Clinical use of Hypericum perforatum (St John's wort) in depression: A meta-analysis.
All the head-to-head studies of St. John's wort against SSRIs lasted twelve weeks or less — if I need treatment for longer than that, what do we actually know?
Well-supported by good-quality research. how we score evidence
Caveat on this rating: The abstract reports p<0.001 alongside pooled risk ratios whose 95% confidence intervals comfortably include 1.0, which is internally inconsistent; read the confidence intervals, which show equivalence rather than superiority. This meta-analysis also inherits the industry funding and country-of-origin biases present in the underlying trial literature, and it did not assess drug interactions at all.
In the United States St. John's wort is sold as a dietary supplement under DSHEA, which means it reaches the shelf without FDA review of efficacy, safety, or potency and the FDA can act only after a problem emerges. It has never been FDA-approved to treat depression or anything else.
Pooling 27 trials that compared St. John's wort head-to-head with SSRIs in 3,808 patients, response rates were statistically indistinguishable (RR 0.983, 95% CI 0.924-1.042) as were remission rates (RR 1.013, 95% CI 0.892-1.134), and fewer people stopped St. John's wort than stopped the SSRI (OR 0.587, 95% CI 0.478-0.697). Every included trial ran only 4 to 12 weeks, and the authors state it is unclear whether St. John's wort helps people with severe depression or high suicide risk.
Worth asking
All the head-to-head studies of St. John's wort against SSRIs lasted twelve weeks or less — if I need treatment for longer than that, what do we actually know?
Source
Clinical use of Hypericum perforatum (St John's wort) in depression: A meta-analysis. — Ng QX, Venkatanarayanan N, Ho CY. (2017)
Reputable peer-reviewed journal
Read the source: https://doi.org/10.1016/j.jad.2016.12.048
DOI: 10.1016/j.jad.2016.12.048
How this was scored
- Study design
- Meta-analysis of randomised trials
- Funding
- Funding not disclosed
- Published in
- Reputable peer-reviewed journal
- Sample size
- 3,808
- Preregistered
- No
- Conflicts disclosed
- No
- Independent of proponent
- Yes
- Retracted
- No
Read the full scoring rubric, including what it can't tell you.
Published August 19, 2026.
Where we put this study in context
Questions
How strong is the evidence behind this?
Resolv rates this source "strong evidence". Well-supported by good-quality research. It scores 73 out of 100 on our published rubric. One caveat travels with that badge: The abstract reports p<0.001 alongside pooled risk ratios whose 95% confidence intervals comfortably include 1.0, which is internally inconsistent; read the confidence intervals, which show equivalence rather than superiority. This meta-analysis also inherits the industry funding and country-of-origin biases present in the underlying trial literature, and it did not assess drug interactions at all. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
Clinical use of Hypericum perforatum (St John's wort) in depression: A meta-analysis. — Ng QX, Venkatanarayanan N, Ho CY. (2017). Published in: Reputable peer-reviewed journal. DOI: 10.1016/j.jad.2016.12.048. The full source is linked on this page so you can read it yourself.
Who paid for this research, and does that matter?
Study design: Meta-analysis of randomised trials. Funding: Funding not disclosed. The researchers were independent of whoever benefits from the result. Industry sponsorship is one of the most reliably measured biases in medicine, which is why funding carries real weight in the score rather than sitting in a footnote.
Is st-johns-wort, hypericum perforatum, sjw, hypericum, klamath weed, tipton's weed, li 160, ws 5570, stw3-vi, ze 117 FDA approved for this use?
No. Its current status is: Not FDA-evaluated for this use. In the United States St. John's wort is sold as a dietary supplement under DSHEA, which means it reaches the shelf without FDA review of efficacy, safety, or potency and the FDA can act only after a problem emerges. It has never been FDA-approved to treat depression or anything else.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.