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Extracts of the plant Hypericum perforatum (St John's wort) are widely used
as herbal remedies for depression
- the pharmacologically active constituents
have not been precisely identified (1)
- Hypericum is unlicensed as a
medicine in the UK, but can be bought from pharmacies, supermarkets and health
The use of St John's wort (Hypericum perforatum) extract
in the treatment of depression has been reviewed by Linde and Mulrow (2).
- a meta-analysis of 27 trials comparing St John's wort with either placebo
or active treatments was undertaken
- this analysis suggests that St. John's
wort is more effective than placebo and is as effective as low-dose tricyclic
antidepressants (TCAs) as an antidepressant therapy
- the mechanism of
action appears to be the inhibition of the reuptake of noramines
- no long-term
efficacy and safety data are available on use of hypericum
randomised placebo-controlled studies have yielded conflicting results
- Hypericum gave benefit (matching that of imipramine) in an 8-week study
in general practice patients with mild or moderate depression, present, on average,
for less than 6 month (3)
- by contrast, it was no more effective than placebo
in two large studies conducted in the USA in outpatients with similarly severe,
but more longstanding, major depression (4,5)
is evidence supporting the use of St John's wort as a therapeutic option for treating
depression although, when used in the treatment of longstanding, major depression,
St John's wort was no more effective than placebo.
NICE guidance concerning
the use of St John's wort in depression states (6):
- although there
is evidence that St John's wort may be of benefit in mild or moderate depression,
healthcare professionals should not prescribe or advise its use by patients because
of uncertainty about appropriate doses, variation in the nature of preparations
and potential serious interactions with other drugs (including oral contraceptives,
anticoagulants and anticonvulsants)
- patients who are taking St John's
wort should be informed of the different potencies of the preparations available
and the uncertainty that arises from this. They should also be informed of the
potential serious interactions of St John's wort with other drugs (including oral
contraceptives, anticoagulants and anticonvulsants
- Drug and Therapeutics Bulletin (2003); 41 (8): 63.
- Evidence Based
Medicine (1999); 4(3): 82.
M et al. Hypericum extract versus imipramine or placebo in patients with moderate
depression: randomised multicentre study of treatment for eight weeks. BMJ 1999;
RC et al. Effectiveness of St John's wort in major depression. A randomized controlled
trial. JAMA 2001; 285: 1978-86.
Depression Trial Study Group. Effect of Hypericum perforatum (St John's wort)
in major depressive disorder. JAMA 2002; 287: 1807-14.
(December 2004). Management of depression in primary and secondary care
Last reviewed 01/2018