An Open-Label Trial of St. John's Wort (Hypericum perforatum) in Obsessive-Compulsive Disorder

Background: Recent interest in and evidence forthe efficacy of St. John’s wort (Hypericum perforatum) forthe treatment of mild-to-moderate depression has led tospeculation about its efficacy in other disorders. Hypericum’smechanism of action is postulated to be via inhibition of thesynaptosomal uptake of serotonin. As such, there is a suggestionthat Hypericum may be effective for obsessive-compulsivedisorder (OCD).

Method: Twelve subjects were evaluated with aprimary DSM-IV diagnosis of OCD of at least 12 months’ duration.Treatment lasted for 12 weeks, with a fixed dose of 450 mg of0.3% hypericin (a psychoactive compound in Hypericum)twice daily (extended-release formulation). Weekly evaluationswere conducted with the Yale-Brown Obsessive Compulsive Scale(Y-BOCS), the Patient Global Impressions of Improvement Scale,and the Clinical Global Impressions of Improvement scale (CGI)and monthly evaluation with the Hamilton Rating Scale forDepression.

Results: A significant change from baseline toendpoint was found, with a mean Y-BOCS change of 7.4 points (p =.001). Significant change occurred at 1 week (p = .020) andcontinued to increase throughout the trial. At endpoint, 5 (42%)of 12 were rated “much” or “very muchimproved” on the clinician-rated CGI, 6 (50%) were”minimally improved,” and 1 (8%) had “nochange.” The most common side effects reported were diarrhea(N = 3) and restless sleep (N = 2).

Conclusion: Significant improvement was foundwith Hypericum, with a drop-in Y-BOCS score similar tothat found in clinical trials. The fact that a significant changewas found as early as 1 week into treatment suggests a possibleinitial placebo response, although improvement grew larger overtime. Results warrant a placebo-controlled study of Hypericum inOCD.