Natural Remedies - St. John's Wort

St. John's wort is a plant extract whose chemical name is Hypericum Perforatum. It is widely used as a natural (herbal) remedy for depression. Since many psychiatric drugs used for the treatment of depression have significant adverse reactions, it would be very useful to have a remedy that works and has few, if any, side effects. Initial studies in the 90's indicated that it was reasonably effective. However, in 2002, JAMA (Journal of the American Medical Association) published a study by the "Hypericum Depression Trial Study Group" (v 287, p 1807, 2002) that seemed to convince the medical community that St. John's wort was innefective. This study was a double-blind, randomized, placebo-controlled trial conducted at 12 different academic and community psychiatric research clinics in the United States. It involved 340 patients with severe depression, who were randomly assigned to receive St; John's wort, a placebo, or sertraline (an active anti-depressant). Patients who responded to the medication after 8 weeks were assigned to continue their treatment (still blinded) for another 18 weeks.

Two tests were used to determine the degree to which the medication affected the depression. One was a "HAM-D" score, and the other was a "CGI" score. On the "HAM-D" score, the primary goal on the test, neither St. John's wort, nor sertraline provided any better results than those of a placebo! (Sertraline, but not St. John's wort, was slightly better than a placebo in the CGI results). The study concludes that St. John's wort "should not be substituted for standard clinical care of proven efficacy ... for the treatment of major depression of moderate severity".

However, several other studies came to a different conclusion. A meta-study (study of studies, adding the results of several previous studies) published in the British Journal of Psychiatry (v 186, p 99, 2005) reviewed 37 double-blind randomized controlled trials that compared St. John's wort to either a placebo or a standard antidepressant in adults with depression. In this analysis, St. John's wort extracts improved symptoms more than a placebo in adults with mild to moderate depression. However, the sum of results of six recent trials restricted to people with major depression showed only minimal effects compared to a placebo. Their conclusion - there may be only minor benefits for patients with major depression, and no benefits for patients with prolonged duration of depression. There is a suggestion of a benefit for patients with mild to moderate depression. One other noteworthy issue - St. John's wort has less side effects compared to standard medication!

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Last Modification - March 4, 2006