Meta-analysis confirms efficacy and tolerability of Hypericum

In the secondary analysis published last year in the journal Advances in Clinical and Experimental Medicine , researchers compared the effects of St. John’s wort versus SSRIs or placebo in adults with depressive disorders. Controlled studies from large scientific databases, in which the Hamilton Depression Scale (HAM-D) was used in each case, were used as the data basis.

Depression is the most common mental disorder, with a prevalence of around 3.8% worldwide. The main symptom is anhedonia, but many other symptoms can also occur, such as mood swings and anxiety. In addition to psychotherapeutic methods, the use of selective serotonin reuptake inhibitors (SSRIs) is one of the most widespread treatment methods. St. John’s wort preparations (Hypericum perforatum) are considered a low-side-effect alternative to SSRIs.

In order to objectively evaluate the efficacy of Hypericum preparations compared to SSRIs and placebo, Zhao et al. conducted a meta-analysis [1]. The researchers used the following databases to search for relevant articles: Medline via PubMed; Cinahl via EBSCO; Scopus; Web of Sciences databases. A total of 14 studies with 2270 depressed patients were identified that met the predefined inclusion criteria** [1–15] (Table 1). The duration of the included studies was 6 weeks (7 studies), 8 weeks (4 studies), 12 weeks (2 studies) and 26 weeks (1 study). In 8 studies the reference substance was an SSRI (sertraline 4 studies, paroxetine 2 studies, fluoxetine 1 study, citalopram 1 study) and in 6 studies St. John’s wort extract was compared with placebo.

** The predefined inclusion criteria concerned study population, intervention, comparator arms, endpoints and PICOS.

According to the meta-analysis, the overall effectiveness of the treatment was in favor of St. John’s wort. The HAM-D score improved more with SSRIs than with SSRIs (pooled odds ratio of 2.44; 95% confidence interval [KI] 1.33-4.45).

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