Hypericum perforatum L. Extracts (St. John’s Wort)
Statement of the Problem
To determine the efficacy of nutritional supplements (Hypericum perforatum L.) in the treatment
and prevention of suicide, and other closely related mental conditions, including, depression,
anxiety, and risk-taking behaviors.
Summary of the relevant literature
Hypericum perforatum L., most widely known as St. John’s Wort (SJW), is a medicinal plant
with established antidepressant properties. There have been multiple randomized, double-blind
studies that have compared SJW to placebo as well as to standard antidepressants in the
treatment of depression. In a review of the literature it was found that 16 out of the 18 placebo
controlled trials found a decrease in depressive symptoms in the groups receiving SJW (Linde,
Berner & Kriston, 2008). The same review analyzed 17 trials comparing SJW to standard
antidepressants and found there were no relevant differences in the treatment outcomes between
the groups, however; participants using SJW were less likely to drop out of the study and
reported less negative side effects (Linde, Berner & Kriston, 2008). A year long safety study was
conducted and found that SJW not only has no long term side effects but is also suitable for
relapse prevention (Brattstrom, 2009). A more recent a study looked at how SJW effected
depression relapse and recurrence compared to a placebo and a standard antidepressant. It was
found that SJW is more efficient in lowering depression relapse and recurrence rates of
responders when compared to an antidepressant and placebo (Singer, Schmidt, Hauke & Stade,
2011). SJW is empirically supported as an effective treatment of depression. SJW has been
shown to produce the same results as antidepressants but with fewer side effects. In addition,
SJW does not have any long term effects.
There have been few studies looking at the effects of SJW on anxiety. Only four RCTs and two
uncontrolled observational studies have been completed looking at treating anxiety with SJW.
The published studies present contradictory results (Lakhan & Vieira, 2010).
Side Effects: There is a risk of drug interactions between hypericum and other drugs. An
interaction was recently discovered between hypericum and Indinavir, a protease inhibitor used
to treat HIV (FDA, 2000). It is possible that hypericum has interactions with other protease
inhibitors as well as other types of drugs.
Gaps in the literature
There is no literature looking specifically at SJW as a treatment intervention for suicide or how it
affects risk taking behaviors. There is also not sufficient evidence for or against using SJW as a
treatment for anxiety. More research is needed to draw a conclusion.
Despite having multiple empirical studies supporting SJW as a treatment of depression it would
be helpful to investigate SJW and how it affects suicide.
Information on potential interactions between SJW and commonly prescribed medications for the treatment of depression and anxiety is needed in order to assess the safety of combined use. Recommendations Review of the current literature suggests that SJW is a safe and effective treatment option for major depression, a well known correlate of suicide risk. There is insufficient data on which to base recommendations for treatment of anxiety. Due to the complete lack of research examining SJW directly as a suicide prevention agent, use for this purpose cannot be recommended at this time. References Brattstrom, A. (2009). Long-term effects of St. John’s wort (Hypericum perforatum) treatment:
A 1-year safety study in mild to moderate depression. Phytomedicine,16
, 277-283. doi:
Lakhan, E., & Vieira, K. (2010) Nutritional and herbal supplements for anxiety and anxiety-
related disorders: Systematic review. Nutrition Journal, 9,
Linde, K., Berner, M.M., & Kriston, L. (2008). St. John’s wort for major depression. Cochroane
Database of Systematic Reviews 4,
1-107. doi: 10.1002/14651858.CD000448.pub3.
Singer,A., Schmidt, M., Hauke, W., & Stade, K. (2011) Clinical trials with hypericum extracts
in patients with depression-Results, comparisons, conclusions for therapy with
antidepressants drugs. Phytomedicine ,9,
468-474. doi: 10.1016/j.phymed.2011.02.016.
U.S. Food and Drug Administration (FDA). (2000). FDA Public Health Advisory. Retrieved
Approved by: Peter M. Gutierrez, Ph.D. and Thomas Joiner, Ph.D.
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