Canenguez Benitez Johanna S, Hernandez Tabata E, Sundararajan Ramaswamy, Sarwar Sarosh, Arriaga Angel J, Khan Asma T, Matayoshi Andrea, Quintanilla Herbert A, Kochhar Hansini, Alam Mehwish, Mago Arpit, Hans Aakash, Benitez Guadalupe A
Internal Medicine, Larkin Community Hospital, South Miami, USA.
Internal Medicine, Jagadguru Sri Shivarathreeshwara (JSS) Academy of Higher Education and Research, Bangalore, IND.
Cureus. 2022 Sep 22;14(9):e29468. doi: 10.7759/cureus.29468. eCollection 2022 Sep.
St. John's wort (SJW) extracts are currently being used to treat depression of various degrees of severity. While many studies have shown it to be superior to placebo, data regarding the effectiveness of using SJW as a stand-alone treatment compared with standard antidepressants has yet to be proven conclusively. This study aims to understand the advantages and disadvantages of SJW as a treatment modality for depression.
The authors searched PubMed, JAMA network, Springer Link, Elsevier, Google Scholar, and Scientific Progress databases, from 2011 through August 2021, using the following keywords: St John's wort, Hypericum perforatum, depression, antidepressant, complementary alternative medicine, economic evaluation depression St. wort, St John's wort and depression, antidepressant interactions. This yielded a total of 27 papers following a thorough removal of irrelevant content and dissemination in languages other than English.
In patients with mild and moderate depression, SJW proved superior to placebo. Certain studies comparing the efficacy of SJW versus selective serotonin reuptake inhibitors (SSRIs), especially fluoxetine, reported SJW to be more efficacious, while the majority reported no significant difference. Tricyclic antidepressants were also found to have similar efficacy as SJW. Moreover, treatment with SJW was also found to reduce postmenopausal depression. Regarding the safety profile, although SJW is better tolerated with fewer adverse effects when compared to standardized antidepressants, its predisposition to causing fatal serotonin syndrome, when used in conjunction with other serotonergic agents and drug interactions noted with CYP 450 drugs, raises a question in the safety profile.
It is essential to acknowledge that SJW has been used as a treatment measure in Germany. Despite being only listed as a dietary supplement by the FDA and not a drug, SJW has shown to be comparable, if not more efficacious, than most standard treatment options for depression. SJW does prove to be an exciting piece of pharmacotherapy in the realm of mental health and post-menopausal treatment. More prospective studies will help us better understand its efficacy in mild and moderate depression and its ability to serve as a long-term agent. Considering its mechanism of action, its role in relieving patients suffering from an anxiety disorder is also worth considering.
圣约翰草提取物目前被用于治疗不同严重程度的抑郁症。虽然许多研究表明它优于安慰剂，但与标准抗抑郁药相比，将圣约翰草提取物作为单一治疗方法的有效性数据尚未得到确凿证实。本研究旨在了解圣约翰草提取物作为抑郁症治疗方式的优缺点。
作者检索了2011年至2021年8月期间的PubMed、美国医学会杂志网络、施普林格链接、爱思唯尔、谷歌学术和科学进展数据库，使用了以下关键词：圣约翰草、贯叶连翘、抑郁症、抗抑郁药、补充替代医学、抑郁症的经济评估、圣约翰草与抑郁症、抗抑郁药相互作用。在彻底剔除无关内容并排除非英语语言的文献后，共得到27篇论文。
在轻度和中度抑郁症患者中，圣约翰草提取物被证明优于安慰剂。某些比较圣约翰草提取物与选择性5-羟色胺再摄取抑制剂（SSRI），特别是氟西汀疗效的研究报告称圣约翰草提取物更有效，而大多数研究报告无显著差异。还发现三环类抗抑郁药与圣约翰草提取物具有相似的疗效。此外，还发现使用圣约翰草提取物治疗可减轻绝经后抑郁症。关于安全性，尽管与标准化抗抑郁药相比，圣约翰草提取物耐受性更好，不良反应更少，但当与其他5-羟色胺能药物联合使用时，其引发致命性5-羟色胺综合征的倾向以及与CYP 450药物的药物相互作用，在安全性方面引发了问题。
必须承认，圣约翰草提取物在德国已被用作一种治疗措施。尽管美国食品药品监督管理局仅将其列为膳食补充剂而非药物，但圣约翰草提取物已显示出与大多数标准抑郁症治疗方案相当的疗效，甚至可能更有效。在心理健康和绝经后治疗领域，圣约翰草提取物确实被证明是一种令人兴奋的药物治疗方法。更多的前瞻性研究将有助于我们更好地了解其在轻度和中度抑郁症中的疗效以及作为长期药物的能力。考虑到其作用机制，它在缓解焦虑症患者痛苦方面的作用也值得考虑。
