St. John’s wort for depression: likely effective

Does the traditional medicinal plant St. John’s wort deserve a place in modern depression therapy?

St. John’s wort is considered a natural mood enhancer. Rightly so: it can probably help with depression as well as antidepressants.

All people go through life stages where they are sad or lack joy and energy. But: Such bad times are not to be confused with depression. Depression doesn’t go away on its own. Depressed people suffer from profound despondency and listlessness. They withdraw or have difficulty coping with everyday life and professional life [2].

Depression is a serious illness. In many cases, however, it can be cured, for example with psychotherapy and drugs (antidepressants) [3].

support from nature

In addition, there are preparations of St. John’s wort (Hypericum perforatum). Extracts from the yellow flowering plant are considered natural mood enhancers and are said to help with depression. At least these remedies have been used for centuries [4]. But – tradition or not – is St. John’s wort effective?


St. John’s wort: effective for mild to moderate depression

Probably yes. For mild to moderate depression, St. John’s Wort supplements are likely to work better than a placebo. This is evidenced by the summary results of the best available studies [1]:

  • With St. John’s wort extract, about 56 out of 100 affected people have improved.
  • About 35 out of 100 people on a placebo got better.

St John’s wort preparations probably work as well as antidepressants. These include, for example, the active ingredients citalopram, sertraline or fluoxetine.

It is unclear whether the effects of St. John’s wort last or perhaps lessen over time. In the studies, participants were not followed up for more than 8 weeks.

St. John’s wort and antidepressants can relieve symptoms, but neither remedy can likely cure depression permanently. In case of severe depression, one should not rely on the effects of St. John’s wort alone. Here the effectiveness of the plant extract is not sufficiently proven.

Better tolerated than drugs

St John’s wort supplements are generally well tolerated, apparently even better than antidepressants. This is also demonstrated by the summarized results of the study [1].

St. John’s wort can still have side effects – nausea, skin irritation, or headache, for example. St. John’s wort can also cause sunburn-like symptoms when exposed to the sun, which experts call phototoxic reactions. [4,5].


Attention interaction!

You should be careful if you combine St. John’s wort with other medicines. Preparations based on St. John’s wort can adversely affect their effect. Medicines to thin the blood or to suppress the immune system (immunosuppressants), for example, may be less effective when taken at the same time. The reliability of the contraceptive pill may also decrease.

In any case, St. John’s wort is not compatible with antidepressants: the undesirable effects of the substances can increase in combination [4,5].

People taking St. John’s wort should definitely tell their doctor to avoid dangerous interactions with other medications. Self-medication without medical supervision is never a good idea – anyone who suspects depression should speak to a doctor.

Other than melancholy

Depression is a common disease. About 16-20 in 100 people will develop a depressive disorder in their lifetime [2]. Depression makes you listless and takes away the joy of the things you enjoyed doing. Patients often have difficulty concentrating, sleep poorly, or feel that their mind is not working properly. Add to that insecurity and guilt. Depression can lead to suicidal thoughts, in the worst case to suicide.

help with depression

If you are familiar with these symptoms and suspect you are suffering from depression, contact someone you trust and seek professional support together. The contact persons can be the family doctor or specialists in psychiatry and psychotherapy. In the event of an emergency, the telephone advice service in Austria can be reached 24 hours a day under number 142.

You can find more information on depression, how it can develop and what treatment options are available at www.gesundheitsinformation.de.

History:
07/11/2022: During a new search we found a current overview article. Their findings raised confidence in our previous assessment.
16/01/2015: First publication of the article.

Studies in detail

What studies did we consider?

In our research, we looked for randomized controlled trials. People suffering from depression are randomly divided into two groups. One group takes a St. John’s wort supplement, the other group a placebo or a common antidepressant drug. To rule out a placebo effect, participants would not have to know which group they belong to – the study should therefore be “blinded”. Because depression medications take a few weeks to take effect, studies should last at least six weeks to provide meaningful results.

We found a systematic review that summarized the results of all these available randomized controlled trials of St. John’s wort [1]. A total of over 6,000 people took part in these studies.

The review article was published in 2016. We then also searched the databases for studies that were published later, but found nothing. The results of the review therefore appear to be the most recent available.

How significant are the studies?

The review was conducted according to strict scientific criteria and we can understand the analyzes and conclusions that came from it. However, the quality of the studies summarized there varies considerably. Under the confidence in the result is relatively high. However, some uncertainties remain. Because the individual studies are very different and often they didn’t look at the same things in the same way.

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