St john's wort dosage for depression
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St. John's Wort Dosage for Depression: Clinical Evidence
Standard Dosages for Mild to Moderate Depression
Clinical studies have shown that St. John's wort (Hypericum perforatum) is effective for treating mild to moderate depression at daily doses of 600 mg to 1200 mg of standardized extract. In a large randomized trial, both 600 mg once daily and 1200 mg (600 mg twice daily) were found to be safe and more effective than placebo, with the higher dose group showing a slightly higher remission rate after 6 weeks of treatment . Other studies have used 900 mg per day (300 mg three times daily) of standardized extract containing 0.3% hypericin, which also demonstrated significant improvement in depression symptoms and was comparable in efficacy to some prescription antidepressants, but with fewer side effects 210.
Dosage Adjustments for Severity
For more severe depression, higher doses such as 1800 mg per day (600 mg three times daily) have been suggested, though most evidence supports the 900–1200 mg per day range for mild to moderate cases . In long-term use, a daily dose of 500 mg has been shown to be safe and effective for up to one year, supporting its use for relapse prevention in mild to moderate depression .
Dosage in Children and Adolescents
In children under 12 years, dosages ranged from 300 mg to 1800 mg per day, with most children responding well and experiencing good tolerability . For adolescents, an initial dose of 150 mg three times daily (450 mg/day) was used, with an increase to 300 mg three times daily (900 mg/day) if needed after four weeks, resulting in a high response rate and good tolerability .
Consumer Use and Real-World Dosages
Surveys of consumers using St. John's wort for depression report average daily doses around 475 mg, with a range from 300 mg to 1200 mg per day, and treatment durations typically lasting several weeks . Most users reported improvement, but some experienced side effects or drug interactions, highlighting the importance of medical supervision.
Formulation and Active Components
The effectiveness of St. John's wort is linked to its content of hypericins and hyperforin. Standardized extracts used in clinical trials typically contain 0.3% hypericin, and solid dosage forms (tablets or capsules) provide daily hypericin doses between 0.288 mg and 0.636 mg . Liquid tinctures and infusions are less commonly used for depression, as ethanolic extracts are preferred for central nervous system effects .
Safety and Tolerability
Across studies, St. John's wort was generally well tolerated, with a lower incidence of side effects compared to conventional antidepressants 12310. However, some users may experience gastrointestinal or skin complaints, and there is a risk of drug interactions, especially with other medications affecting serotonin levels 47.
Conclusion
The most commonly studied and recommended dosage of St. John's wort for mild to moderate depression is 900–1200 mg per day of a standardized extract, divided into two or three doses. Lower doses may be used in children and adolescents, with adjustments based on response and tolerability. While St. John's wort is generally safe, it should be used under medical supervision due to the potential for side effects and drug interactions.
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