St. John's Wort

Abstract

This article reviews the historical background, active ingredients of St. John's Wort and the major double-blind placebo-controlled studies. Despite the two major failed clinical trials conducted in American Research Centers, most of the data reviewed support that hypericum extracts are more effective than placebo for the treatment of mild to moderate depressive illness. The authors examine the likely reasons for the failed studies and also describe drug interactions and the side effects of St. John's Wort. Those patients who are prescribed St. John's Wort should be closely monitored.

Management of the psychological comorbidities of dermatological conditions: practitioners' guidelines

“…SSRIs and SNRIs are widely prescribed and overall safe options that dermatologists can feel comfortable prescribing, but in cases where discomfort is too high, the over-the-counter herbal supplement, St. John’s wort (hypericum perforatum) has demonstrated effectiveness in mild-to-moderate depression 90–93. Adverse effects are uncommon (2.4%) and mild, including GI upset, headaches, and insomnia 90.…”

“…Adverse effects are uncommon (2.4%) and mild, including GI upset, headaches, and insomnia 90. Although effective and well-tolerated, it does affect the metabolism of various other drugs by acting as an inducer of the cytochrome p450 34A enzyme 94.…”

“…This activity can lead to decreased serum levels of other medications, like alprazolam, for instance. For this reason, St. John’s wort is contraindicated in patients taking cyclosporine to prevent organ transplant rejection or GVHD, as blood levels of cyclosporine can drop dangerously low and lead to serious consequences 90. Careful review of the patient’s medication list is thus necessary before recommending St. John’s wort, but this is a good alternative to prescription of antidepressants for those with mild disease.…”