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Jundishapur J Nat Pharm Prod. 2012 Summer;7(3):106-10. Epub 2012 Aug 25.

Evaluation of Pharmaceutical Products of St. John's Wort Efficacy Added on Tricyclic Antidepressants in treating Major Depressive Disorder: A Double Blind Randomized Control Trial.

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Department of Psychiatry, Jundishapur University of Medical Sciences, Ahvaz, IR Iran.
Department of Pharmacognosy, School of Pharmacy, Jundishapur University of Medical Sciences, Ahvaz, IR Iran ; Medical Herbs and Natural Products Research Center, Jundishapur University of Medical Sciences, Ahvaz, IR Iran.
School of Medicine, Jundishapur University of Medical Sciences, Ahvaz, IR Iran.
Golestan Hospital, Jundishapur University of Medical Sciences, Ahvaz, IR Iran.



Major depressive disorder (MDD) is the most common disorder in our community. Hypericum perforatumm, is a herb with a long application history in treating depression. A controlled study to evaluate the effects of this herbal medicine in Iran did not exist.


This study aimed to assess the effect of Hypericum perforatom (perforan), in combination with tricyclic antidepressants in MDD treatment.


The present study was a placebo-controlled double blind randomized clinical trial including 40 patients with major depressive disorder who referred to Psychiatric Clinic and Golestan Hospital in 2011. Patients were randomly distributed in 4 blocks with 10 patients in each. 5 out of 10 patients took medicine (group I) and the others received placebo (group II).


After six weeks, both groups indicated some improvement, there was also a significant degree of recovery in the perforan group (P = 0.04).


The results of the current study suggested that combinations of St. John's Wort and tricyclic antidepressants compared to tricyclic antidepressants alone had significant effect on mild to moderate depression improvement. According to the numerous side effects of antidepressants, their continuous use was not well tolerated. There is a strong global tendency to use herbal medicines. Hypericum perforatom (St. John's Wort) is one of the best types of unapproved MDD treatments. Also, the most common reason to discontinue antidepressant treatments is their sexual side effects. None of the patients in the two groups had complained about sexual side effects which was consistent with other studies and it was an advantage of using this herbal medicine. Perforan group had improved in quality of sleep and the increase of energy. This improvement had not been reported in previous studies. Sleep problems are common complications of specific serotonin reuptake inhibitors (SSRIs).


Antidepressive Agents; Depressive Disorder; Major; Tricyclic


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