From the Guidelines
St. John's wort is a viable treatment option for mild to moderate depression, with similar response rates to second-generation antidepressants, but its use should be approached with caution due to potential drug interactions and variable quality of available preparations.
Key Considerations
- The standard dosage of St. John's wort is typically 300 mg three times daily of an extract standardized to contain 0.3% hypericin, with full benefits potentially taking 4-6 weeks to experience 1.
- Studies have shown that St. John's wort has similar response rates to second-generation antidepressants for mild to moderate depression, with a meta-analysis of 9 trials indicating response rates of 52% vs. 54% 1.
- However, St. John's wort is not regulated by the U.S. Food and Drug Administration, and its quality can vary, which may impact its effectiveness and safety 1.
- Common side effects of St. John's wort include dry mouth, dizziness, digestive issues, and increased sensitivity to sunlight, and it can also interact with various medications, including birth control pills, blood thinners, heart medications, and some cancer drugs 1.
Recommendations for Use
- St. John's wort may be considered as an alternative treatment for mild to moderate depression, particularly for patients who cannot tolerate or prefer not to use conventional antidepressants.
- However, patients should be closely monitored for potential side effects and drug interactions, and its use should be approached with caution, especially in patients with existing health conditions or taking other medications.
- It is essential to consult with a healthcare provider before starting St. John's wort to discuss the potential benefits and risks and determine the best course of treatment.
From the Research
Efficacy of St John's Wort
- St John's Wort has been found to be effective in treating mild to moderate depression, with some studies suggesting it is comparable to selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants 2, 3, 4, 5, 6.
- A meta-analysis of randomized clinical trials found that St John's Wort reduced the number of depressive patients and their Hamilton Depression Rating Scale (HAMD) scores, with fewer risks and side effects than conventional medications 2.
- Studies have also demonstrated its efficacy in treating seasonal affective disorder and postmenopausal depression 4, 5.
Safety and Tolerability
- St John's Wort has been found to be well-tolerated, with a lower incidence of side effects compared to standard antidepressants 3, 4, 5, 6.
- However, it may interact with other medications, including warfarin, digoxin, and cyclosporin, by inducing the metabolism of co-administered medications 3.
- The risk of fatal serotonin syndrome is also a concern when St John's Wort is used in conjunction with other serotonergic agents 5.
Comparison to Other Antidepressants
- St John's Wort has been compared to SSRIs, tricyclic antidepressants, and placebo, with some studies suggesting it is more efficacious, while others found no significant difference 2, 3, 5, 6.
- A study found that St John's Wort was more efficacious than fluoxetine, a type of SSRI, in treating mild and moderate depression 5.
Regulatory Status
- St John's Wort is currently listed as a dietary supplement by the FDA, but its regulatory status is being reviewed 6.
- In Germany, St John's Wort has been used as a treatment measure for depression, and it has been found to be comparable, if not more efficacious, than most standard treatment options for depression 5.