St John's wort for depression: scoping review about perceptions and use by general practitioners in clinical practice

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Abstract

Background

Extracts of Hypericum perforatum, more commonly known as St John's wort (SJW), have good evidence for treating depression. The herb is easily accessible and widely used by consumers, although it has potential for interaction with other medicines. Consumers’ use of SJW is often not discussed with their general practitioners (GPs). It is unclear how GPs perceive use of SJW in practice and the implications for consumers and pharmacists.

Objective

Explore GPs’ perception of SJW use in practice.

Methods

Scoping review.

Key findings

Few studies explore GPs’ perceptions of SJW for depression, but they appear to recommend it infrequently, except in Germany. Reasons for limited use in practice include lack of knowledge, particularly regarding which preparations and dosages have trial evidence, and lack of standardisation of active ingredients. Guidelines either do not mention SJW or advise against its use.

Conclusions

Consumers drive SJW use but often do not disclose to their GPs, which is concerning due to issues about safety. Pharmacists could play an important role here. Improved education about SJW is required for both GPs and consumers, including the need for communication between them and their pharmacists. Lack of adoption of evidence-based therapy for depression should be explored further.

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