St John’s Wort for Depression
St John’s wort for depression – You’ve likely heard that one of St John’s wort uses is to treat depression but do you know what it is?
What is St John’s wort?
St John’s wort is actually an extract of the plant Hypericum perforatum and it has been used for centuries for medicinal purposes which includes the treatment of depression.
The St John’s wort extract is widely available. You may have come across preparations of it in health food shops and over the counter in pharmacies.
There are many different branded preparations of the St John’s wort and many will have different concentrations of the variety of compounds which form the entire preparation. This variation is thought to be a problem in clinical use.
Notwithstanding this St John’s wort is actually licensed as a treatment for depression in Germany.
You may be interested in reading in full the National Institute for Clinical Excellence determination of the composition of St John’s wort:
‘St John’s wort is known to contain at least 10 constituents or groups of components that may contribute to its pharmacological effects (Linde & Mulrow, 2004), but its exact mode of action is unknown. These include naphthodianthrons, flavonoids, xanthons and biflavonoids (Wagner & Bladt, 1994). In common with all herbal preparations, the quantity and proportions of each constituent varies among batches (Wang et al., 2004). Most commercial products are standardised with respect to hypericin content but it is not known if this is the only active component. Individual brands or batches of the same brand may, therefore, not be therapeutically equivalent. Many clinically important drug interactions have been reported (Committee on Safety of Medicines, 2000). St John’s wort may also cause photosensitivity.’
National Institute for Health and Clinical Excellence (2010) Depression: the treatment and management of depression in adults: National Clinical Practice Guideline 90.
Research into using St John’s wort for depression
A considerable amount of research effort has been devoted to determining whether or not St John’s Wort is effective as an antidepressant. So, what are the benefits of St John’s wort?
Well, the overall pattern of results seems to indicate that St John’s wort is useful as an antidepressant and better than placebo in most studies.
What may surprise you is that research has shown that it is overall as effective as prescription antidepressants for moderate depression. However, it may be less effective than antidepressants for severe depression.
In the interests of fidelity I quote verbatim the determination of the National Institute for Health and Clinical Excellence (2010) Depression: the treatment and management of depression in adults: National Clinical Practice Guideline 90.
‘St John’s wort is more effective than placebo on achieving response in both moderate and severe depression, and on reducing depression symptoms in moderate depression.
There appears to be no difference between St John’s wort and other antidepressants, other than in moderate depression where it is better at achieving response and in severe depression where it is less effective than low dose antidepressants in achieving response.
However, St John’s wort appears as acceptable as placebo, and more acceptable than antidepressants, particularly TCAs, with fewer people leaving treatment early due to side effects and reporting adverse events.’
Guidance to doctors regarding St John’s wort for depression
Despite the above findings, the actual guidance to doctors in the UK with regard to St John’s wort for depression is not to recommend its use as a natural antidepressant.
Mainly, it seems, because of the lack of detailed information about the quantity of active ingredient in the various preparations of the St John’s wort and because of the possible interactions with a number of other commonly used prescription drugs. NICE 2010 published this statement as the clinical practice recommendation to doctors:
‘Although there is evidence that St John’s wort may be of benefit in mild or moderate depression, practitioners should:
• not prescribe or advise its use by people with depression because of uncertainty about appropriate doses, persistence of effect, variation in the nature of preparations and potential serious interactions with other drugs (including oral contraceptives, anticoagulants and anticonvulsants)
• advise people with depression of the different potencies of the preparations available and of the potential serious interactions of St John’s wort with other drugs.’
National Institute for Health and Clinical Excellence (2010) Depression: the treatment and management of depression in adults: National Clinical Practice Guideline 90.
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