St John's wort for depression: Time for a different perspective?

https://doi.org/10.1016/j.ctim.2006.01.003Get rights and content

Summary

Objectives

To review the development of the evidence on the herbal remedy, St John's wort (SJW) (Hypericum perforatum), in the treatment of depression.

Methods

Searches of major biomedical and specialist databases including EMBASE, MEDLINE, PsycINFO, AMED and HerbMed were conducted. Searches aimed to identify quantitative research (systematic reviews and meta-analyses) and relevant qualitative studies. Data were extracted systematically.

Results

Systematic reviews have been published regularly over the past 10 years. Methodology has varied resulting in differing estimates of effectiveness but overall findings have been positive when compared with placebo for mild to moderate depression. Recent reviews have focused on adverse effects and interactions. One qualitative study focusing on SJW in depression was retrieved.

Conclusions

SJW has received intensive and continued attention since initial indications of its potential effectiveness for depression. The focus appears to be moving from effectiveness to safety but the patient's perspective has received less attention and may prove a valuable avenue for future studies.

Section snippets

Background

St John's wort (SJW) (Hypericum perforatum) is a flowering plant that is a member of the family Hypericaceae. It is widely used as a herbal remedy particularly for self-treatment for depression. The active parts of the plant are the dried, above-ground parts containing several active constituents of which two, hypericin and hyperforin, are understood to be the most significant.1 The antidepressant action is probably mediated by serotonergic, noradrenergic and dopaminergic system activation and

Aim and objectives

The aim of this study was to evaluate the evidence from a range of sources on the effectiveness, safety and patient experience of SJW (Hypericum) for the treatment of depression.

Main results

Numbers of studies found:

Meta-analyses10
Systematic reviews25 (including the above)
Qualitative research1 study

Conclusions

SJW has received intensive and continued attention since the initial indications of its potential effectiveness in the treatment of depression. Systematic reviews and meta-analyses of its effectiveness continue to be conducted and published. Estimates of effectiveness have varied due to methodological differences, a finding reported previously by Linde and Willich.88 While exact measures of its effectiveness in comparison to placebo have varied, positive results have been obtained even when

Note

After this study was completed, an update of the Cochrane review was published89 which has now replaced the review mentioned in this paper.

Acknowledgements

Professor Irving Kirsch, Faculty of Health and Social Work, University of Plymouth and Hugh McGuire, CCDAN Trials Search Coordinator, Institute of Psychiatry for helpful comments on the draft of this paper.

The Project Advisory Group and Specialist Advisory Group (mental health) for the NHS Priorities Project for advice and support to the project.

The NHS Priorities Project is funded by the Department of Health. The views and opinions expressed are those of the authors and do not necessarily

References (89)

  • R.A. Parslow et al.

    Use of prescription medications and complementary and alternative medicines to treat depressive and anxiety symptoms: results from a community sample

    J Affect Disord

    (2004)
  • G. Calapai et al.

    Serotonin, norepinephrine and dopamine involvement in the antidepressant action of Hypericum perforatum

    Pharmacopsychiatry

    (2001)
  • P. Zanoli

    Role of hyperforin in the pharmacological activities of St John's wort

    CNS Drug Rev

    (2004)
  • K. Linde et al.

    St John's wort for depression—an overview and meta-analysis of randomised clinical trials

    BMJ

    (1996)
  • Linde K, Mulrow CD. St John's wort for depression. The Cochrane Database of Systematic Reviews 1998. Issue 4. Art. No.:...
  • H.P. Volz

    Controlled clinical trials of Hypericum extracts in depressed patients—an overview

    Pharmacopsychiatry

    (1997)
  • M. Friede et al.

    Therapy of anxiety syndromes in depressive moods with St John's Wort. [JOHANNISKRAUT ZUR THERAPIE VON ANGSTSYNDROMEN BEI DEPRESSIVEN VERSTIMMUNGEN]

    Z Phytother

    (1998)
  • H. Hippius

    St John's Wort (Hypericum perforatum)—a herbal antidepressant

    Curr Med Res Opin

    (1998)
  • C.D. Mulrow et al.

