Herbal remedies. New England Journal of Medicine. Hypericum Depression Trial Study Group. Effect of Hypericum perforatum St. Nutritional and herbal supplements for anxiety and anxiety-related disorders: systematic review. Nutrition Journal. Complementary and alternative medicine usage for behavioral health indications.
Primary Care. Linde K. Cochrane Database of Systematic Reviews. Accessed at www. National Institute of Mental Health. What You Need To Know. National Institute of Mental Health Web site. European Journal of Pain. The treatment of minor depression with St. Journal of Psychiatric Research. Other References. Association between patient beliefs regarding assigned treatment and clinical response: reanalysis of data from the Hypericum Depression Trial Study Group.
Journal of Clinical Psychiatry. However, research consistently shows that it has fewer side effects than standard antidepressant medications. In most cases, it decreases their effects, but it can also increase them, potentially resulting in more frequent and severe side effects. It is important that you speak to your doctor before taking it if you are currently on any other medications.
The standard strength is 0. But given that the FDA does not recognize it as a drug, it is not regulated as such and products can vary greatly in strength. This makes accurate dosing difficult to determine, but most studies on St. Capsules or tablets seem to allow for more accurate dosing. Buying it from a reputable source can further ensure accurate dosing. Accurate dosing can be difficult to determine. Additionally, some evidence supports its use for the treatment of PMS, wound healing and symptoms of menopause.
John's wort and anxiety are connected mostly as a possible remedy to help people with anxiousness. In some people, it may have an opposite affect…. Some research shows St. Young men using the hair loss drug finasteride Propecia , may be at higher risk of depression, anxiety, and suicidal thoughts, a new study suggests. We break down some of the basics surrounding what masculinity is, how it harms men, and what we can do about it.
Ruined orgasms are about control, domination, and power. And with the right partner s , these aspects of kink can all be super sexy. Autosexual people are mainly sexually attracted to themselves. They typically experience little to no sexual attraction to other people. To embody a healthy sexual self, you must actively engage in yourself. It helps break it into stages: warm-up, action, climax, and reflection. Whether or not you use the term is up to you.
Two reviewers abstracted study-level information. Categorical data concerning study details were abstracted independently by both reviewers; free text information concerning study details were abstracted by one reviewer and checked by the review lead. The reviewers pilot-tested the data collection forms prior to data extraction to ensure agreement of interpretation.
Numerical outcome data were abstracted and checked by a single biostatistician. Interventions : details including amount and type of active compounds contained in the SJW supplement, dosage, co-intervention s.
Outcomes assessed : assessment measures and primary endpoint, method of data expression e. Study design : aim of study, inclusion and exclusion criteria, sample size and reported power calculations, funding source. Outcome data were based on intention-to-treat ITT analyses. In the absence of reported ITT data, we used the number randomized as the denominator; in the absence of the number randomized, we used the number of participants at follow-up. All studies were analyzed using the latest reported follow-up; however, studies reporting follow-up only for a subsample of treatment responders were not considered.
Follow-up used the baseline as the point of reference, not the end of treatment; most studies assessed treatment effects directly after the end of treatment but treatment duration varied. When multiple depression measures were available, we used HAMD scores to assess treatment effects on depression symptoms. Two reviewers independently assessed the risk of bias of included studies using the Cochrane Risk of Bias tool [ 9 ] and criteria used by the US Preventative Services Task Force [ 10 ].
The criteria were used to rate the quality of individual studies using the following guidelines [ 10 , 11 ]:. Fair : One or more of the following issues is found in the study: some though not major differences between groups exist at follow-up; measurement instruments are acceptable but not ideal, though are generally applied equally; some but not all important outcomes are considered; some but not all potential confounders are accounted for in analyses.
ITT analysis must be done. Critical appraisal assessments were used for sensitivity analyses by excluding poor quality studies to evaluate the robustness of findings. The primary aim of this systematic review was to determine effects of SJW on depressive symptoms, quality of life, and adverse events compared with placebo and active comparators. We differentiated effectiveness and comparative effectiveness analyses.
Placebo trials were used to estimate the treatment effect of SJW by demonstrating effects that go beyond placebo effects. A further key aim of the review was to determine the comparative effectiveness of SJW compared with standard antidepressant treatment both psychotherapy or antidepressant medication.
