Documentary Analysis of Hypericum perforatum (St. John's Wort) and Its Effect on Depressive Disorders

Abstract

Hypericum perforatum, also known as St. John's Wort, pericon, or yellow grass, is known for its antidepressant potential. It could represent a natural alternative to current pharmacological antidepressant treatments, which have a high incidence of side effects in patients and therefore lead to early dropouts. Through a bibliographic revision of clinical trials and information collected from scientific articles during the first period of 2020, we aimed to evaluate whether its administration could be beneficial in the treatment of mild-to-moderate depression, with fewer side effects compared to synthetic drugs. Among the main components, hypericin and hyperforin have been related to the observed antidepressant activity; therefore, their possible mechanism of action was reviewed and highlighted. Furthermore, patients receiving Hypericum extracts were less likely to withdraw from studies because of adverse effects compared to those receiving older standard antidepressants. This review aims to provide suggestions for an alternative treatment of mild-to-moderate depression disorder under the supervision of a medical doctor, since, although it appears to be a potentially efficient treatment with a low presence of adverse effects in comparison to synthetic antidepressants, it might also interact with other medications and lead to therapeutic failures if misused for self-medication.

Keywords: antidepressants; medicinal plants; naphthodianthrones; phloroglucinols.

Figure 1

Structure of the molecules involved in the antidepressive activities found in H. perforatum. 1: hyperforin; 2: adhyperforin; 3: protohypericin; 4: hypericin; 5: protopseudohypericin; 6: pseudohypericin.

Figure 2

Treatment with synthetic antidepressants and extracts of Hypericum perforatum. Comparison of response rates among patients treated with St. John’s Wort and its various extracts versus synthetic drugs and the placebo based on the percentage of responders. Data are expressed as the proportion of patients who experienced a reduction of at least 50% of their initial Hamilton Depression Rating Scale (HAMD-17) scores after the specified treatment duration. This analysis highlights the relative efficacy and acceptance of each treatment option among the individuals who utilized them.

Figure 3

Adverse events in the treatments with synthetic antidepressants. The data reveal a high prevalence of side effects among patients treated with these medications. Imipramine exhibited the highest incidence of adverse effects at 63%, followed by citalopram at 42%. Sertraline, while having the lowest incidence among the three at 32%, still demonstrates a noteworthy percentage of patients experiencing side effects. This figure underscores the variability in the side-effect profiles across different synthetic antidepressants.