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Sj9.0
St. John's Wort Research
Mixed evidenceLimited safety
36 peer-reviewed studies
What the evidence says
Mixed evidence
Studies are split: St. John's Wort helped in 4 of 9 cases, with the rest inconclusive or showing no benefit.
Most evidence is from high-quality meta-analyses and randomised trials published 2002–2026 with a typical study size of 332 participants.
Based on 36 studies · 14 meta-analyses · 5 RCTs · 30,410 total participants
Confidence
High
What the studies found
4helped4unclear1didn't help· 27 more without graded effect data
By outcome
Depression & moodSignificant improvement in depressive symptoms · 4-6 weeks
Women's healthMay help manage menopausal symptoms like hot flashes and mood changes · 4-8 weeks · Supports healthy estrogen metabolism and hormonal equilibrium · 4-8 weeks
Too few graded studies2 studies
Skin health
Too few graded studies1 study
Cognitive function
Too few graded studies1 study
By the numbers
Pulled from 30 studies with measurable effects
Likely real effects
100%
across studies
People studied
30k
typical study: 332 people
Strongest designs
19
14 pooled, 5 randomised
Showed benefit
44%
4/9 studies
How long studies ran
1–3 months
2
Populations Studied
Adults with mild depression1
Adults with depression1
Type 2 diabetes patients1
Patients with mild-to-moderate depression1
Active research area
13 studies in the last 5 years · Latest meta-analysis: 2025
200220142026
1Depression response ratesMeta-Analysisn=1,049 · large study2025
This review demonstrates that certain supplements, such as eicosapentaenoic acids and Rhodiola rosea, are therapeutic options for mild depression.
Urata M et al. · Neuropsychopharmacology reports (2025)
No clear effect
← WorseNo effectBetter →
A meta-analysis found no significant difference in response rates between the two treatments (risk ratio [RR] = 0.96, 95% CI: 0.78-1.18) or dropout rates (RR = 1.08, 95% CI: 0.62-1.88).
Eicosapentaenoic acid and Rhodiola rosea demonstrated significant improvements in depressive symptoms compared to placebo.
Conversely, S-adenosylmethionine did not produce significant improvements relative to placebo.
2Systematic ReviewCited 5×n=1,115 · large study2025
Herbal therapies present a diverse array of options for psoriasis management, but further research is essential to elucidate their safety profile and true effectiveness.
Anheyer M et al. · Complementary therapies in medicine (2025)
Herbal therapies present a diverse array of options for psoriasis management, but further research is essential to elucidate their safety profile and true effectiveness.
Healthcare providers should engage in shared decision-making with patients, considering individual preferences and treatment goals while remaining vigilant in guiding towards evidence-based treatments.
3Depression treatment responseMeta-AnalysisCited 15×n=2,270 · very large study2023
Our research supports the use of SJW as it reduced the number of depressive patients and their HAMD scores while having fewer risks and side effects than conventional medications.
Zhao X et al. · Advances in clinical and experimental medicine : official organ Wroclaw Medical University (2023)
Huge harm
← WorseNo effectBetter →
Likely real
For patients treated with either SSRIs or SJW, a pooled OR of 2.44 with a 95% confidence interval (95% CI) of 1.33-4.45 was obtained.
The data were heterogeneous, with a tau2 value of 0.54, χ2 value of 31.05, degrees of freedom (df) value of 7, I2 value of 77%, and an overall Z-value of 2.90 with p = 0.004.
Our research supports the use of SJW as it reduced the number of depressive patients and their HAMD scores while having fewer risks and side effects than conventional medications.
5HAM-D depression scoresMeta-AnalysisCited 151×n=3,808 · very large study2017
For patients with mild-to-moderate depression, St John's wort has comparable efficacy and safety when compared to SSRIs.
Ng QX et al. · Journal of affective disorders (2017)
No clear effect
← WorseNo effectBetter →
Likely real
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.
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.