    Treatment of depression—newer pharmacotherapies

    Psychopharmacol Bull

    (1998)
  • J.W. Williams et al.

    A systematic review of newer pharmacotherapies for depression in adults: evidence report summary

    Ann Intern Med

    (2000)
  • H.L. Kim et al.

    St. John's wort for depression: a meta-analysis of well-defined clinical trials

    J Nerv Ment Dis

    (1999)
  • B. Gaster et al.

    St John's wort for depression: a systematic review

    Arch Intern Med

    (2000)
  • E. Whiskey et al.

    A systematic review and meta-analysis of Hypericum perforatum in depression: a comprehensive clinical review

    Int Clin Psychopharmacol

    (2001)
  • V. Schulz

    New therapeutic studies and meta-analysis, St. John's wort extract vs. synthetics

    Pharm Unserer Zeit

    (2003)
  • U. Werneke et al.

    How effective is St John's wort? The evidence revisited

    J Clin Psychiatry

    (2004)
  • C. Roder et al.

    Meta-analysis of effectiveness and tolerability of treatment of mild to moderate depression with St John's Wort

    Fortschr Neurol Psychiatr

    (2004)
  • J. Hoffmann et al.

    Therapie von depressiven Zuständen mit Hypericin. [Therapy of depressive states with hypericin]

    ZFA (Stuttgart)

    (1979)
  • W. Steger

    Depressive Verstimmungen

    ZFA (Stuttgart)

    (1985)
  • G. Warnecke

    Beeinflussung klimakterischer Depressionen

    ZFA (Stuttgart)

    (1986)
  • D. Schlich et al.

    Behandlung depressiver Zustände mit Hypericinium

    Psycho

    (1987)
  • R. Kniebel et al.

    Zur Therapie depressiver Verstimmungen in der Praxis

    ZFA (Stuttgart)

    (1988)
  • U. Schmidt et al.

    Zur Therapie depressiver Verstimmungen

    Psycho

    (1989)
  • W. Werth

    Psychotonin M versus Imipramin in der Chirurgie

    Kassenarzt

    (1989)
  • J. Kugler et al.

    Therapie depressiver Zustände

    ZFA (Stuttgart)

    (1990)
  • P. Halama

    Wirksamkeit des Johanniskrautextraktes LI 160 bei depressiver Verstimmung

    Nervenheilkunde

    (1991)
  • P. Halama

    Wirksamkeit des Hypericum-Extraktes LI 160 bei 50 Patienten einer psychiatrischen Fachpraxis

    Nervenheilkunde

    (1991)
  • G. Harrer et al.

    “Alternative” Depressionsbehandlung mit einem Hypericum-Extrakt

    Therapiewoche Neurol Psychiatr

    (1991)
  • K. Ditzler et al.

    Johanniskraut bei leichten bis mittelschweren Depressionen - Ergebnisse einer plazebo-kontrollierten Doppelblindstudie

    Heilkunst

    (1992)
  • K. Ditzler et al.

    Clinical trial on Neuropas versus placebo in patients with mild to moderate depressive symptoms: a placebo-controlled, randomised double-blind study

    Complement Ther Med

    (1994)
  • M. Osterheider et al.

    Behandlung depressiver Syndrome mit Hypericum (Johanniskraut) - eine placebokontrollierte Doppelblindstudie

    Fortschr Neurol Psychiatr

    (1992)
  • C. Reh et al.

    Hypericum-Extrakt bei Depressionen - eine wirksame Alternative

    Therapiewoche

    (1992)
  • R. Bergmann et al.

    Behandlung leichter bis mittelschwerer Depressionen

    Therapiewoche Neurol Psychiatr

    (1993)
  • K.D. Hänsgen et al.

    Multizentrische Doppelblindstudie zur antidepressiven Wirksamkeit des Hypericumextraktes LI 160

    Nervenheilkunde

    (1993)
  • Cited by (0)

    1

    Present address: Royal London Homoeopathic Hospital, London, UK.

    View full text