Is St. John's Wort Effective in Treating Depression?

St. John's wort has been used for centuries to treat "nervous disorders" as well as heal wounds and burns.  Widely prescribed in Europe and especially Germany for treatment of mild to moderate depression, the herb has become popular in the United States as well.  But does it work and is it safe?  Should you recommend it to your patients?

What Do Studies Show About the Efficacy of St. John's Wort?

Scientific research indicates that St. Jon's wort is in fact effective in treatment of mild to moderate depression.  This flowering plant contains a chemical called hypercin thought to be the active chemical responsible for the plant's anti-depressive and anti-inflammatory properties.  Studies show that the herbal treatment has a similar efficacy to commonly prescribed SSRI's including Prozac, Celexa and Zoloft.  In studies comparing St. John's wort and SSRI's for treatment of depression not only did participants taking St. John's wort report relief of depressive symptoms, but fewer participants taking the herbal supplement dropped out of the study due to adverse side effects.  St. John's wort does not appear to have the most common side effect of SSRI's, decreased sex drive.  Studies are conflicting regarding the efficacy of St. John's wort in treatment of major depression.  St. John's wort has been shown to be effective and safe for treatment of depression in children and adolescents and is widely used in Germany for this purpose.  Research also indicates St. John's wort is also effective in treatment of premenstrual syndrome, menopause and seasonal affective disorder. 

How Should St. John's Wort Be Taken?

Sold over the counter, St. John's wort typically comes in 300mg capsules.  Capsules should be taken three times daily with meals.  Time-release capsules are also available for less frequent dosing.  Similar to SSRI's, it may take three to four weeks to feel the anti-depressive effects of the herb.  St. John's wort therapy should not be stopped abruptly but must be gradually tapered. 

Side Effects and Drug Interactions

Like all medications, taking St. John's wort can have side effects.  Reported side effects of St. John's wort include dizziness, dry mouth, headache, sedation, nausea and fatigue.  Side effects are reported in three percent of users.

Perhaps the most important precaution to consider in recommending St. John's wort to your patients is drug interactions.  St. John's wort may reduce the efficacy of anticonvulsants, cyclosporine, digoxin, HIV drugs, theophylline, warfarin and oral contraceptives.  It is not recommended that patients on these types of medications use St. John's wort for treatment of depression.  The effects of SSRI's and triptan drugs may be increased with St. John's wort and should also not be used concurrently.

Photosensitivity can occur when taking St. John's wort so users should take precautions to prevent sunburn.  The safety of the herb in pregnant and breastfeeding women is not established.

Should Healthcare Providers Recommend St. John's Wort for Treatment of Depression

Based on study results, St. John's wort is an excellent option for treatment of depression in your patients.  With a similar efficacy to commonly prescribed SSRI's and fewer side effects, St. John's wort should be considered for treatment of mild to moderate depression.  Patients must be closely questioned regarding their medication regimens so that interactions can be avoided.  Similarly to recommending any medication, patients should also be educated regarding the potential side effects of the herb and be cautioned to take it only as directed. 

 

Comments

Since herbal medications aren't 'prescribed' you just recommend thm similarly to how you might recommend your pateints take tylenol or motrin. You might do some research to find a brand you can recommend to your patients that is reputable and FDA approved. Also, make sure to tell them how much to take. Developing a handout is a good way to get this information across. Make sure you chart the handout was given or that you gave standard instructions and precautions. 

Erin Tolbert

As a wa state ARNP what is my scope of practice in recommending or 'prescribing' herbal medicine ? What type of written disclosure and/or consent should I obtain ?
Thank you for you guidance.

erin jacobson-kasler

Never would have thought of recommending an herbal remedy to my patients seeking treatment for depression. I just might try it!

Kasey