting tinnitus from taking Gabapentin so it sure wouldn’t have been my choice of a drug.
Cordially,
Neil
Just wanted to mention that I started drink some SJW sun tea this past week (pretty strong), and immediately noticed a bit of stimulation, accompanied by a somewhat subtle increase in tinnitus. By the next day, I was noticing a paradoxical sense of stimulation AND relaxation.
I experimented with different amounts of tea, and had both positive and uncomfortable effects. The main positive is that my energy increased, and which has continued. This is BIG for me because I have ME/CFS and Lyme. My cognitive function and ability to sleep both increased as well.
The main downside is that I at times felt a little too stimulated, but feel it’s from taking too much. But by last night I had the best night’s sleep I’ve had in a while. Also, my tinnitus has been noticeably subdued for the past 3-4 days (even when I had moments of feeling a bit too stimulated). So, brief tinnitus volume increase on day 1 (perhaps 2), and less volume since.
Hi Lane:
I have seen reports of St. John’s Wort causing tinnitus in a few people. So it is possible that your temporary tinnitus increase was indeed due to the St. John’s Wort tea. It’s good that you found the right dose that works for you.
Cordially,
Neil
Hi, I just wanted to check with you, in your reply on
March 16, 2019 at 9:40 AM, you advised that ‘As far as I know, St. John’s Wort has not been implicated in increasing tinnitus, no matter what any studies may say about serotonin’. Then on
July 15, 2019 at 11:16 PM, you advised ‘I have seen reports of St. John’s Wort causing tinnitus in a few people. So it is possible that your temporary tinnitus increase was indeed due to the St. John’s Wort tea’. Can you please clarify, is there evidence St John wort can worsen tinnitus? Please help. Thank you.
Hi Patricia:
Sorry for the confusion. Between the writing the original article and reply and the second reply, I have come across some new information indicating that for a handful of people St. John’s Wort can cause tinnitus and some other ototoxic side effects.
I’ve made a note to myself to update this article when I compile this information as I make updates to the 4th edition of my book Ototoxic Drugs Exposed.
So, for the record, St. John’s Wort is very mildly ototoxic and can cause various balance disorders plus tinnitus in a few people. No mention of any hearing loss though.
Cordially,
Neil
I feel like every time I find something that may help my anxiety due to tinnitus I come back and find it’s a no go. Naturopath gave me lithium then I read it’s ototoxic. Just bought SKW and now scared it’s going to make my T worse.
Hi Jessica:
The chance that St. John’s Wort will make your tinnitus worse is slim–not impossible, but slim–so I sure wouldn’t worry about it. Besides SJW is for treating depression, not anxiety, so it is the wrong herbal for treating anxiety (as I understand it).
Cordially,
Neil
I am on Gavapentin
It is not doing anything but increasing my tinnitus
How do I get off it without problems
I am on 1200 mg. Can I half the dose for a week and then stop
Hi Wayne:
You don’t want to taper off Gabapentin too fast or you risk withdrawal side effects. Dropping the dose by 50% for a week is probably much too fast.
How fast you taper off this drug depends on a number of factors such as how long you took the drug, how large the dose was, your age, gender, and body weight.
It is always better to err on the side of a slower taper rather than a faster taper.
Here is a good article on tapering safely off Gabapentin. The link is https://www.ridgefieldrecovery.com/drugs/gabapentin/related/gabapentin-taper/
Based on their information and the fact that you have been taking 1200 mg of Gabapentin and assuming you’ve been taking it for some time, a safer, 9-week taper would look something like this.
Week 1: 1200 mg daily
Week 2: 1050 mg daily
Week 3: 900 mg daily (25% reduction at this point)
Week 4: 750 mg daily
Week 5: 600 mg daily (50% reduction at this point)
Week 6: 450 mg daily
Week 7: 300 mg daily (75% reduction at this point)
Week 8: 150 mg daily
Week 9: 50 mg daily
Of course you could taper faster, but the faster the taper the higher the risk of withdrawal side effects. This should be a safe taper for the average person.
Cordially,
Neil
I have read elsewhere that SJW is ototoxic and I see your correction in a comment above. I only discovered this when I started taking SJW after getting (mild) tinnitus from taking other meds. It makes my tinnitus worse and I notice the difference on the days I take it and the days I don’t.
Hi Elizabeth:
Yes, St. John’s Wort can be mildly ototoxic in some people. In your case, are you saying that it just TEMPORARILY makes your tinnitus worse for a few hours or so, then your tinnitus drops back to its old level? If so, how long does it typically take?
Cordially,
Neil
Hello, The st Johns Wort I’m taking has made my tinnitus incredibly worse. I think it’s been helpful with my depression (I’ve been taking it for almost 2 weeks now) but the tinnitus is unbearable. I’ve been taking 2,000mg each morning and I’m wondering if I should lower my dosage or drop it alltogether. I first developed tinnitus and hearing damage from doxycycline for Lyme disease treatment, and things started to get lighter on my ears as the months passed. Since I started St Johns Wort however, it’s so amplified that schoolwork is difficult. Any advice?
Hi Io:
You are taking an awfully high dose, and are taking it all at once so I’m not surprised that you are having bad tinnitus. To me, a safer dose would be 300 mg per day or maybe even 600 mg split into morning and evening, not 2.000 mg all at one time.
Note that a few people do have a tinnitus reaction to taking St. John’s Wort. You may be one of them, but it was probably exacerbated by the high dose you are taking.
You may find that taking 300 mg a day will let your tinnitus drop back to baseline.
Cordially,
Neil
I got severe tinitus with SJW moderate dose. I reduced the dose but even small dose caused tinitus to me. Finally I had to stop taking it and throw the balance capsules in dustbin.
Hi Nirmal:
Thanks for the report. It just goes to show that even with herbals that are only very mildly ototoxic, some people can still be very sensitive to them and thus should not use them. So you always want to watch and see if any ototoxic side effects develop.
Cordially,
Neil
Hello, you mention that St. John’s wort is mildly ototoxic. I researched this assertion but couldn’t find anything confirming. Are there any scientific resources with this claim?
Hi Markus:
I’m not aware of any studies that prove that St. John’s wort is ototoxic. I base my assertion on the fact that a few people have reported to the FDA’s data base that they had ototoxic side effects from taking this herbal. Most reported side effects related to balance issues, but some related to tinnitus and to a lesser extent, hyperacusis.
I have personally received 2 reports of people getting tinnitus from taking St. John’s Wort. One was taking a VERY high dose, far too high in my opinion, and the other didn’t state the dose.
Thus, for a few people, they may have ototoxic side effects, but the vast majority of people taking St. John’s Wort don’t have any ototoxic side effects.
Cordially,
Neil
Hello, I started getting tinnitus last year with citalopram. Tried Sertraline after that, same problem. Yesterday I decided to try SJW and bam tinnitus again after just taking 2x 300mg once a day, yest and today. It’s unmistakably linked to serotonin in my case. I might continue for a but and see if it goes off as I know now from experience that it will stop if I stop taking it. Just thought I would add to your evidence pile. Thanks for this useful thread.