Skip to main content
Evidence-Based Supplement Research
Evidence-Based Supplement Research
Pillser
Search
Sign UpLog In

Advantages and Disadvantages of Using St. John's Wort as a Treatment for Depression.

  • 2022-09-22
  • Cureus 14(9)
    • Johanna S Canenguez Benitez
    • Tabata E Hernandez
    • Ramaswamy Sundararajan
    • Sarosh Sarwar
    • Angel J Arriaga
    • Asma T Khan
    • Andrea Matayoshi
    • Herbert A Quintanilla
    • Hansini Kochhar
    • Mehwish Alam
    • Arpit Mago
    • Aakash Hans
    • Guadalupe A Benitez

Study Design

Type
Review
Sample size
n = 27
Methods
The authors searched PubMed, JAMA network, Springer Link, Elsevier, Google Scholar, and Scientific Progress databases, from 2011 through August 2021, using specific keywords, yielding 27 papers after removal of irrelevant content and non-English languages.

Background and objectives

St. John's wort (SJW) extracts are currently being used to treat depression of various degrees of severity. While many studies have shown it to be superior to placebo, data regarding the effectiveness of using SJW as a stand-alone treatment compared with standard antidepressants has yet to be proven conclusively. This study aims to understand the advantages and disadvantages of SJW as a treatment modality for depression.

Methods

 The authors searched PubMed, JAMA network, Springer Link, Elsevier, Google Scholar, and Scientific Progress databases, from 2011 through August 2021, using the following keywords: St John's wort, Hypericum perforatum, depression, antidepressant, complementary alternative medicine, economic evaluation depression St. wort, St John's wort and depression, antidepressant interactions. This yielded a total of 27 papers following a thorough removal of irrelevant content and dissemination in languages other than English.

Results

 In patients with mild and moderate depression, SJW proved superior to placebo. Certain studies comparing the efficacy of SJW versus selective serotonin reuptake inhibitors (SSRIs), especially fluoxetine, reported SJW to be more efficacious, while the majority reported no significant difference. Tricyclic antidepressants were also found to have similar efficacy as SJW. Moreover, treatment with SJW was also found to reduce postmenopausal depression. Regarding the safety profile, although SJW is better tolerated with fewer adverse effects when compared to standardized antidepressants, its predisposition to causing fatal serotonin syndrome, when used in conjunction with other serotonergic agents and drug interactions noted with CYP 450 drugs, raises a question in the safety profile.

Conclusion

 It is essential to acknowledge that SJW has been used as a treatment measure in Germany. Despite being only listed as a dietary supplement by the FDA and not a drug, SJW has shown to be comparable, if not more efficacious, than most standard treatment options for depression. SJW does prove to be an exciting piece of pharmacotherapy in the realm of mental health and post-menopausal treatment. More prospective studies will help us better understand its efficacy in mild and moderate depression and its ability to serve as a long-term agent. Considering its mechanism of action, its role in relieving patients suffering from an anxiety disorder is also worth considering.

Research Insights

Adverse Events Reported

  • St. John's Wort→Overall tolerability

    SJW is better tolerated with fewer adverse effects when compared to standardized antidepressants

    Finding
    Reported
  • St. John's Wort→drug interactions

    drug interactions noted with CYP 450 drugs, raises a question in the safety profile

    Finding
    Reported
  • St. John's Wort→serotonin syndrome

    its predisposition to causing fatal serotonin syndrome, when used in conjunction with other serotonergic agents

    Finding
    Reported
    Severity
    Serious adverse event
Back to top