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Brown et al. II (by Sarris), while agreeing that St. John’s wort is not a first-line
treatment for severe depression, concedes that at least one study does support such
use if medications are ineffective or poorly tolerated and no suicidal thinking is
evident.^15
- SUGGESTED BUT UNPROVEN USES: SEASONAL AFFECTIVE DISORDER: Based on a few
randomized studies, Brown et al. also recommend St. John’s wort for seasonal affective
disorder. However, the studies show no incremental benefit over light therapy alone. Other
uses, including anxiety, perimenopausal mood disorders, premenstrual syndrome, and
fibromyalgia, have been proposed, but neither Brown et al. nor Brown et al. II nor Lake and
Spiegel recommend using St. John’s wort for any of these uses. The relative risks St. John’s
wort compared to other CAM remedies weigh against experimentation outside of clinical
studies.
- ADJUNCTIVE USE - CAUTION: Brown et al. recommend that: “St. John’s wort can be useful
for mild depression, combined with other treatments, when there is need for an
incremental boost in antidepressant effect, if there is seasonal affective disorder, or when
somatic symptoms are prevalent.”^16 But see MAJOR RISKS below, concerning the danger
of serotonin syndrome. Adjunctive use of St. John’s wort is not yet evidence-based,
drug/herb interactions must be monitored and studied, and caution is advised. People
considering using St. John’s wort together with an antidepressant or other prescription
medicine are strongly advised to do so ONLY under a physician’s supervision. See Drug
Interactions below for more information.
- NEGATIVE EVIDENCE
According to Berkeley Wellness, a well-designed 2010 study found St. John’s wort
ineffective to relieve irritable bowel syndrome. According to Brown et al. II, high-quality
clinical trials have ruled out use of St. John’s wort for ADHD, obsessive- compulsive
disorder and social phobia.
