title: Clinical use of Hypericum perforatum (St John's wort) in depression: A meta-analysis.
abstract: St John's wort is a popular herbal remedy recommended by Traditional Chinese Medicine (TCM) practitioners and licensed and widely prescribed for depression in many European countries. However, conflicting data regarding its benefits and risks exist, and the last large meta-analysis on St John's wort use for depression was done in 2008, with no updated meta-analysis available.
  
  
  
  Using the keywords [St John's Wort OR Hypericum perforatum OR hypericin OR hyperforin OR johanniskraut OR] AND [depression OR antidepressant OR SSRI], a preliminary search (without language restriction) on the PubMed, Ovid, Clinical Trials Register of the Cochrane Collaboration Depression, Anxiety and Neurosis Group, Cochrane Field for Complementary Medicine, China National Knowledge Infrastructure and WanFang database yielded 5428 papers between 1-Jan-1960 and 1-May-2016.
  
  
  
  27 clinical trials with a total of 3808 patients were reviewed, comparing the use of St John's wort and SSRI. In patients with depression, St John's wort demonstrated comparable response (pooled RR 0.983, 95% CI 0.924-1.042, p<0.001) and remission (pooled RR 1.013, 95% CI 0.892-1.134, p<0.001) rate, and significantly lower discontinuation/dropout (pooled OR 0.587, 95% CI 0.478-0.697, p<0.001) rate compared to standard SSRIs. The pooled SMD from baseline HAM-D scores (pooled SMD -0.068, 95% CI -0.127 to 0.021, p<0.001) also support its significant clinical efficacy in ameliorating depressive symptoms.
  
  
  
  Evidence on the long-term efficacy and safety of St. John's wort is limited as the duration of all available studies ranged from 4 to 12 weeks. It is also unclear if St John's wort would be beneficial for patients with severe depression, high suicidality or suicide risk.
  
  
  
  For patients with mild-to-moderate depression, St John's wort has comparable efficacy and safety when compared to SSRIs. Follow-up studies carried out over a longer duration should be planned to ascertain its benefits.
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore. Electronic address: ng.qin.xiang@u.nus.edu.
authors.forename: Qin Xiang
authors.initials: QX
authors.lastname: Ng
authors.affiliation: University of Nottingham Medical School, Queen's Medical Centre, Nottingham NG7 2UH, United Kingdom.
authors.forename: Nandini
authors.initials: N
authors.lastname: Venkatanarayanan
authors.affiliation: National University Hospital, National University Health System, Singapore 119074, Singapore.
authors.forename: Collin Yih Xian
authors.initials: CY
authors.lastname: Ho
mesh_terms: D000873:Anthracenes; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy*; D006801:Humans; D020902:Hypericum; D010569:Perylene / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010696:Phloroglucinol / Q000031:analogs & derivatives; D008517:Phytotherapy; D010936:Plant Extracts / Q000627:therapeutic use*; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D013729:Terpenes
chemical_list: D000873:Anthracenes; D000928:Antidepressive Agents; D010569:Perylene; D010696:Phloroglucinol; D010936:Plant Extracts; D017367:Selective Serotonin Reuptake Inhibitors; D013729:Terpenes; C004965:hypericin; C001654:hyperforin
keywords: Antidepressant; Complementary and alternative medicine; Depression; Hyperforin; Hypericin; St John's wort