St John's wort for major depression
Key Finding
St. John's wort is as effective as conventional antidepressants for mild to moderate depression with fewer side effects.
Plain-English Summary
This comprehensive Cochrane meta-analysis evaluated 29 randomized trials including 5,489 patients with depression. Studies compared St. John's wort (typically 300-900mg daily) to placebo or conventional antidepressants.
Results showed that St. John's wort was significantly superior to placebo for treating major depression, with response rates similar to conventional antidepressants. The supplement was effective for mild to moderate depression, with larger studies showing more conservative but still positive effects.
St. John's wort was better tolerated than conventional antidepressants, with fewer side effects and lower dropout rates. The active compounds (hypericin and hyperforin) appear to work through multiple mechanisms including serotonin, dopamine, and norepinephrine reuptake inhibition. However, St. John's wort interacts with many medications through effects on liver enzymes, requiring careful consideration of drug interactions.