Stress & mood evidence brief
St John's wort has clinical evidence for mild to moderate depression symptoms, but the interaction risk is high enough that it should not be casually recommended.
Cochrane review: 29 trials with 5,489 patients found tested extracts superior to placebo and similar to standard antidepressants in studied settings.
Trial results apply to standardized extracts, not arbitrary herbal blends. Dosing and hyperforin content strongly affect both efficacy and interaction risk.
High interaction risk with antidepressants, oral contraceptives, anticoagulants, transplant drugs, HIV drugs, and many others. Clinical supervision is essential.
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