St John's Wort

St John's Wort

• shown to be as effective as tricyclic antidepressants in the treatment of mild-moderate depression
• mechanism: thought to be similar to SSRIs (although noradrenaline uptake inhibition has also been demonstrated)
• NICE advise 'may be of benefit in mild or moderate depression, but its use should not be prescribed or advised because of uncertainty about appropriate doses, variation in the nature of preparations, and potential serious interactions with other drugs'

• profile in trials similar to placebo
• can cause serotonin syndrome
• inducer of P450 system
  inducer of P450 system
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  , therefore decreased levels of drugs such as warfarin, ciclosporin. The effectiveness of the combined oral contraceptive pill may also be reduced