Ng Qin Xiang, Venkatanarayanan Nandini, Ho Collin Yih Xian
Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore.
University of Nottingham Medical School, Queen's Medical Centre, Nottingham NG7 2UH, United Kingdom.
J Affect Disord. 2017 Mar 1;210:211-221. doi: 10.1016/j.jad.2016.12.048. Epub 2017 Jan 3.
St John's wort is a popular herbal remedy recommended by Traditional Chinese Medicine (TCM) practitioners and licensed and widely prescribed for depression in many European countries. However, conflicting data regarding its benefits and risks exist, and the last large meta-analysis on St John's wort use for depression was done in 2008, with no updated meta-analysis available.
Using the keywords [St John's Wort OR Hypericum perforatum OR hypericin OR hyperforin OR johanniskraut OR] AND [depression OR antidepressant OR SSRI], a preliminary search (without language restriction) on the PubMed, Ovid, Clinical Trials Register of the Cochrane Collaboration Depression, Anxiety and Neurosis Group, Cochrane Field for Complementary Medicine, China National Knowledge Infrastructure and WanFang database yielded 5428 papers between 1-Jan-1960 and 1-May-2016.
27 clinical trials with a total of 3808 patients were reviewed, comparing the use of St John's wort and SSRI. In patients with depression, St John's wort demonstrated comparable response (pooled RR 0.983, 95% CI 0.924-1.042, p<0.001) and remission (pooled RR 1.013, 95% CI 0.892-1.134, p<0.001) rate, and significantly lower discontinuation/dropout (pooled OR 0.587, 95% CI 0.478-0.697, p<0.001) rate compared to standard SSRIs. The pooled SMD from baseline HAM-D scores (pooled SMD -0.068, 95% CI -0.127 to 0.021, p<0.001) also support its significant clinical efficacy in ameliorating depressive symptoms.
Evidence on the long-term efficacy and safety of St. John's wort is limited as the duration of all available studies ranged from 4 to 12 weeks. It is also unclear if St John's wort would be beneficial for patients with severe depression, high suicidality or suicide risk.
For patients with mild-to-moderate depression, St John's wort has comparable efficacy and safety when compared to SSRIs. Follow-up studies carried out over a longer duration should be planned to ascertain its benefits.
圣约翰草是一种广受欢迎的草药疗法，被中医从业者推荐使用，并且在许多欧洲国家获得许可并被广泛用于治疗抑郁症。然而，关于其益处和风险的数据存在冲突，上一次关于圣约翰草治疗抑郁症的大型荟萃分析是在2008年进行的，目前尚无更新的荟萃分析。
使用关键词[圣约翰草或贯叶连翘或金丝桃素或贯叶连翘素或约翰草或]和[抑郁症或抗抑郁药或选择性5-羟色胺再摄取抑制剂（SSRI）]，在PubMed、Ovid、Cochrane协作网抑郁症、焦虑症和神经症组临床试验注册库、补充医学Cochrane领域、中国知网和万方数据库上进行初步检索（无语言限制），检索1960年1月1日至2016年5月1日期间的文献，共得到5428篇论文。
对27项临床试验（共3808例患者）进行了综述，比较了圣约翰草和SSRI的使用情况。在抑郁症患者中，圣约翰草的反应率（合并相对危险度0.983，95%可信区间0.924 - 1.042，p<0.001）和缓解率（合并相对危险度1.013，95%可信区间0.892 - 1.134，p<0.001）相当，且与标准SSRI相比，停药/退出率显著更低（合并比值比0.587，95%可信区间0.478 - 0.697，p<0.001）。基于汉密尔顿抑郁量表（HAM-D）基线评分的合并标准化均数差（合并标准化均数差 -0.068，95%可信区间 -0.127至0.021，p<0.001）也支持其在改善抑郁症状方面具有显著的临床疗效。
由于所有现有研究的持续时间为4至12周，关于圣约翰草长期疗效和安全性的证据有限。圣约翰草对重度抑郁症、高自杀倾向或自杀风险患者是否有益也尚不清楚。
对于轻至中度抑郁症患者，圣约翰草与SSRI相比具有相当的疗效和安全性。应计划进行更长时间的随访研究以确定其益处。
