St John's Wort for Depression

Abstract

T o address whether St John's wort is useful for the treatment of depression we attempted to retrieve all English-language articles with data on the efficacy, safety, and availability of St John's wort. Randomized, controlled, double-blind trials were selected and assessed for methodological quality using a standardized checklist, and data on pharmacology, cost, regulation, and safety were extracted. Eight studies were identified, found to be of generally good methodological quality, and determined to provide a modest amount of data to suggest that St John's wort is more effective than placebo in the treatment of mild to moderate depression. The absolute increased response rate with the use of St John's wort ranged from 23% to 55% higher than with placebo, but ranged from 6% to 18% lower compared with tricyclic antidepressants. More data are required to assess both its use in severe depression and its efficacy compared with other antidepressants. Rates of side effects were low. As a dietary supplement, St John's wort is currently largely unregulated, but the Food and Drug Administration is reviewing plans to tighten its regulatory oversight.Arch Intern Med. 2000;160:152-156

Effects of Herbal Supplements on Drug Glucuronidation. Review of Clinical, Animal, andIn VitroStudies

“…Johnʼs wort (Hypericum perforatum) extract is used for insomnia and depression [113]. Flavonol glycosides are the major class of compounds found in St. Johnʼs wort extract, with rutin, hyperoside, isoquercitrin, quercitrin (quercetin 3-rhamnoside), and miquelianin being the main compounds.…”

Effects of Standardized Extracts of St. John's Wort on the Single-Unit Activity of Serotonergic Dorsal Raphe Neurons in Awake Cats Comparisons with Fluoxetine and Sertraline

“…In Germany, where extracts of the plant are licensed as a medication, St. John's wort or hypericum is used more extensively than et al 1996). Since the publication of that influential report, several other systematic reviews (and one metaanalysis) have appeared which further support the antidepressant efficacy of hypericum (Josey and Tackett 1999;Kim et al 1999;Stevinson and Ernst 1999;Gaster and Holroyd 2000). Furthermore, in comparison with other antidepressants, St. John's wort is well tolerated and has a low side effect profile (Linde et al 1996;Ernst et al 1998 Despite its widespread use, the active constituents and mechanism of antidepressant action of St. John's wort remain largely unknown (Bennett et al 1998;Nathan 1999).…”

“…A widely cited meta-analysis of 23 randomized clinical trials concluded that hypericum extracts were significantly superior to placebo and comparable to tricyclic antidepressant drugs in alleviating depressive symptoms (Linde et al 1996). Since the publication of that influential report, several other systematic reviews (and one metaanalysis) have appeared which further support the antidepressant efficacy of hypericum (Josey and Tackett 1999;Kim et al 1999;Stevinson and Ernst 1999;Gaster and Holroyd 2000). Furthermore, in comparison with other antidepressants, St. John's wort is well tolerated and has a low side effect profile (Linde et al 1996;Ernst et al 1998).…”

Hyperforin: A lead for antidepressants

“…The ethnopharmacological uses and huge prescriptions of St.John's wort (Hypericum perforatum L) -best known as 'Nature's Prozac® (fluoxetine) 3 -established this herbal drug as natural antidepressant. All critical analysis on commercial and other information available on sales of herbal medicines in the USA shows that, for the first eight months of 1998, it ranked second to Ginko as the best selling herbal drug, with retail sales valued at over $200 million 4 .…”