st. john's wort for depressionA recently published study raises questions about whether the natural supplement St. John’s wort is actually associated with fewer adverse effects than commonly prescribed SSRIs.

Living in the Bay Area it is common for me to run into a strong conviction that any natural supplement is bound to be safer than any manufactured medication.

Perhaps the most problematic of these beliefs has to do with the use of medical marijuana. I have had patients who clearly have bipolar disorder tell me that they would never use a mood stabilizer and instead are treating themselves with medical marijuana. As I’ve discussed elsewhere on this blog, the evidence is pretty overwhelming that that “treatment” actually makes most people with bipolar worse.

To be fair, in general it is true that natural supplements have fewer adverse effects. This study raises the question about whether that perception might in part be due to to under reporting of adverse effects. After all, in this country, the FDA has an active process of soliciting adverse event reports for medications, but no such process exists in the United States for natural supplements.

In Australia, adverse drug reports appear to be more common for natural supplements. These researchers took a look at the pattern of adverse drug reports for St. John’s wort and compared it with the pattern of reports for SSRIs. What they found was that the two appeared fairly similar in terms of which types of adverse events were most often recorded.

Because there’s no easy way of monitoring St. John’s Wort purchases it is impossible to compare whether the number of reports per “prescription” is different, although the authors suggested that probably the percentage of reports was lower for St. John’s Wort, speculating that perhaps there was underreporting of natural supplement adverse drug reactions, which is a reasonable hypothesis.

I was a bit surprised by the result, or at least by the conclusion, since it has been my experience that St. John’s Wort is associated with fewer adverse effects than SSRIs, although, unfortunately, somewhat less effectiveness as well.


Hoban CL, Byard RW, Musgrave IF. A comparison of patterns of spontaneous adverse drug reaction reporting with St. John’s Wort and fluoxetine during the period 2000-2013. Clin Exp Pharmacol Physiol. 2015 Jul;42(7):747-51. doi: 10.1111/1440-1681.12424. PubMed PMID: 25988866.