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St. John's Wort Not Effective for Major Depression

In small studies with methodologic flaws, researchers have shown St. John's wort (Hypericum perforatum) to be effective for treating depression. With support from a manufacturer of antidepressants and St. John's wort products, investigators at 11 U.S. academic medical centers conducted a randomized, double-blind, placebo-controlled trial of St. John's wort extract.

Two hundred outpatients with major depression were enrolled; excluded were patients with other psychiatric diagnoses and those who previously had used herbal preparations. Participants (mean age, 42; 67 percent female; 85 percent white) had had their current major depressive disorder for a mean of 2.5 years. After 1 week of placebo run-in for all participants and 8 weeks of assigned treatment, multiple measures showed that St. John's wort (900 to 1200 mg/day) was no more effective than placebo.

Comment: The negative results of this well-conducted trial stand in stark contrast to the findings of multiple smaller and less rigorously conducted studies of St. John's wort for depression. For now, it is prudent to conclude that St. John's wort does not produce clinically meaningful responses in the treatment of major depression, at least among people with relatively chronic symptoms who obtain psychiatric treatment in academic medical centers and who do not initially self-treat with herbal preparations. We must await future studies to find out whether St. John's wort truly is effective for patients unlike those in this study.

— WC Taylor

Published in Journal Watch General Medicine May 8, 2001

Citation(s):

Shelton RC et al. Effectiveness of St John's wort in major depression: A randomized controlled trial. JAMA 2001 Apr 18 285 1978-1986.

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