Comparative effectiveness results and equivalence assessments of the efficacy and safety took the consistency of effects across individual studies and the statistical power to detect a statistically significant difference between treatment groups into account.
For all efficacy outcomes and the number of patients with adverse events, we used the Hartung-Knapp-Sidik-Jonkman method for a random effects meta-analysis [ 12 — 14 ].
For specific adverse events, many of which are very rare, we used exact conditional methods to estimate ORs and CIs. We conducted preplanned subgroup analyses for different patient groups depending on the severity of depression. In studies comparing SJW to antidepressant medication we differentiated selective serotonin reuptake inhibitors SSRIs , tricyclic antidepressants imipramine, amitriptyline , and other e. Further meta-regressions were conducted to identify sources of heterogeneity across studies where appropriate.
We conducted sensitivity analyses to test the robustness of results e. Publication bias was assessed with the Begg and Egger tests; in the case of indications for bias, treatment estimates were estimated using the trim-and-fill method. The body of evidence was evaluated on the following dimensions: study limitations , inconsistency , directness , and precision.
The quality was downgraded when results were primarily based on studies with substantial limitations and suspected risk of bias; when results were inconsistent across individual studies or the result was based on a single study without replication in an independent research study; in the presence of substantial heterogeneity in pooled analyses and variation in the direction of effects; when conclusions were based on indirect evidence e.
The quality of evidence was graded on a 4-item scale:. High indicates that review authors are very confident that the effect estimate lies close to the true effect for a given outcome, as the body of evidence has few or no deficiencies.
As such, the reviewers believe the findings are stable and further research is very unlikely to change confidence in the effect estimate. Moderate indicates that the review authors are moderately confident that the effect estimate lies close to the true effect for a given outcome, as the body of evidence has some deficiencies. As such, the reviewers believe that the findings are likely to be stable, but further research may change confidence in the effect estimate and may even change the estimate.
Low indicates that the review authors have limited confidence that the effect estimate lies close to the true effect for a given outcome, as the body of evidence has major or numerous or both deficiencies. As such, the reviewers believe that additional evidence is needed before concluding either that the findings are stable or that the effect estimate lies close to the true effect. Very low indicates that the review authors have very little confidence that the effect estimate lies close to the true effect for a given outcome, as the body of evidence has very major deficiencies.
As such, the true effect is likely to be substantially different from the estimated effect; thus, any estimate of effect is very uncertain. We identified potentially relevant citations through the electronic database search and reference mining. We obtained 93 studies as full text. In total, 35 studies met inclusion criteria see Fig. All studies addressed the efficacy of SJW reporting on the rate of treatment responders, mean scores on depression scales, or the number of patients in remission.
Very few studies reported on relapse and quality of life and studies. In total, 34 studies addressed safety and reported on the number of patients with adverse events or the frequency of individual events. Table 2 shows key characteristics of the included studies. The summary of findings table Table 3 summarizes the review findings by comparator and outcome, the GRADE score, and the reason for downgrading the quality of evidence, where applicable.
To answer our first research question, we examined the efficacy and safety of SJW compared to both placebo and standard antidepressant treatment. We found evidence that SJW is associated with statistically significant improvement in depression symptoms compared to placebo.
SJW groups reported significantly more treatment responders RR 1. Both analyses indicated substantial heterogeneity that lowered the quality of evidence.
Sensitivity analyses showed very similar results when excluding poor quality studies indicating that the effects of SJW were not primarily driven by poor methodological quality. SJW vs. We found no statistically significant difference in the number of patients in remission comparing SJW and placebo RR 1. However, there was considerable heterogeneity which lowered the quality of evidence assessment and the direction of effects varied across studies: in the majority favoring SJW but two studies reported more patients in remission in the placebo arm.
Results were similar when excluding poor quality studies and between-study heterogeneity was not reduced. In the majority of studies the number of patients in remission was small in both treatment arms. The median follow-up time across studies was 6 weeks range 4—12 weeks. Relapse was only assessed in one study without replication by another study and did not indicate a statistically significant difference between SJW and placebo.
