From: A systematic review of St. John’s wort for major depressive disorder
Outcome | Study design: number of studies, number of participants | Findings: direction and magnitude of effect | GRADE |
---|---|---|---|
Comparison: SJW vs. placebo | |||
Depression, number of treatment responders | 18 RCTs, N = 2922 | RR 1.53 (1.19, 1.97), favors SJW | Moderate^{a} |
Depression scale score | 16 RCTs, N = 2888 | SMD 0.49 (0.23, 0.74), favors SJW | Moderate^{a} |
Depression remission | 9 RCTs, N = 1419 | RR 1.69 (0.63, 4.55), n.s. | Low^{a,b} |
Depression relapse | 1 RCT, N = 426 | RR 0.70 (0.49, 1.02), n.s. | Very low^{a,b} |
Quality of life—mental | 2 RCTs, N = 358 | SMD 0.48 (0.24, 0.73), favors SJW | Low^{b} |
Quality of life—physical | 2 RCTs, N = 358 | SMD 0.28 (−1.03, 0.47), n.s. | Very low^{a,b} |
Number of patients with adverse events | 13 RCTs, N = 2600 | OR 0.83 (0.62, 1.13), n.s. | Moderate^{b} |
Serious adverse events | 6 RCTs, N = 1358 | OR 0.26 (0.04, 1.23), n.s. | Moderate^{a} |
Gastrointestinal/metabolic/nutritional adverse events | 16 RCTs, N = 2490 | OR 1.06 (0.83, 1.41), n.s. | Low^{a,b} |
Neurologic/nervous system adverse events | 14 RCTs, N = 2404 | OR 1.56 (1.08, 3.32) SJW more AE | Low^{a,b} |
Skin/musculoskeletal adverse events | 10 RCTs, N = 1978 | OR 1.47 (0.98, 2.21), n.s. | Very low^{a,b} |
Photosensitivity | 4 RCTs, N = 1054 | OR 1.10 (0.36, 3.56), n.s. | Low^{a,b} |
Respiratory/infectious adverse events | 7 RCTs, N = 1081 | OR 1.48 (0.95, 2.33), n.s. | Low^{a,b} |
Other organ system (eye, ear, liver, renal, reproductive) adverse events | 5 RCTs, N = 1054 | OR 1.87 (1.08, 3.32), SJW more AE | Low^{a,b} |
Cardiovascular adverse events | 4 RCTs, N = 759 | OR 6.81 (0.92, 304.08), n.s. | Very low^{a,b,d} |
Psychiatric adverse events | 3 RCTs, N = 608 | OR 1.61 (0.34, 10.21), n.s. | Very low^{a,b,d} |
Sexual dysfunction adverse events | 2 RCTs, N = 428 | OR 1.92 (0.94, 4.00), n.s. | Very low^{a,b,d} |
Comparison: SJW vs. antidepressant | |||
Depression, number of treatment responders | 17 RCTs, N = 2776 | RR 1.01 (0.90, 1.14), n.s. | Moderate^{b} |
Depression scale score | 14 RCTs, N = 2248 | SMD 0.03 (−0.15, 0.21), n.s. | Moderate^{b} |
Depression remission | 7 RCTs, N = 787 | RR 1.17 (0.84, 1.62), n.s. | Low^{b} |
Depression relapse | 1 RCT, N = 241 | RR 4.17 (0.47, 33.33), n.s. | Very low^{a,b} |
Quality of life—mental | 1 RCT, N = 216 | SMD −0.11 (−0.15, 0.38), n.s. | Very low^{a,b} |
Quality of life—physical | 1 RCT, N = 153 | SMD 0.35 (0.01, 0.70), favors SJW | Very low^{a,b} |
Number of patients with adverse events | 11 RCTs, N = 1946 | OR 0.67 (0.56, 0.81), favors SJW | Moderate^{a} |
Serious adverse events | 4 RCTs, N = 805 | OR 0.62 (0.05, 5.46) n.s. | Low^{a,b} |
Gastrointestinal/metabolic/nutritional adverse events | 15 RCTs, N = 2491 | OR 0.43 (0.34, 0.55) favors SJW | Low^{a,b} |
Neurologic/nervous system adverse events | 15 RCTs, N = 2492 | OR 0.29 (0.24, 0.36) favors SJW | Low^{a,b} |
Skin/musculoskeletal adverse events | 10 RCTs, N = 1587 | OR 1.18 (0.79, 1.78) n.s. | Low^{a,b} |
Respiratory/infectious adverse events | 2 RCTs, N = 352 | OR 1.25 (0.70, 2.25) n.s. | Very low^{a,b} |
Other organ system (eye, ear, liver, renal, reproductive) adverse events | 4 RCTs, N = 761 | OR 0.85 (0.52, 1.38), n.s. | Low^{a,b} |
Cardiovascular adverse events | 5 RCTs, N = 750 | OR 0.55 (0.26, 1.16), n.s. | Low^{a,b} |
Psychiatric adverse events | 4 RCTs, N = 552 | OR 0.41 (0.19, 0.87) favors SJW | Very low^{a,b} |
Sexual dysfunction adverse events | 2 RCTs, N = 301 | OR 0.51 (0.30, 0.88) favors SJW | Low^{a,b} |
Effect of depression severity | |||
Depression, treatment responders | 18 RCTs, N = 2922 |
Meta-regression did not suggest differences between patient subgroups (p = 0.798) | Very low^{a,c} |
Depression scale score | 16 RCTs, N = 2888 |
Meta-regression did not suggest differences between patient subgroups (p = 0.365) | Very low^{a,c} |
Depression remission | 9 RCTs, N = 1507 |
Meta-regression did not suggest differences between patient subgroups (p = 0.159) | Very low^{a,c} |
Number of patients with adverse events | 13 RCTs, N = 2600 |
Meta-regression did not suggest differences between patient subgroups (p = 0.480) | Very low^{a,c} |