St. John's wort (Hypericum perforatum L.)

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Evidence

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Depressive disorder (mild-to-moderate)
St. John's wort has been extensively studied in Europe over the last two decades, with more recent research in the United States. Short-term studies (1-3 months) suggest that St. John's wort is more effective than placebo (sugar pill), and equally effective as tricyclic antidepressants (TCAs) in the treatment of mild-to-moderate major depression. Comparisons to the more commonly prescribed selective serotonin reuptake inhibitor (SSRI) antidepressants, such as fluoxetine (Prozac®) or sertraline (Zoloft®), are more limited. However, other data suggest that St. John's wort may be just as effective as SSRIs with fewer side effects. Safety concerns exist as with most conventional and complementary therapies. 		A
Somatoform disorders
Somatoform disorders show physical symptoms that cannot be attributed to organic disease and appear to be of psychic origin. Early evidence shows that St. John's wort may help with somatoform disorders. Further research is needed to confirm these results. 		B
Anxiety disorder
Overall, there is currently not enough evidence to recommend St. John's wort for the primary treatment of anxiety disorders. 		C
Atopic dermatitis
Early study of hypericum-cream in the topical treatment of mild to moderate atopic dermatitis shows positive results. Further studies are needed before a firm recommendation can be made. 		C
Attention deficit hyperactivity disorder (ADHD) (children)
It is unclear whether St. John's wort is an effective treatment in children with ADHD. More study is needed to confirm these findings. 		C
Depression (children)
There is not enough evidence to determine if St. John's wort is an effective treatment for depression in children younger than 18 years of age. 		C
Nerve pain
Early study shows that St. John's wort may help neuropathic (nerve) pain. Further research is needed to confirm these results. 		C
Obsessive-compulsive disorder (OCD)
There are a few reported cases of possible benefits of St. John's wort in patients with obsessive-compulsive disorder (OCD). Currently there is not enough scientific evidence to recommend St. John's wort for this condition. 		C
Pain (burning mouth syndrome)
It is unclear whether St. John's wort is an effective treatment for pain associated with burning mouth syndrome. More study is needed. 		C
Pain relief (after surgery)
It is unclear whether St. John's wort is an effective treatment for pain after surgery. More study is needed. 		C
Peri-menopausal symptoms
There is currently not enough scientific evidence to recommend St. John's wort for this indication. 		C
Premenstrual syndrome (PMS)
Further studies are needed before a strong recommendation can be made. 		C
Seasonal affective disorder (SAD)
Despite some promising early data, there is currently not enough evidence to recommend St. John's wort for depressive disorder with seasonal pattern or Seasonal Affective Disorder (SAD). 		C
Social phobia
Results of early study on the efficacy of St. John's wort in social phobia are unclear. More study is needed. 		C
Depressive disorder (severe)
Studies of St. John's wort for severe depression have not provided clear evidence of effectiveness. 		D
Human immunodeficiency virus (HIV)
Anti-viral effects of St. John's wort have been observed in laboratory studies, but were not found in one human study. Multiple reports of significant adverse effects and interactions with drugs used for HIV/AIDS, including protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs), suggest that patients being treated for HIV/AIDS should avoid this herb. Therefore, there is evidence to recommend against using St. John's wort in the treatment of patients with HIV/AIDS. 		D

Key to grades
A Strong scientific evidence for this use
B Good scientific evidence for this use
C Unclear scientific evidence for this use
D Fair scientific evidence against this use (it may not work)
F Strong scientific evidence against this use (it likely does not work)

Grading rationale

Uses based on tradition or theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Abdominal discomfort or irritation, abrasions (topical), alcoholism, allergies, anti-inflammatory, anti-malarial, antioxidant, antiviral, asthma, athletic performance enhancement, bacterial skin infections (topical), bedwetting, benzodiazepine withdrawal, bruises (topical), burns (topical), cancer, chronic bowel irritation, chronic ear infections, colitis, contusions, dental pain, diarrhea, diuretic (increasing urine flow), dyspepsia, Epstein-Barr virus infection, fatigue, glioma (brain tumor), heartburn, hemorrhoids, herpes virus infection, hypnotic, immune function, influenza, insomnia, joint pain, liver protection from toxins, malaria treatment, menstrual pain, mood disorders (menopause), nicotine withdrawal, rheumatism, skin scrapes, sleep, snakebites, sprains, substance abuse, ulcers, weight loss, wound healing (topical).

Dosing Related terms
NS_patient-stjohnswort Portions of this document last updated: Oct. 1, 2012

THIS EVIDENCE-BASED MONOGRAPH WAS PREPARED BY
THE NATURAL STANDARD RESEARCH COLLABORATION
(www.naturalstandard.com)

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