Quality of life was assessed in two fair quality trials; SJW treatment effects were shown to be superior for the mental but not for the physical component see Table 3. The total number of serious adverse events also did not differ significantly between patients who were administered SJW and those who were received a placebo OR 0. However, across studies, the adverse event assessments were limited and inadequate for the assessment of rare adverse events which lowered the quality of evidence.
Comparative efficacy. The included studies showed the efficacy of SJW for depression symptoms was comparable to antidepressant medication, with SJW being neither inferior nor superior. We found no systematic differences in the rate of treatment responders RR 1. The effects for the treatment responder rate and depression scale scores remained stable when analyses were limited to RCTs that had reported a power calculation and that had sufficient statistical power to detect differences between treatments treatment responders: RR 0.
Pooled estimates were similar when excluding poor quality studies; however, the study quality of this subset of studies was limited with mostly fair quality studies, which lowered our confidence in the evidence assessment. Patients who received SJW did not experience remission from depression at statistically significantly lower or higher rates than patients who received antidepressants RR 1.
However, studies reporting on remission were limited due to study quality and the statistical power to detect differences between interventions was unclear. The quality of evidence was downgraded accordingly. Only one RCT reported on depression relapse and quality of life and effect estimates were not replicated in another, independent study resulting in a very low quality of evidence rating Table 3.
All but one identified comparative study compared SJW to antidepressant medication. One study compared SJW and psychotherapy and no replication was identified in the literature. Comparative safety. In the included RCTs comparing SJW to standard antidepressant medications, there was evidence that more patients taking antidepressants experienced adverse events OR 0. Adverse events involving psychiatric or sexual functioning were also lower in patients treated with SJW, but only a small number of studies reported on these symptoms.
Serious adverse events did not differ statistically significantly between the treatment approaches OR 0. Subgroup analyses for different types of antidepressant medication were hindered by the small number of RCTs testing a specific antidepressant and reporting on specific adverse events. In the largest group of antidepressants used in studies, SSRIs, subgroup results were similar to the main analysis, but the difference in the number of participants with adverse events was not statistically significantly different OR 0.
There were fewer serious adverse events in the SJW group but the difference was not statistically significant OR 0. In studies on tricyclic antidepressants, more participants experienced adverse events than compared to SJW OR 0. One RCT in this subgroup that reported on serious adverse events reported the absence of events in both groups. The rigor of adverse event assessments and the reporting of recorded events varied greatly across studies.
Comparative analyses were potentially limited due to the lack of statistical power to show differences in individual rare events. In addition, the RCTs only addressed a limited range of potential adverse events. Consequently, the quality of evidence was downgraded, in particular when sensitivity analyses excluding poor quality studies could not be performed or suggested different effect estimates.
We also investigated the comparative effects of the different extracts used in included studies. We found only one study that compared two different standardized extracts and three studies that compared different dosages, none of which found statistically significant differences between treatment arms. An extract of 0. Review question 2: Is there a difference in effect, depending on the type of MDD i.
Of the identified studies, 12 included patients with either mild or moderate depression. Three studies are limited to patients with moderate depression alone. No study was identified that examined patients with mild depression alone. Finally, only one study was identified that focused exclusively on patients with severe depression.
We determined that the quality of evidence that suggested that there is no difference in SJW effectiveness depending on depression severity as very low Table 3. This was due to the fact that the results were based on an indirect comparison across studies a meta-regression , the majority of samples were in mixed patient samples of combined mild or moderate-severe depression, and the absence of data on patients with severe depression which limited the range of depression severity that was analyzed.
The effect of SJW among only patients with mild-moderate depression was similar to main analyses for treatment responders RR 1. Only three studies examined the effect of SJW on moderate depression against placebo, and all three showed significant effects in terms of treatment responder rate and depression scale scores [ 22 , 37 , 43 ].
But other SJW products have been found to have food coloring and other unwanted additives designed to confuse laboratory tests. Added coloring is especially problematic, because herbalists like St. The best herbs are picked when the flowers peak in summer, St. Ours says. Sign up for our newsletter to get the best of Tonic delivered to your inbox. Sign In Create Account. John's Wort for Depression. Psychiatrists tells us the risks and benefits of the most popular alternative to antidepressants.
August 13, , pm. When did it become so popular in the US? Is there scientific evidence that St. John's wort works for depression? Does it help with severe depression?
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