[Saint John's Wort as an antidepressant].

Although in Germany St. John's wort (Hypericum perforatum) is the most widely prescribed antidepressant, in the Netherlands little is known about it. Nevertheless patients ask for it more often or take it as self-medication. There has been much research into the antidepressant efficacy of hypericum extracts, but the methodological quality has been moderate. In recent years studies with a much better design were published in European journals. Hypericum extract in a dosage of 900 mg/day is effective in mild to moderately severe depressed outpatients. Maintenance therapy has not been studied sufficiently yet. The side effect profile is on a placebo level. Recently interactions with other medications were described (decrease of plasma level/clinical efficacy of protease inhibitors, warfarin, theophyllin, cyclosporin, third generation oral contraconceptives, digoxin and phenprocoumon). A patient's request to be treated with hypericum extract can be considered, e.g. if the patient experiences troublesome side effects on other drugs. In case hypericum is the initial antidepressant and the effect falls short of the expectations, treatment with a synthetic standard antidepressant should be applied.