St. John’s wort (Hypericum perforatum) is commonly used to treat depression.

Is it more effective than placebo? Is it as effective as standard antidepressants?

Read on.

First, the details.

  • 29 studies in 5489 patients were included in the review.
  • There were 18 comparisons with placebo and 17 vs synthetic standard antidepressants.
  • Studies of several different St. John’s wort extracts were carried out in several countries.
  • Most studies included patients with mild to moderately severe symptoms.

And, the results.

  • Overall, St. John’s wort was superior to placebo.
  • It was as effective as standard antidepressants, with fewer side effects.
  • St. John’s wort was better tolerated than antidepressants.
    • The drop out rate in patients taking St John’s wort was 76% lower than patients on tri– or tetracyclic antidepressants.
    • It was 47% lower than in patients receiving selective serotonin reuptake inhibitors (SSRIs).
  • Findings were more favorable for St. John’s wort in studies from German-speaking countries.
    • In studies from other countries, St. John’s wort extracts seemed less effective.
  • The 9 smallest studies reported that St. John’s wort was 87% more effective, while the 9 largest studies reported an 28% better response.

The bottom line?
The reviewers think that differences in results between countries might be due to patients with different types of depression. It’s also possible that some smaller studies from German-speaking countries reported overoptimistic results.

Overall, the evidence suggests…

  • St. John’s wort is better than placebo to treat major depression.
  • It’s as effective as standard antidepressants.
  • It has fewer side effects than standard antidepressants.

10/10/08 10:44 JR

Hi, I’m JR

John Russo, Jr., PharmD, is president of The MedCom Resource, Inc. Previously, he was senior vice president of medical communications at, a complementary and alternative medicine website.