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St John's wort for depression

Meta-analysis of randomised controlled trials^*

Centre for Complementary Medicine Research, Department of Internal Medicine II, Technische Universität München, Munich

MICHAEL BERNER, MD

Department of Psychiatry and Psychotherapy, University of Freiburg, Germany

MATTHIAS EGGER, MD

Department of Social and Preventive Medicine, University of Berne, Switzerland

CYNTHIA MULROW, MD, MSc

University of Texas Health Science Center at San Antonio, Texas, USA

Correspondence: Dr med. Klaus Linde, Centre for Complementary Medicine Research, Department of Internal Medicine II, Technische Universität München, Kaiserstrasse 9, 80801 München, Germany. Tel: +49 89 726697 15; fax: +49 89 393484; e-mail: Klaus.Linde{at}lrz.tu-muenchen.de

Declaration of interest M.B. has received a grant for research on Hypericum from Schwabe and fees for speaking at a meeting. K.L. has received travel expenses for speaking at a symposium sponsored by Schwabe.

^* This review has been performed as an update of an existing Cochrane review; an expanded version will be published in the Cochrane Library.

Background Extracts of Hypericum perforatum (St John's wort) are widely used to treat depression. Evidence for its efficacy has been criticised on methodological grounds.

Aims To update evidence from randomised trials regarding the effectiveness of Hypericum extracts.

Methods We performed a systematic review and meta-analysis of 37 double-blind randomised controlled trials that compared clinical effects of Hypericum monopreparation with either placebo or a standard antidepressant in adults with depressive disorders.

Results Larger placebo-controlled trials restricted to patients with major depression showed only minor effects over placebo, while older and smaller trials not restricted to patients with major depression showed marked effects. Compared with standard antidepressants Hypericum extracts had similar effects.

Conclusions Current evidence regarding Hypericum extracts is inconsistent and confusing. In patients who meet criteria for major depression, several recent placebo-controlled trials suggest that Hypericum has minimal beneficial effects while other trials suggest that Hypericum and standard antidepressants have similar beneficial effects.

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