title: Kava and St. John's Wort: current evidence for use in mood and anxiety disorders.
abstract: BACKGROUND
  Mood and anxiety disorders pose significant health burdens on the community. Kava and St. John's wort (SJW) are the most commonly used herbal medicines in the treatment of anxiety and depressive disorders, respectively.
  
  
  OBJECTIVE
  The objective of this study was to conduct a comprehensive review of kava and SJW, to review any evidence of efficacy, mode of action, pharmacokinetics, safety and use in major depressive disorder, bipolar disorder, seasonal affective disorder (SAD), generalized anxiety disorder, social phobia (SP), panic disorder (PD), obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).
  
  
  METHODS
  A systematic review was conducted using the electronic databases MEDLINE, CINAHL, and The Cochrane Library during late 2008. The search criteria involved mood and anxiety disorder search terms in combination with kava, Piper methysticum, kavalactones, St. John's wort, Hypericum perforatum, hypericin, and hyperforin. Additional search criteria for safety, pharmacodynamics, and pharmacokinetics were employed. A subsequent forward search was conducted of the papers using Web of Science cited reference search.
  
  
  RESULTS
  Current evidence supports the use of SJW in treating mild-moderate depression, and for kava in treatment of generalized anxiety. In respect to the other disorders, only weak preliminary evidence exists for use of SJW in SAD. Currently there is no published human trial on use of kava in affective disorders, or in OCD, PTSD, PD, or SP. These disorders constitute potential applications that warrant exploration.
  
  
  CONCLUSIONS
  Current evidence for herbal medicines in the treatment of depression and anxiety only supports the use of Hypericum perforatum for depression, and Piper methysticum for generalized anxiety.
authors.affiliation: School of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Queensland, Brisbane, Australia. j.sarris@uq.edu.au
authors.forename: Jerome
authors.initials: J
authors.lastname: Sarris
authors.forename: David J
authors.initials: DJ
authors.lastname: Kavanagh
mesh_terms: D000873:Anthracenes; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001007:Anxiety / Q000188:drug therapy*; D001643:Bridged Bicyclo Compounds; D006801:Humans; D020902:Hypericum; D020901:Kava; D019964:Mood Disorders / Q000188:drug therapy*; D010569:Perylene / Q000031:analogs & derivatives; D010696:Phloroglucinol / Q000031:analogs & derivatives; D008517:Phytotherapy; D010936:Plant Extracts / Q000627:therapeutic use*; D013729:Terpenes
chemical_list: D000873:Anthracenes; D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D001643:Bridged Bicyclo Compounds; D010936:Plant Extracts; D013729:Terpenes; D010569:Perylene; C004965:hypericin; D010696:Phloroglucinol; C001654:hyperforin