St John's wort for depression: meta-analysis of randomised controlled trials.
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.


OBJECTIVE
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.
Linde
Klaus
K
Centre for Complementary Medicine Research, Department of Internal Medicine II, Technische Universität München, Munich, Germany. Klaus.Linde@lrz.tu-muenchen.de
Berner
Michael
M
Egger
Matthias
M
Mulrow
Cynthia
C
D000928:Antidepressive Agents / Q000627:therapeutic use; D003866:Depressive Disorder / Q000188:drug therapy*; D006801:Humans; D020902:Hypericum; D008517:Phytotherapy / Q000379:methods; D010936:Plant Extracts / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D000928:Antidepressive Agents; D010936:Plant Extracts