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Psychosomatics 44:271-282, August 2003
© 2003 The Academy of Psychosomatic Medicine


Review

St. John's Wort: A Systematic Review of Adverse Effects and Drug Interactions for the Consultation Psychiatrist

Paul Hammerness, M.D., Ethan Basch, M.D., Catherine Ulbricht, Pharm.D., E.-P. Barrette, M.D., Ivo Foppa, M.D., Sc.D., Samuel Basch, M.D., Steve Bent, M.D., Heather Boon, B.Sc.Phm., Ph.D., and Edzard Ernst, M.D., Ph.D., F.R.C.P., for the Natural Standard Research Collaboration

Received May 30, 2002; revision received July 3, 2002; accepted Dec. 13, 2002. From Harvard Medical School, Boston; Massachusetts General Hospital, Boston; Northeastern University, Chicago; the Natural Standard Research Collaboration, the University of Rhode Island, Kingston, R.I.; the University of California, San Francisco; Mt. Sinai School of Medicine, New York; the University of Toronto, Toronto, Ont. Canada; the University of Exeter, Exeter, U.K.; the University of Plymouth, Plymouth, U.K.; Case Western Reserve University School of Medicine, Cleveland; and Harvard School of Public Health, Boston. Address reprint requests to Dr. Ulbricht, Natural Standard Research Collaboration, P.O. Box 390709, Cambridge, MA 02139-0008; kate{at}naturalstandard.com (e-mail).

St. John's wort is an herb commonly used in Europe for decades and more recently the topic of scientific investigation in this country. St. John's wort has been found more effective than placebo and equally as effective as tricyclic antidepressants in the short-term management of mild-to-moderate depression. Comparisons to selective serotonin reuptake inhibitors have provided equivocal data. While it is generally well tolerated in clinical use, there is accumulating evidence of significant interactions with drugs. This evidence-based presentation of the literature includes a brief description of pharmacodynamics and clinical applications, followed by a systematic review of adverse effects, toxicity, and drug interactions.




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