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Large-scale observational studies of hypericum extracts in patients with depressive disorders--a systematic review
1Department of Internal Medicine II, Centre for Complementary Medicine Research, Technische Universität München, Kaiserstr. 9, Munich 80801, Germany. klaus.linde@lrz.tu-muenchen.de
Insights
Hypericum extract (St. John's Wort) shows promise for treating mild to moderate depression. This review of observational studies found it well-tolerated with significant response rates in patients.
Area of Science:
- Pharmacology and Psychiatry
- Herbal Medicine Research
- Clinical Observational Studies
Background:
- Depressive disorders represent a significant global health burden.
- Hypericum extracts, commonly known as St. John's Wort, are frequently used for mood disorders.
- Evidence from observational studies on efficacy and tolerability in real-world settings is crucial.
Purpose of the Study:
- To systematically review observational studies on hypericum extracts for depressive disorders.
- To assess the efficacy and tolerability of hypericum mono-preparations in a large patient cohort.
- To evaluate both short-term and long-term treatment outcomes.
Main Methods:
- Systematic review of non-randomized observational studies.
- Inclusion criteria: ≥100 patients, depressive disorders, hypericum mono-preparations, ≥4 weeks treatment, clinical outcomes.
- Data extraction on patient demographics, interventions, and results by two independent reviewers.
Main Results:
- Sixteen studies with 34,804 patients were included, primarily focusing on mild to moderate depression.
- Short-term (4-6 weeks) response rates ranged from 65% to 100%, with dropout rates due to side effects between 0.0% and 2.8%.
- Long-term (52 weeks) data showed response rates of 60-69% and slightly higher dropout rates (3.4-5.7%); no serious adverse events were reported.
Conclusions:
- Hypericum extracts appear well-tolerated and effective for the routine treatment of mild to moderate depressive disorders.
- The quality of reporting in the included studies was generally insufficient.
- Further high-quality research is warranted to confirm these findings.
Abstract:
We present a systematic review of observational studies of hypericum extracts in the treatment of depressive disorders. We included non-randomized studies with at least 100 patients suffering from depressive disorders treated with hypericum mono-preparations for at least 4 weeks, which reported clinical outcomes. Potentially relevant studies were identified through searches in electronic databases (Medline, PubMed), contacts with manufacturers, and handsearching of proceedings of phytomedicine congresses. Information on patients, interventions, methods an results were extracted by two reviewers. Sixteen studies including a total of 34,804 (range 101-11,296) patients met the inclusion criteria. Most studies investigated short-term effects (4-6 weeks) in patients with mild to moderate depression. Response rates (according to physician assessment) varied between 65% and 100%, the proportion of patients dropping out due to side effects varied between 0.0% and 2.8%. Two studies investigated long-term effects (52 weeks). Reponse rates were 60% and 69%, respectively, and the proportions of patients dropping out due to side effects were 3.4% and 5.7%, respectively. Serious side effects or interactions were not reported in any study. The quality of reporting was insufficient in the majority of publications. The available studies show that hypericum extract are well tolerated and seem to be effective in routine treatment of mild to moderate depressive disorders.
