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St. John's Wort for Mild and Moderate Depression Outperforms Placebo and Is Comparable to Antidepressants, but the Evidence Has Limitations

• The review showed that SJW given as monotherapy for mild and moderate depression is superior to placebo in improving symptoms and not significantly different from antidepressant medication; however, there was evidence of substantial heterogeneity between studies.
• There is low quality evidence of no statistically significant difference in the number of patients in remission compared with placebo and antidepressants.
• Only two trials assessed quality of life.
• SJW adverse events reported in included trials were comparable to placebo groups, and there were fewer compared with antidepressant medication; however, adverse event assessments were limited and inadequate for rare events.
• We found no systematic difference between SJW extracts, but head-to-head trials are missing; LI 160 (0.3% hypericin, 1–4% hyperforin) was the extract with the greatest number of studies.