St. John’s Wort

Study findings are variable, but SJW may benefit patients with mild-to-moderate depression who have no suicidal ideation. Well-designed studies have been done on SJW treating major depression. Recommended doses are 300 to 900 mg orally once a day of a preparation standardized to 0.2 to 0.3% hypericin, to 1 to 4% hyperforin, or to both (usually).

St. John’s wort is also said to be useful for treating HIV infection because hypericin inhibits a variety of encapsulated viruses, including HIV, but has proven adverse interactions with protease inhibitors and non-nucleoside reverse transcriptase inhibitors (NNRTIs) and should therefore be avoided (1-2 References The flowers of St. John’s wort (Hypericum perforatum) (SJW) contain its biologically active ingredients, hypericin and hyperforin. SJW may increase central nervous system serotonin and... read more ).

SJW has also been claimed to treat skin disorders, including psoriasis, and attention-deficit/hyperactivity disorder (ADHD) in children.

Numerous randomized, placebo-controlled studies have evaluated safety and efficacy of SJW in treating mild-to-moderate depression and, recently, major depressive disorders (3-8 References The flowers of St. John’s wort (Hypericum perforatum) (SJW) contain its biologically active ingredients, hypericin and hyperforin. SJW may increase central nervous system serotonin and... read more ). SJW has also been compared with tricyclic antidepressants (amitryptiline, imipramine) and more recently with the selective serotonin reuptake inhibitors (SSRIs) fluoxetine, sertraline, and paroxetine (4-8 References The flowers of St. John’s wort (Hypericum perforatum) (SJW) contain its biologically active ingredients, hypericin and hyperforin. SJW may increase central nervous system serotonin and... read more ). Most placebo-controlled studies have shown that standardized extracts of SJW in the dose range of 300 mg to 900 mg once a day are moderately effective in the treatment of mild-to-moderate depressive symptoms. Some studies have shown equivalence of 900 mg of SJW to low-dose imipramine and low-dose fluoxetine. A study of patients with major depression failed to show significant improvement over either placebo or standard doses of sertraline over a short period of time (7 References The flowers of St. John’s wort (Hypericum perforatum) (SJW) contain its biologically active ingredients, hypericin and hyperforin. SJW may increase central nervous system serotonin and... read more ). However, the authors state that both SJW and sertraline were equally effective over long periods of time, indicating the potential alternative economic value of SJW as a therapeutic treatment of depression when taken at low doses and when drug interactions are not of concern (7 References The flowers of St. John’s wort (Hypericum perforatum) (SJW) contain its biologically active ingredients, hypericin and hyperforin. SJW may increase central nervous system serotonin and... read more ).

Overall, some studies show efficacy of SJW in treating mild depression, whereas in major depression most studies do not show efficacy. Differences in study design (lack of active control and placebo), study populations (major vs mild/moderate depression), length of time, and dosing of SJW or comparator agents are likely responsible for some variance in results.

A 2016 systematic review of 35 studies (6993 subjects) compared SJW to placebo or conventional antidepressants (9 References The flowers of St. John’s wort (Hypericum perforatum) (SJW) contain its biologically active ingredients, hypericin and hyperforin. SJW may increase central nervous system serotonin and... read more ). SJW was superior to placebo but not different than conventional antidepressants for mild-to-moderate depression. However studies were heterogenous and severe depression was not studied (9 References The flowers of St. John’s wort (Hypericum perforatum) (SJW) contain its biologically active ingredients, hypericin and hyperforin. SJW may increase central nervous system serotonin and... read more ). A 2017 meta-analysis of 27 studies (3808 subjects) compared SJW to SSRIs. SJW was comparable to SSRIs in response and remission for mild-to-moderate depression but had lower discontinuation rates (10 References The flowers of St. John’s wort (Hypericum perforatum) (SJW) contain its biologically active ingredients, hypericin and hyperforin. SJW may increase central nervous system serotonin and... read more ).

Two very small pilot studies show potential topical application relief from skin disorders, including psoriasis (11-12 References The flowers of St. John’s wort (Hypericum perforatum) (SJW) contain its biologically active ingredients, hypericin and hyperforin. SJW may increase central nervous system serotonin and... read more ). A small trial showed SJW (standardized to hypericin but not hyperforin) did not relieve symptoms of attention-deficit/hyperactivity disorder (ADHD) in children (13 References The flowers of St. John’s wort (Hypericum perforatum) (SJW) contain its biologically active ingredients, hypericin and hyperforin. SJW may increase central nervous system serotonin and... read more ).

Photosensitivity, dry mouth, constipation, dizziness, confusion, and mania (in patients with bipolar disorder) may occur. A rare case of supraventricular tachycardia was reported (14 References The flowers of St. John’s wort (Hypericum perforatum) (SJW) contain its biologically active ingredients, hypericin and hyperforin. SJW may increase central nervous system serotonin and... read more ). SJW is contraindicated in pregnant women.

Potential adverse interactions occur with cyclosporine, digoxin, iron supplements, monoamine oxidase inhibitors (MAOIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), oral contraceptives, opioids, protease inhibitors, SSRIs, tricyclic antidepressants, and warfarin, as well as some direct-acting oral anticoagulants (15-17 References The flowers of St. John’s wort (Hypericum perforatum) (SJW) contain its biologically active ingredients, hypericin and hyperforin. SJW may increase central nervous system serotonin and... read more ). (See also table .)

The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.