St. John’s Wort Effective for Depression, But without SSRI Side Effects

St. John’s wort, an herbal remedy readily available as a dietary supplement, may treat depression as effectively as SSRIs (selective serotonin reuptake inhibitors), but with fewer side effects compared to the prescription antidepressants.

Researchers in China conducted a meta-analysis — a study of prior studies — of studies conducted between 1966 and April 2015 comparing the efficacy and/or safety of St. John’s wort with SSRIs. A total of 27 such studies accounting for 3,127 people with depression were identified.

SSRIs are the most commonly prescribed antidepressants. Brand names include Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline) and Lexapro (escitalopram). Common side effects associated with SSRIs include insomnia, nausea and sexual dysfunction.

Overall, St. John’s wort was found to do as well as SSRIs in terms of reduction in depression symptoms, clinical response and remission of depression. However, St. John’s wort was associated with far fewer adverse events; the researchers wrote in the journal Neuropsychiatric Disease and Treatment.

Also, far fewer patients who were taking St. John’s wort withdrew from trials due to adverse events compared to those on SSRIs. The herbal supplement also had better safety in patients with depression compared to those on an antidepressant.

However, before you consider St. John’s wort as a potential treatment option, you should be aware it has side effects of its own. Combining St. John’s wort with antidepressants can cause dangerously high levels of serotonin in the body (a condition known as serotonin syndrome) that can lead to tremor, diarrhoea or severe confusion.

Also, psychosis is a rare, but possible, side effect of St. John’s wort. The supplement can also interact with many other drugs, including birth control pills, blood thinners and certain cancer medications.

“Given the low cost of treatment with St John’s wort extract versus SSRIs, its significant efficacy, and good safety profile, St John’s wort extract may be a preferred therapeutic choice in the management of depression,” the researchers conclude.

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