Meta-Analysis Compares SSRIs, St. John's Wort Efficacy in Depression

St. John's wort has been used as an herbal remedy for over 100 years
St. John's wort has been used as an herbal remedy for over 100 years

St. John's wort and selective serotonin reuptake inhibitors (SSRIs) were effective in treating mild-to-moderate depression but St. John's wort was safer, a meta-analysis in Neuropsychiatric Diseasefound

Common SSRIs used to treat major depressive disorder include fluoxetine, paroxetine, sertraline, citalopram, escitalopram, and fluvoxamine. These antidepressants may cause various adverse effects such as nausea insomnia, and sexual dysfunction. St. John's wort has been used as an herbal remedy for over 100 years, and its safety and efficacy have been demonstrated in clinical trials. Its use to treat patients with depression, however, remains debated since some studies show no significant difference in safety and efficacy between St. John's wort and conventional SSRIs. 

Researchers from Beijing Anding Hospital and Beijing Institutes of Brain Disorders aimed to investigate the safety and efficacy of St. John's wort and SSRIs for the treatment of depression. They searched databases for studies that compared the treatment's safety and/or efficacy in depression from 1966-April 2015. 

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A total of 27 studies met the inclusion criteria for analysis, which included 3,126 patients. Overall, St. John's wort did not differ from SSRIs in clinical response, remission, and mean reduction in Hamilton Rating Scale for Depression score. The summary relative risk (RR) for all included studies for clinical response was 1.02 (95% CI: 0.96, 1.09; P=0.51). The combined summary RR of all studies for remission with St. John's wort vs. SSRIs was 1.07, (95% CI: 0.94, 1.22; P=0.308). 

St. John's wort had a significantly lower rate of adverse events vs. SSRIs (RR 0.77, 95% CI: 0.70, 0.84) and had less withdrawals due to adverse events. Withdrawal due to adverse events in the St John's wort extract group was significantly less vs. the SSRI group (OR =0.60, 95% CI: 0.39, 0.90, P=0.02). In addition, St. John's wort demonstrated superior safety in patients with depression. 

Study findings support the hypothesis that St. John's wort is an effective treatment for depression and that its efficacy was comparable to SSRIs in treating mild-to-moderate depression. St. John's wort may be a favorable choice in the management of depression due to its low cost, significant efficacy, and good safety profile. 

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