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July 2013

St. John's Wort May Be Cost-Effective Alternative For Depression

The use of St. John's wort to relieve symptoms of depression may be a cost-effective alternative to generic antidepressants, according to a study.

Extracts of Hypericum perforatum L. (St. John's wort) have been recommended traditionally for a wide range of medical conditions. The most common modern-day use of St. John's wort is the treatment of depression. Numerous studies report St. John's wort to be more effective than placebo and equally effective as tricyclic antidepressant drugs in the short-term treatment of mild-to-moderate major depression (1-3 months).

St. John's wort has been extensively studied in Europe over the last two decades, with more recent research in the United States. Short-term studies (1-3 months) suggest that St. John's wort is more effective than placebo (sugar pill), and equally effective as tricyclic antidepressants (TCAs) in the treatment of mild-to-moderate major depression. Comparisons to the more commonly prescribed selective serotonin reuptake inhibitor (SSRI) antidepressants, such as fluoxetine (Prozac®) or sertraline (Zoloft®), are more limited. However, other data suggest that St. John's wort may be just as effective as SSRIs with fewer side effects. Safety concerns exist as with most conventional and complementary therapies.

In the new study, the authors noted that the burden of rising health care costs has created a demand for alternative treatments that may pose a more cost-effective route. Many clinical trials report that St. John's wort may be as effective as antidepressants in the treatment of mild-to-moderate depressive symptoms. The research team set out to develop a model to assess the cost-effectiveness of replacing generic medications for this condition with St. John's wort.

The researchers looked at the potential impacts of St. John's wort on health and economics, and compared these effects to those of antidepressants. They considered treatment costs, quality-adjusted life years, and net monetary benefits.

The results suggested that St. John's wort may be the strategy with the highest net benefit. The authors reported that the total cost savings for St. John's wort were approximately $359.66 and $202.56 per person for the antidepressants venlafaxine and sertraline, respectively. They also found a gain of 0.08 to 0.12 quality-adjusted life years over the course of 72 weeks of the model.

The researchers concluded that St. John's wort may be a cost-effective alternative to antidepressants. They wrote that this intervention may be associated with reduced incidence of side effects and improved outcomes. However, they emphasized that more research is needed before firm conclusions can be made.

In addition to St. John's wort, there is strong scientific evidence in support of music therapy and light therapy for the treatment of depression and related conditions.

For more information about St. John's wort, please visit Natural Standard's Foods, Herbs & Supplements Database.


  1. Natural Standard: The Authority on Integrative Medicine.
  2. Solomon D, Adams J, Graves N. Economic evaluation of St. John's wort (Hypericum perforatum) for the treatment of mild to moderate depression. J Affect Disord. 2013 Jun;148(2-3):228-34. doi: 10.1016/j.jad.2012.11.064. Epub 2013 Jan 3. 

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