Authors' objectives:

This report aims to assess the effectiveness of St John's wort as an antidepressant.

Authors' recommendations: With the passage of DSHEA, the FDA has less stringent authority governing St John's wort, and dietary supplements; therefore, clinical trials showing safety and effectiveness are not required. Variances exist in purity, strength, and potency. Strong marketing and belief by consumers that herbal supplements are 'natural', and therefore safe and effective, have resulted in increased use. Herbal supplements are taken based on self-diagnosis, beliefs or customs, advice of friends, or advice of nontraditional providers. This has created the potential for severe problems by users. Limited data exists demonstrating the effectiveness of St John's wort with mild to moderate depression. Safety, interactions, and toxicity have not been fully studied. Clinically significant drug interactions have recently been reported with St John's wort. All persons using St John's wort or herbal supplements should consult with their physician prior to using St John's wort or other herbal supplements. Additional data from well-designed, controlled studies is needed to determine the effectiveness and safety of St John's wort and its potential interactions with other drugs. Physicians should inquire if patients are taking any herbal supplements prior to prescribing any drug. Pharmacists should inquire if patients are taking any herbal supplements prior to dispensing any drug. Patients should be informed about possible complications, drug interactions, and food interactions that can occur with St John's wort and other herbal supplements. Patients who are currently taking indinavir, cyclosporine, or digoxin should not take St John's wort. The use of St John's wort has been shown to significantly decrease the concentration in the blood of indinavir (Crixivan), cyclosporine, and digoxin. Women should be informed that the effectiveness of oral contraceptives could be reduced by St John's wort. Due to a lack of clinical data, pregnant or nursing women should first contact their physician before taking St John's wort or any herbal supplement. Equal caution should be exercised when using herbal supplements and any drugs. FDA rules should require herbal supplements to be systematically studied, (including interactions with other drugs) in order to protect the public from harm.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.health.state.mn.us/htac/sjwmd.htm

Year Published: 2000

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Health Technology Advisory Committee

Contact Address: Queries should be referred to the Minnesota Department of Health (http://www.health.state.mn.us/)

Copyright: Health Technology Advisory Committee