St. John's wort for depression

Abstract

Depression is a common and serious mood disorder, with nearly 7% of U.S. adults reporting at least one episode of major depression in the past year. The common adverse effects associated with antidepressants cause many patients to turn to alternative treatments like St. John's wort (Hypericum perforatum). This yellow-flowering plant is one of the most popular supplements promoted for depression, menopause symptoms, and mood disorders. St. John's wort blooms in June around the time of the feast of St. John the Baptist, thereby earning its name. This wild-growing plant has been used for centuries in traditional medicine to treat a variety of conditions, including kidney and lung ailments, insomnia, and depression, and to aid in wound healing. Several active components found in the leaves and flowers may be responsible for St. John's wort's healing properties. Many of the pharmacologic activities of St. John's wort appear attributable to hypericin, hyperforin, and several flavonoids. These organic compounds act to improve and regulate mood through inhibition of the uptake of neurotransmitters like serotonin, dopamine, and noradrenaline. St. John's wort leads to a downregulation of beta-adrenergic receptors and an upregulation of serotonin 5-HT(2) receptors. By causing changes in neurotransmitter concentrations implicated in depression, St. John's wort acts on several messengers in the brain, similarly to antidepressants. A 2016 in-depth analysis in Systematic Reviews evaluated the efficacy and safety of St. John's wort for treatment of major depressive order. The researchers examined 35 studies with 6,993 patients prescribed a hypericum extract of 0.3% hypericin and 1% to 4% hyperforin. St. John's wort showed clinical significance and appeared to be more effective compared with placebo. However, it is unclear if this holds true for severe depression or time periods longer than 12 weeks. A 2017 review in Journal of Affective Disorders detailed data from 27 clinical trials including 3,808 patients that compared St. John's wort and SSRIs. Results indicated that St. John's wort improved depression symptoms and was as effective as standard antidepressant medications for symptoms of mild and moderate depression. The authors also found a lower dropout rate for patients using St. John's wort over SSRIs. Lack of research on severe depression, limited study length, and poor reporting on adverse events mean the findings from both studies should be interpreted with caution. St. John's wort grows in the wild, and chopped or powdered forms of the dried herb are available in capsules, tablets, liquid extracts, and teas, all standardized to contain 0.3% hypericin. Because of its anti-inflammatory properties, oil-based topical lotions of St. John's wort are promoted for various skin conditions as well as wounds, bruises, and muscle pain. For mood disorders and mild to moderate depression, St. John's wort extract is well tolerated as 0.3% hypericin or 5% hyperforin at doses of 300 mg three times daily, with meals. For symptoms of menopause, St. John's wort extract may be taken in doses of 300 mg three times daily for 3 to 4 months. Overall, St. John's wort is considered safe, with few reported minor and uncommon adverse effects, including upset stomach, dry mouth, headache, fatigue, dizziness, confusion, sexual dysfunction, or sensitivity to sunlight when taken in large doses. Because St. John's wort is a stimulant, it may worsen feelings of anxiety in some people. Counsel patients that St. John's wort limits the effectiveness of many prescription medicines, including antidepressants, birth control pills, cyclosporine, digoxin, and oxycodone, among others. Caution pregnant or breastfeeding patients that there are insufficient data on the safety of St. John's wort during pregnancy and lactation, and it cannot be recommended. Depression can become a serious and severe illness if effective, professional help is not sought. Encourage patients to speak with their health care provider and not attempt to treat depression on their own.