聖約翰草 St. John's Wort × 憂鬱症
結論：證據支持但有警示
聖約翰草對「輕中度」憂鬱症有可重現的人體實證，但效益範圍狹窄、異質性極高且有明確反證據，故獨立評為 B 而非 Examine 的 A。
B 🟡 B 初步證據 附警語發布 ⚠️ medium — moderate promotional content
聖約翰草對「輕中度」憂鬱症有可重現的人體實證，但效益範圍狹窄、異質性極高且有明確反證據，故獨立評為 B 而非 Examine 的 A。
支持面：2008 Cochrane（29 試驗、5,489 人）顯示優於安慰劑、與標準抗憂鬱藥相當且副作用較少，2016 系統性回顧（35 篇、6,993 人，SMD 0.49）與 2017 Meta-analysis 一致；EMA/HMPC well-established use 與 WHO 專論均認可「輕中度憂鬱」之症狀治療。
但三項因素使我下調一階：(1) 證據異質性極高（I²=79–89%）且具明顯「試驗來源效應」——德語系試驗結果偏正面，而美國 NIH 資助之 HDTSG 2002 試驗（340 人）對中重度憂鬱完全無效（vs 安慰劑 P=0.59），這非單純樣本不足，而是系統性的研究來源偏誤訊號；(2) 效益嚴格侷限輕中度，重度／主要憂鬱症無效，多家學會（Cleveland Clinic、NHS、NICE）因此明確不建議使用；(3) 市售製劑 hyperforin／hypericin 含量差異大，療效不可外推。
Examine 的 A 級反映「輕中度」試驗體量大、方向一致，但未充分懲罰來源異質與大型陰性試驗，故我與 Examine partial 一致——同意輕中度有效，但不同意 A 級。
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評分透明度
所有分數由 7 層證據引擎計算，過程公開可查原始分數 0.66
D
C
B
A
S
← 反證據 / 無效有效 / 強證據 →
最終評級
B · 附警語發布
信心度
76%
證據方向大致一致
證據層級
E1
Cochrane 高品質系統性回顧／統合分析
▸查看完整決策路徑（audit trail）
- compute_raw_score — 加權公式: L2×0.30 + L3×0.25 + L5×0.25 + L11×0.10 + L1×0.10 = 0.661
- tier_from_score — 依分數區間映射至 tier letter
- apply_hec_rules — 高品質 SR/MA 顯示 positive (1 篇 > 0 negative)
- tier_strict_requirement_check — Tier 條件達標，未降階
- detect_disputes — 偵測到 0 個 hard + 0 個 soft dispute
- decide_status — 依 tier + dispute 結果決定 status
St John's wort for major depression
結論：Across 29 trials in 5489 patients, hypericum extracts were superior to placebo (combined response RR 1.28 in larger trials, 1.87 in smaller trials) and roughly equivalent to standard antidepressants (RR near 1.0), with fewer adverse-effect dropouts than older antidepressants (OR 0.24) or SSRIs (OR 0.53); the review explicitly flags that effect sizes vary by country of origin, with German-speaking trials reporting more favourable results.
前往 PubMed
A systematic review of St. John's wort for major depressive disorder
結論：In 35 studies (6993 patients), SJW yielded more treatment responders than placebo (RR 1.53, 95% CI 1.19-1.97, I-squared 79%) and greater symptom improvement (SMD 0.49, 95% CI 0.23-0.74, I-squared 89%); versus antidepressants there was no significant efficacy difference (RR 1.01, 95% CI 0.90-1.14) with fewer adverse events (OR 0.67); evidence rated moderate quality, limited by high heterogeneity and a lack of data in severe depression.
前往 PubMed
Clinical use of Hypericum perforatum (St John's wort) in depression: A meta-analysis
結論：Pooling 27 trials (3808 patients), SJW was statistically comparable to SSRIs for response (RR 0.98, 95% CI 0.92-1.04), remission (RR 1.01, 95% CI 0.89-1.13) and symptom severity (SMD -0.07, 95% CI -0.13 to 0.02), with significantly fewer dropouts than SSRIs (OR 0.59, 95% CI 0.48-0.70); the authors conclude SJW has comparable efficacy and safety to SSRIs for mild-to-moderate depression only.
