St. John's Wort (Hypericum perforatum): A Review of its Potential Antidepressant Efficacy and Safety

Mohsin Ahmed ¹, Rownak Jahan ², Mohammed Rahmatullah ^2*

This review provides widely used St. John's Wort as a supplement for depression despite controversies among scientists regarding its efficacy and safety.

Abstract

Background: St. John's Wort (SJW), scientifically known as Hypericum perforatum, is widely utilized as an over-the-counter remedy for various ailments, particularly depression, despite lacking FDA approval. The active compounds in SJW, including hypericin, hyperforin, and flavonoids, are believed to alleviate depressive symptoms by inhibiting neurotransmitter reuptake. However, concerns regarding its safety arise from extensive drug-drug interactions, pointing to deficiencies in quality control and regulation of SJW distribution. Methods: This narrative review synthesizes existing literature on the therapeutic effects, safety profile, indications, and adverse effects of SJW in treating depression. It also examines the regulatory landscape surrounding SJW and highlights the necessity for standardized practices and comprehensive clinical trials. Results: SJW has shown efficacy in managing mild to moderate depression, with some studies suggesting it may offer benefits comparable to conventional antidepressants while exhibiting a more favorable side effect profile. However, significant safety concerns persist due to potential interactions with other medications, leading to adverse reactions such as serotonin syndrome. Current regulatory frameworks vary globally, with SJW classified as a dietary supplement in the U.S. and subjected to stricter regulations in Europe. Conclusion: Despite its widespread use and potential therapeutic benefits, the safety and efficacy of SJW in treating depression remain inadequately substantiated by clinical evidence. Enhanced regulatory measures and rigorous clinical research are imperative to clarify SJW's role in depression treatment and ensure its safe application in clinical practice. Inclusion in pharmacopeias and adherence to good manufacturing practices could further improve the quality and safety of SJW products.

Keywords: St. John's Wort, Hypericums, Hypericum perforatum, Johnswort, Emotional Depression, Major Depressive Disorder.

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