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A systematic review of St. John's wort for major depressive disorder.

Abstract

BACKGROUND

This systematic review evaluated St. John's wort (SJW) for the treatment of Major Depressive Disorder (MDD). The objectives of this review are to (1) evaluate the efficacy and safety of SJW in adults with MDD compared to placebo and active comparator and (2) evaluate whether the effects vary by severity of MDD.

METHODS

We searched PubMed, CINAHL, PsycINFO, CENTRAL, Embase, AMED, MANTIS, Web of Science, and ICTRP and existing reviews to November 2014. Two independent reviewers screened the citations, abstracted the data, and assessed the risk of bias. We included randomized controlled trials (RCTs) examining the effect of at least a 4-week administration of SJW on depression outcomes against placebo or active comparator in adults with MDD. Risk of bias was assessed using the Cochrane Risk of Bias tool and USPSTF criteria. Quality of evidence (QoE) was assessed using the GRADE approach.

RESULTS

Thirty-five studies examining 6993 patients met inclusion criteria; eight studies evaluated a hypericum extract that combined 0.3 % hypericin and 1-4 % hyperforin. The herb SJW was associated with more treatment responders than placebo (relative risk [RR] 1.53; 95 % confidence interval [CI] 1.19, 1.97; I(2) 79 %; 18 RCTs; N = 2922, moderate QoE; standardized mean differences [SMD] 0.49; CI 0.23, 0.74; 16 RCTs; I(2) 89 %, N = 2888, moderate QoE). Compared to antidepressants, SJW participants were less likely to experience adverse events (OR 0.67; CI 0.56, 0.81; 11 RCTs; moderate QoE) with no difference in treatment effectiveness (RR 1.01; CI 0.90, 1.14; 17 RCTs, I(2) 52 %, moderate QoE; SMD -0.03; CI -0.21, 0.15; 14 RCTs; I(2) 74 %; N = 2248, moderate QoE) in mild and moderate depression.

CONCLUSIONS

SJW monotherapy for mild and moderate depression is superior to placebo in improving depression symptoms and not significantly different from antidepressant medication. However, evidence of heterogeneity and a lack of research on severe depression reduce the quality of the evidence. Adverse events reported in RCTs were comparable to placebo and fewer compared with antidepressants. However, assessments were limited due to poor reporting of adverse events and studies were not designed to assess rare events. Consequently, the findings should be interpreted with caution.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42015016406 .

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  • Authors+Show Affiliations

    ,

    Pardee RAND Graduate School, RAND Corporation, 1776 Main St, PO Box 2138, Santa Monica, CA, 90407-2138, USA. eapaydin@rand.org.

    ,

    Akasha Center for Integrative Medicine, Santa Monica, CA, USA.

    ,

    RAND Corporation, Santa Monica, CA, USA.

    ,

    RAND Corporation, Santa Monica, CA, USA.

    ,

    RAND Corporation, Santa Monica, CA, USA.

    ,

    RAND Corporation, Santa Monica, CA, USA.

    RAND Corporation, Santa Monica, CA, USA.

    Source

    Systematic reviews 5:1 2016 09 02 pg 148

    MeSH

    Antidepressive Agents
    Complementary Therapies
    Depressive Disorder, Major
    Humans
    Hypericum
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    27589952

    Citation

    Apaydin, Eric A., et al. "A Systematic Review of St. John's Wort for Major Depressive Disorder." Systematic Reviews, vol. 5, no. 1, 2016, p. 148.
    Apaydin EA, Maher AR, Shanman R, et al. A systematic review of St. John's wort for major depressive disorder. Syst Rev. 2016;5(1):148.
    Apaydin, E. A., Maher, A. R., Shanman, R., Booth, M. S., Miles, J. N., Sorbero, M. E., & Hempel, S. (2016). A systematic review of St. John's wort for major depressive disorder. Systematic Reviews, 5(1), p. 148. doi:10.1186/s13643-016-0325-2.
    Apaydin EA, et al. A Systematic Review of St. John's Wort for Major Depressive Disorder. Syst Rev. 2016 09 2;5(1):148. PubMed PMID: 27589952.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - A systematic review of St. John's wort for major depressive disorder. AU - Apaydin,Eric A, AU - Maher,Alicia R, AU - Shanman,Roberta, AU - Booth,Marika S, AU - Miles,Jeremy N V, AU - Sorbero,Melony E, AU - Hempel,Susanne, Y1 - 2016/09/02/ PY - 2016/03/20/received PY - 2016/08/23/accepted PY - 2016/9/4/entrez PY - 2016/9/4/pubmed PY - 2018/1/31/medline KW - Antidepressant KW - Complementary and alternative medicine KW - Herb KW - Major depressive disorder KW - Meta-analysis KW - St. John’s wort KW - Systematic review SP - 148 EP - 148 JF - Systematic reviews JO - Syst Rev VL - 5 IS - 1 N2 - BACKGROUND: This systematic review evaluated St. John's wort (SJW) for the treatment of Major Depressive Disorder (MDD). The objectives of this review are to (1) evaluate the efficacy and safety of SJW in adults with MDD compared to placebo and active comparator and (2) evaluate whether the effects vary by severity of MDD. METHODS: We searched PubMed, CINAHL, PsycINFO, CENTRAL, Embase, AMED, MANTIS, Web of Science, and ICTRP and existing reviews to November 2014. Two independent reviewers screened the citations, abstracted the data, and assessed the risk of bias. We included randomized controlled trials (RCTs) examining the effect of at least a 4-week administration of SJW on depression outcomes against placebo or active comparator in adults with MDD. Risk of bias was assessed using the Cochrane Risk of Bias tool and USPSTF criteria. Quality of evidence (QoE) was assessed using the GRADE approach. RESULTS: Thirty-five studies examining 6993 patients met inclusion criteria; eight studies evaluated a hypericum extract that combined 0.3 % hypericin and 1-4 % hyperforin. The herb SJW was associated with more treatment responders than placebo (relative risk [RR] 1.53; 95 % confidence interval [CI] 1.19, 1.97; I(2) 79 %; 18 RCTs; N = 2922, moderate QoE; standardized mean differences [SMD] 0.49; CI 0.23, 0.74; 16 RCTs; I(2) 89 %, N = 2888, moderate QoE). Compared to antidepressants, SJW participants were less likely to experience adverse events (OR 0.67; CI 0.56, 0.81; 11 RCTs; moderate QoE) with no difference in treatment effectiveness (RR 1.01; CI 0.90, 1.14; 17 RCTs, I(2) 52 %, moderate QoE; SMD -0.03; CI -0.21, 0.15; 14 RCTs; I(2) 74 %; N = 2248, moderate QoE) in mild and moderate depression. CONCLUSIONS: SJW monotherapy for mild and moderate depression is superior to placebo in improving depression symptoms and not significantly different from antidepressant medication. However, evidence of heterogeneity and a lack of research on severe depression reduce the quality of the evidence. Adverse events reported in RCTs were comparable to placebo and fewer compared with antidepressants. However, assessments were limited due to poor reporting of adverse events and studies were not designed to assess rare events. Consequently, the findings should be interpreted with caution. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42015016406 . SN - 2046-4053 UR - https://www.unboundmedicine.com/medline/citation/27589952/full_citation L2 - https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-016-0325-2 DB - PRIME DP - Unbound Medicine ER -