6Major depression responseMeta-AnalysisCited 97×n=5,489 · very large study2016
St. John's wort was significantly superior to placebo and comparable to standard antidepressants for treating major depression with fewer side effects.
Apaydin EA et al. · Systematic Reviews (2016)
Noticeable benefit
← WorseNo effectBetter →
St. John's wort was significantly more effective than placebo for major depression (SMD -0.49)
Efficacy was comparable to SSRIs with no significant difference in response rates
Adverse event rates were significantly lower than conventional antidepressants
Future longer follow-up, larger samples, and more methodologically rigorous randomized controlled trials are recommended to clearly establish the effects of different dosages on cognitive function and quality of life in stroke patients.
Li J et al. · Phytotherapy research : PTR (2025)
John's Wort extract (SUCRA 71.2%) was the most effective in reducing NIHSS scores, Berberine (SUCRA 84.1%) was most effective in reducing mRS scores, and St.
John's Wort extract (SUCRA 99.1%) showed the highest efficacy in enhancing ADL scores.
Ginsenosides were the most effective in improving Barthel Index (SUCRA 74.7%), MMSE (SUCRA 93%), and MOCA (SUCRA 79.7%) scores.
9Systematic ReviewCited 90×n=149 · medium study2021
While most food, herbs and supplements can be safely taken in moderation, healthcare professionals should be aware of the increased risk of bleeding when taking several food and herbs.
Tan CSS et al. · British journal of clinical pharmacology (2021)
These reports described potentiation with 45 (57.7%) herbs, food or dietary supplements while 23 (29.5%) reported inhibition and 10 (12.8%) reported limited impact on warfarin pharmacokinetics and pharmacodynamics.
While most food, herbs and supplements can be safely taken in moderation, healthcare professionals should be aware of the increased risk of bleeding when taking several food and herbs.
These include Chinese wolfberry, chamomile tea, cannabis, cranberry, chitosan, green tea, Ginkgo biloba, ginger, spinach, St.
This meta-analysis examined the effects of St. John's Wort.
Barrera SD et al. · Scientific reports (2024)
The findings indicated a pain-attenuating effect of herbal extracts such as cannabis, turmeric, capsaicin, licorice, ginger, chamomile, clove, Hypericum perforatum, and Arnica montana.
These findings revindicate that herbal extracts may be valuable alternatives to traditional pain medications and promising source for the development of new active ingredients for pharmaceuticals.
11Systematic ReviewCited 14×n=22 · very small study2024
Based on the review, we cannot recommend any supplement use for the management of CIPN, although further research into N-acetyl-cysteine, l-carnosine, crocin, and magnesium is warranted.
Frediani JK et al. · Pain practice : the official journal of World Institute of Pain (2024)
Based on the review, we cannot recommend any supplement use for the management of CIPN, although further research into N-acetyl-cysteine, l-carnosine, crocin, and magnesium is warranted.
Acetyl-l-carnitine was found to be likely ineffective or harmful.
12Depression improvement in epilepsy patientsMeta-Analysis2024
Our results suggest that SJC may be effective in treating depression in patients with epilepsy.
Kim S et al. · BMC complementary medicine and therapies (2024)
Huge benefit
← WorseNo effectBetter →
Compared with AD, SJC showed significant differences in the improvement of depression (SMD: 3.82, 95% CI: 3.25, 4.39) and reduction in seizure frequency (MD: 0.39 times/month, 95% CI: 0.28, 0.50).
SJC showed more beneficial results than antiepileptic drugs (AED) in terms of antidepressant effects (SMD: 1.10, 95% CI: 0.69, 1.51) and QoL (MD: 11.75, 95% CI: 10.55, 12.95).
When patients were prescribed AED, the additional administration of SJC improved depression symptoms (SMD: 0.96, 95% CI: 0.28, 1.63).
