St. John's Wort vs. Prescription Drugs

How does an herbal extract stack up against pharmaceutical antidepressants? In several head-to-head trials, St. John's Wort has held its own — often with fewer side effects.

Why some people choose it

• In a 2005 British Medical Journal study, 57% of participants taking a 900 mg/day hyperforin-rich extract saw their moderate-to-severe symptoms decrease, compared with 45% on paroxetine (Paxil®).
• An October 2005 trial comparing the herbal extract with fluoxetine (Prozac®) and placebo reported about 48% greater symptom reduction over 12 weeks for the extract.

Effective and gentle

Users often report none of the sedation, numbness or emotional "blunting" associated with SSRIs, and no withdrawal symptoms on stopping. It is considered safe for adolescents with supervision, with no evidence of the increased suicide risk that has been flagged for some SSRIs — while delivering comparable efficacy.

Fewer side effects

In a German randomized double-blind trial of 240 patients, adverse events occurred in 28 patients (25%) on fluoxetine versus 18 (14%) on St. John's Wort. The sexual dysfunction and weight gain common with SSRIs are not typical with the herb. Most users have no side effects; mild ones such as headache or fatigue are usually temporary, and increased sun sensitivity is rare.

Completely natural

St. John's Wort is derived from Hypericum perforatum and sold as dried extract powder, oil, infusion, tincture or salve, with no synthetic chemicals. That said, "natural" does not automatically mean "safe" — though St. John's Wort is considered very safe when used appropriately.