Advantages and Disadvantages of Using St. John's Wort as a Treatment for Depression

Abstract

Background and objectives: St. John's wort (SJW) extracts are currently being used to treat depression of various degrees of severity. While many studies have shown it to be superior to placebo, data regarding the effectiveness of using SJW as a stand-alone treatment compared with standard antidepressants has yet to be proven conclusively. This study aims to understand the advantages and disadvantages of SJW as a treatment modality for depression.Methods: The authors searched PubMed, JAMA network, Springer Link, Elsevier, Google Scholar, and Scientific Progress databases, from 2011 through August 2021, using the following keywords: St John's wort, Hypericum perforatum, depression, antidepressant, complementary alternative medicine, economic evaluation depression St. wort, St John's wort and depression, antidepressant interactions. This yielded a total of 27 papers following a thorough removal of irrelevant content and dissemination in languages other than English.Results: In patients with mild and moderate depression, SJW proved superior to placebo. Certain studies comparing the efficacy of SJW versus selective serotonin reuptake inhibitors (SSRIs), especially fluoxetine, reported SJW to be more efficacious, while the majority reported no significant difference. Tricyclic antidepressants were also found to have similar efficacy as SJW. Moreover, treatment with SJW was also found to reduce postmenopausal depression. Regarding the safety profile, although SJW is better tolerated with fewer adverse effects when compared to standardized antidepressants, its predisposition to causing fatal serotonin syndrome, when used in conjunction with other serotonergic agents and drug interactions noted with CYP 450 drugs, raises a question in the safety profile.Conclusion: It is essential to acknowledge that SJW has been used as a treatment measure in Germany. Despite being only listed as a dietary supplement by the FDA and not a drug, SJW has shown to be comparable, if not more efficacious, than most standard treatment options for depression. SJW does prove to be an exciting piece of pharmacotherapy in the realm of mental health and post-menopausal treatment. More prospective studies will help us better understand its efficacy in mild and moderate depression and its ability to serve as a long-term agent. Considering its mechanism of action, its role in relieving patients suffering from an anxiety disorder is also worth considering.

Effect of St. John’s Wort (Hypericum perforatum L.) on Male Sexual and Reproductive Health: A Narrative Review

“…One study compared SJW with conventional antidepressants, including SSRIs and TCAs. The common adverse effects of SJW were comparable to those of conventional antidepressants, with the added benefits of low cost and minimal withdrawal symptom rates [63]. Although categorized solely as a dietary supplement by the Food and Drug Administration (FDA) and not classified as a drug [63], it is important to mention that while SJW has not obtained FDA approval owing to safety concerns, FDA-approved drugs with similar actions and side-effect profiles as SJW have been available for a long time [64].…”

Utility of pharmacogenetic testing to optimise antidepressant pharmacotherapy in youth: a narrative literature review

“…For instance, foods, including fruits, alcohol, teas, and herbs are commonly known to induce or inhibit the activity of drug metabolising enzymes, such as CYPs ( Fujita, 2004 ). For example, St John’s wort ( Hypericum perforatum ) extract has long been associated with relieving the symptoms of mild depression, demonstrating a high safety and efficacy profile ( Canenguez Benitez et al, 2022 ). However, research has shown that St John’s wort is a potent inducer of CYP enzyme CYP3A4, resulting in the enhanced metabolism and decreased blood concentration of drugs metabolised by this enzyme, including common antidepressants citalopram, fluoxetine, and sertraline ( Zhou et al, 2004 ).…”

Role of Phytoflavonoids in the Management of Anxiety and Depression: An Overview

“…20 . H. perforatum has been shown to elevate the level of different monoamines and 5HT in the cerebellum, amygdala, hippocampus, and prefrontal cortex by inhibiting monoamine neurotransmitters like a substance called (5-HT), noradrenaline, and dopamine levels 21 . One of the main purposes of H. perforatum is overexpression of the 5-HT receptors, which has the effect of upregulating the neurons, it in turn results in a dopamine-related component lowering the neurons' background activity.…”