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Open Source Apothecary At Home / The herbs
Effective for mild to moderate depression in trials — and the longest drug-interaction list in the herbal pharmacopoeia. — Hypericum perforatum
remedySt John's wort (Hypericum perforatum) is one of the very few herbal medicines with systematic-review evidence of effectiveness for a serious condition: mild to moderate depression.
What the evidence supports. Meta-analyses show effectiveness superior to placebo and comparable to standard antidepressants for mild to moderate depression, with fewer side effects. The evidence in severe depression is not sufficient, and severe depression needs clinical care.
Why it is nonetheless one of the more dangerous herbs in the cabinet. St John's wort is a potent inducer of CYP3A4 and P-glycoprotein. That means it reduces blood levels of a very long list of drugs — hormonal contraceptives (with documented contraceptive failure), ciclosporin and other immunosuppressants, some HIV medicines, anticoagulants, some cancer treatments and many others. A herb that quietly makes someone's medication stop working is more dangerous than one that causes obvious side effects.
It is also photosensitising. A photosensitising herb is an obvious mismatch for conditions treated with bright-light therapy, and it increases sunburn risk.
Do not combine it with an SSRI or other serotonergic drug — serotonin syndrome risk.
And it must be tapered, not stopped abruptly, after long use, like any antidepressant.
Our research supports the use of SJW as it reduced the number of depressive patients and their HAMD scores while having fewer risks and side effects than conventional medications.PubMed 36226689 ↗
The results of a meta-analysis of 12 RCTs indicate that TCM intervention can improve the clinical treatment efficacy of CAG.PubMed 38170849 ↗
Based on the current data and clinician input, a range of nutraceuticals and phytoceuticals were given either a supportive recommendation or a provisional recommendation across a range of various psychiatric disorders.PubMed 35311615 ↗
Available data from randomized, controlled clinical trials support that saffron is significantly more effective than placebo (g = 0.891; 95% CI: 0.369 - 1.412, p = 0.001), and non-inferior to tested antidepressant drugs (g = - 0.246; 95% CI: - 0.495 - 0.004, p = 0.053).PubMed 30036891 ↗
Our studies show that meta-analyses are important in the area of natural products to provide necessary information on their use in overall medication plans in order to avoid unintended interactions.PubMed 30660822 ↗
For patients with mild-to-moderate depression, St John's wort has comparable efficacy and safety when compared to SSRIs.PubMed 28064110 ↗
| | | |---|---| | Life | Perennial; spreads by runners | | Propagation | Seed, surface-sown, or division | | Light | Full sun | | Soil | Any; drought tolerant once established | | Spacing | 30-45 cm; it will spread aggressively | | Harvest | Flowering tops at full flower, midsummer | | Dry | Shade, ambient | | Note | The fresh flowering tops infused in oil make the traditional red oil |
Cut at full flower in dry conditions. The oil made from fresh flowering tops turns a deep red as the hypericin extracts — the traditional St John's wort oil, used topically for nerve pain and wounds.
Tea — 2 teaspoons dried flowering tops per cup, 10 minutes, up to three times daily. The trials mostly used standardised extracts rather than tea.
Tincture — the conventional form; fresh or dried flowering tops in alcohol.
Standardised extract — what most of the clinical trials used; 300 mg three times daily is the common trial dose.
Red oil — fresh flowering tops macerated in oil in sunlight for several weeks until deep red; for topical use on nerve pain, bruises and wounds.
Tapering — do not stop abruptly after long use.