Clinical use of Hypericum perforatum (St John's wort) in depression: A meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of clinical trials
PubMed 28064110 · doi:10.1016/j.jad.2016.12.048
What was done
A systematic literature search across multiple databases (including PubMed, Ovid, Cochrane registers, CNKI, and WanFang) identified 27 clinical trials comprising 3,808 patients published between 1960 and 2016. The meta-analysis compared the efficacy and tolerability of St John's wort (Hypericum perforatum) directly against SSRIs in patients with depression.
What was found
St John's wort showed comparable response rates (pooled RR 0.983, 95% CI 0.924–1.042, p<0.001) and remission rates (pooled RR 1.013, 95% CI 0.892–1.134, p<0.001) to SSRIs. Changes in HAM-D scores were also comparable (pooled SMD -0.068, 95% CI -0.127 to 0.021, p<0.001). Patients receiving St John's wort had significantly lower discontinuation/dropout rates compared to those receiving SSRIs (pooled OR 0.587, 95% CI 0.478–0.697, p<0.001).
Why it matters
This meta-analysis demonstrates that St John's wort provides comparable antidepressant efficacy to standard SSRIs for mild-to-moderate depression, with fewer treatment discontinuations.
Limits
Study durations were brief (4 to 12 weeks), precluding conclusions about long-term efficacy or safety. Results cannot be generalized to severe depression or patients with high suicide risk. Specific extract formulations, dosages, and detailed adverse event profiles were not reported in the abstract.
Cited by
- supports St. John's wort has been shown to significantly improve both depression and anxiety.