What is the recommended dose of St. John's wort (Hypericum perforatum) for treating mild to moderate depression?

From the Guidelines

The recommended dose of St. John's wort for treating mild to moderate depression is typically 300 mg three times daily (900 mg total daily dose) of a standardized extract containing 0.3% hypericin or 3-5% hyperforin. This dosage has been studied in clinical trials and shown to be effective for many people, as indicated by a meta-analysis of 9 trials (1513 participants) that found similar response rates for patients treated with second-generation antidepressants or St. John's wort 1. Treatment should be continued for at least 4-6 weeks to determine effectiveness, as St. John's wort, like conventional antidepressants, may take several weeks to show full benefits. Some key points to consider when using St. John's wort include:

• Purchasing products from reputable manufacturers that specify the standardized content of active compounds
• Being aware of potential interactions with other medications, including birth control pills, blood thinners, chemotherapy drugs, HIV medications, and other antidepressants
• Understanding that St. John's wort works by inhibiting the reuptake of neurotransmitters like serotonin, dopamine, and norepinephrine, similar to conventional antidepressants
• Recognizing that side effects are generally mild but may include dry mouth, dizziness, digestive upset, and increased sensitivity to sunlight
• Consulting with a healthcare provider before starting St. John's wort, especially if taking other medications, as it may reduce the bioavailability or efficacy of some drugs and is contraindicated in patients receiving monoamine oxidase or serotonin reuptake inhibitors 1.

From the FDA Drug Label

DIRECTIONS: Adults and children above 12 years: 10 drops orally 3 times daily, or as directed by a health care professional. The recommended dose of St. John's wort (Hypericum perforatum) for treating mild to moderate depression is 10 drops orally 3 times daily. This dosing is based on the directions for hypericin (PO) 2.

From the Research

St. John's Wort Dosing for Mild to Moderate Depression

The recommended dose of St. John's wort (Hypericum perforatum) for treating mild to moderate depression is not explicitly stated in the provided studies. However, the following information can be gathered:

• A study published in 2009 3 used 500 mg of St. John's wort extract per day (Ze 117) for up to 1 year in the treatment of patients with mild to moderate depression.
• The studies do not provide a clear consensus on the optimal dosage, but they suggest that St. John's wort can be effective in treating mild to moderate depression at various doses.

Key Findings

• St. John's wort has been shown to be as effective as standard antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), in treating mild to moderate depression 4, 5, 6.
• The herb has been found to have a broad spectrum of action, inhibiting the re-uptake of various neurotransmitters, including serotonin, noradrenaline, and dopamine 7.
• St. John's wort has been reported to have a good safety profile, with few adverse events and no significant changes in clinical chemistry and electrocardiogram recordings 3.

Considerations

• St. John's wort can interact with many medications, including antiretrovirals, cyclosporine, and antidepressants, due to its induction of cytochrome P-450 3A4 and other mechanisms 4.
• The long-term efficacy and safety of St. John's wort are not well established, with most studies lasting only a few weeks or months 5, 3.
• More research is needed to determine the optimal dosage and duration of treatment with St. John's wort for mild to moderate depression.