St John’s wort is effective for depression

Clinical question: 
How effective is St John's wort for patients with major depression?
Bottom line: 
St John's wort is superior to placebo in patients with major depression. It is as effective as standard antidepressants (tricyclics, tetracyclics and selective serotonin reuptake inhibitors), and has fewer side effects than standard antidepressants. The 29 trials reviewed lasted for 4 to 12 weeks and included 18 comparisons with placebo and 17 comparisons with synthetic standard antidepressants.
Caveat: 
Findings were more favourable for St John's wort extracts in studies from German-speaking countries where these products have a long tradition and are often prescribed by physicians. In studies from other countries, St John's wort extracts seemed less effective. The difference could be due to the inclusion of patients with slightly different types of depression, but it cannot be ruled out that some of the smaller studies from German-speaking countries were flawed and reported over-optimistic results.
Context: 
Extracts from St John's wort (Hypericum perforatum) are widely used for treating patients with depression. Hypericum extracts contain at least seven constituents or groups of components that may contribute to its pharmacological effects.¹ Extracts of St John's wort are licensed and widely used in Germany for the treat•ment of depressive, anxiety and sleep disorders. 1. Nahrstedt A, Butterweck V. Pharmacopsychiatry 1997;30(Suppl 2):12-134
Review CD#: 
CD000448
PEARLS No: 
147
Date: 
March, 2009
Authored by: 
Brian R McAvoy