13Treatment recommendations for nutraceuticals and phytoceuticals in psychiatric disordersMeta-AnalysisCited 117×2022
Based on the current data and clinician input, a range of nutraceuticals and phytoceuticals were given either a supportive recommendation or a provisional recommendation across a range of various psychiatric disorders.
Sarris J et al. · The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry (2022)
Based on the current data and clinician input, a range of nutraceuticals and phytoceuticals were given either a supportive recommendation or a provisional recommendation across a range of various psychiatric disorders.
However several had only a weak endorsement for potential use; for a few it was not possible to reach a clear recommendation direction, largely due to mixed study findings; while some other agents showed no obvious therapeutic benefit and were clearly not recommended for use.
It is the intention of these guidelines to inform psychiatric/medical, and health professional practice globally.
Aside from this, future focus should involve the incorporation of more biomarker analysis, in particular pharmacogenomics, to determine genetic factors moderating response to herbal medicines.
Sarris J · Phytotherapy research : PTR (2018)
Other encouraging herbal medicines with preliminary evidence include Curcuma longa (turmeric) in depression, Withania somnifera (ashwagandha) in affective disorders, and Ginkgo biloba (ginkgo) as an adjunctive treatment in Schizophrenia.
Although depression and anxiety are commonly researched, many other mental disorders still require further prospective investigation.
Although the previous review suggested increasing the adjunctive study of select herbal medicines with pharmaceuticals, this was still only found to sparingly occur in research designs.
17Dietary supplement interactions with antiretroviralsSystematic ReviewCited 21×2017
This systematic review shows the importance of screening all human immunodeficiency virus patients for dietary supplement use to prevent treatment failure or adverse effects related to an interaction.
Jalloh MA et al. · International journal of STD & AIDS (2017)
John's wort, vitamin C, zinc sulfate, and multivitamins were all found to significantly decrease the levels of selected antiretrovirals and should be avoided in patients taking these antiretrovirals.
Cat's claw and evening primrose oil were found to significantly increase the levels of antiretrovirals and patients should be monitored for adverse effects while taking these dietary supplements with antiretrovirals.
Calcium carbonate, ferrous fumarate, some forms of ginkgo, some forms of garlic, some forms of milk thistle, St.
18Warfarin pharmacokinetic and pharmacodynamic interactionsSystematic ReviewCited 29×2017
It was difficult to determine whether ten herbal medicines had significant effects on the PK-PD parameters of warfarin.
Choi S et al. · PloS one (2017)
Using CONSORT, the reporting percentages for the articles ranged from 36.5% to 61.5% and the mean percentage for all articles was 45.6%.
It was difficult to determine whether ten herbal medicines had significant effects on the PK-PD parameters of warfarin.
Low quality of evidence, different compounds within and different compositions of the herbs, and methodological limitations of the crossover study, which is a clinical study in which subjects receive a sequence of different interventions, made it difficult to form conclusions.
19Depression improvementMeta-AnalysisCited 288×n=5,489 · very large study2008
The available evidence suggests that the hypericum extracts tested in the included trials are superior to placebo and similarly effective as standard antidepressants.
Linde K et al. · Cochrane Database of Systematic Reviews (2008)
As effective as standard antidepressants for mild-moderate depression
Although more research is needed to confirm effectiveness, present preclinical studies indicate that monoamine pathway modulation (in particular serotonin reuptake inhibition) may be the most important anti-OCD mechanism among the studied natural compounds.
Ayati Z et al. · Phytotherapy research : PTR (2020)
Additional search criteria were employed for locating research on the underpinning mechanisms of action.
Results revealed that tentative low-quality evidence exists for several plant medicines, including Crocus sativus, Silybum marianum, Echium amoenum, Hypericum perforatum, and Withania somnifera, along with several natural molecules, including crocin, cannabidiol, and curcumin.
Although more research is needed to confirm effectiveness, present preclinical studies indicate that monoamine pathway modulation (in particular serotonin reuptake inhibition) may be the most important anti-OCD mechanism among the studied natural compounds.