前往 PubMed
Effect of Hypericum perforatum (St John's wort) in major depressive disorder: a randomized controlled trial
結論：In this NIH-funded US multicenter trial of 340 outpatients with moderately severe major depression, Hypericum did not differ significantly from placebo on HAM-D change (P=0.59) or full response (23.9% vs 31.9%, P=0.21), and sertraline beat placebo only on a secondary CGI measure — the trial failed to support efficacy of H. perforatum in moderately severe major depression.
前往 PubMed
St John's wort for depression
結論：This earlier Cochrane review version concluded that available evidence on hypericum extracts is inconsistent and confusing: larger placebo-controlled trials restricted to patients meeting strict major-depression criteria showed only minor effects over placebo, whereas trials in milder/heterogeneous depression and trials versus standard antidepressants showed comparable efficacy — anticipating the heterogeneity later quantified in the 2008 update.
前往 PubMed
L4a US FDA
謹慎
St. John's Wort appears to be an inducer of an important metabolic pathway, cytochrome P450. As many prescription drugs used to treat conditions such as heart disease, depression, seizures, certain cancers or to prevent conditions such as transplant rejection or pregnancy (oral contraceptives) are metabolized via this pathway, health care providers should alert patients about these potential dr… 來源↗
L4b EU EFSA
謹慎
L4c UK NHS
反對
St John's wort is a herbal treatment that some people take for depression. ... There's some evidence that it may help less severe depression, but it's not recommended by doctors. This is because the amount of active ingredients varies among individual brands and batches, so you can never be sure what sort of effect it'll have on you. Taking St John's wort with other medicines, such as anticonvu… 來源↗
L4d TW TFDA / 衛福部
謹慎
根據台灣衛生福利部的規定，聖約翰草不能當作一般食品原料使用，因此在台灣無法購買到合法含有聖約翰草的食品。 來源↗
L4e WHO
支持
Herba Hyperici. WHO Monographs on Selected Medicinal Plants, Volume 2 (Geneva: World Health Organization, 2002), pp. 149-171. The crude drug herba hyperici consists of the dried flowering aerial parts of Hypericum perforatum L. Uses supported by clinical data include the symptomatic treatment of mild to moderate depressive disorders. Verbatim section text of the WHO monograph could not be extra… 來源↗
L5a NIH Office of Dietary Supplements
謹慎
L5b Mayo Clinic
支持
Many studies have found St. John's wort to be helpful in treating mild to moderate depression. In fact, some research has shown the supplement to work as well as many prescription antidepressants. However, it's unclear whether the supplement helps treat severe depression. St. John's wort interacts with many medicines, so it might not be a suitable choice, especially if you take any prescription… 來源↗
L5c Cleveland Clinic
謹慎
L5d Harvard Health
中性
L5e Specialty Society (condition-mapped)
謹慎
PTT · Dcard · Mobile01 彙整自公開論壇討論，非統計抽樣，僅反映社群風向。
廣告 / 業配密度 中度
低中高
📍立場總覽
台灣社群討論集中在 PTT 芳療板（Aromatherapy），且多繞著純露/浸泡油的外用而非口服膠囊。對情緒效果評價分歧：有人覺得有舒緩、有人反映效果退去後出現「失落感」反彈；有 15 年資歷的版友反覆強烈警告「有在服藥就別碰、千萬不要口服」，因其與百種以上藥物（含抗憂鬱藥）有交互作用。台灣未核准為合法食品，民眾多靠 iHerb/日本代購（DHC、GNC）取得。口服膠囊的在地實測心得稀少。
💬社群實感
分歧（部分人覺得情緒有舒緩，部分人反映效果退去後出現失落感反彈；口服膠囊的在地真實心得稀少，討論多集中於外用純露/浸泡油）
破解迷思 社群最常見的 4 個誤解
✕
迷思「天然草藥所以安全、沒副作用」
✓
事實實際上聖約翰草是影響藥物代謝最廣的草藥之一，與 100 種以上藥物（含抗憂鬱藥）有交互作用
✓
事實把外用的聖約翰草純露/浸泡油與口服抗憂鬱膠囊混為一談，誤以為效果與安全性相同
✓
事實誤以為可與醫師開立的抗憂鬱藥（SSRI 等）併用以加強療效，實則有血清素症候群與藥效加成風險
✓
事實誤以為台灣可合法買到聖約翰草食品（實際未核准，多靠海外代購）
🩹 社群通報的副作用
- 光敏感（曬太陽易過敏/起疹）
- 焦慮、暈眩
- 口乾
- 腸胃不適、噁心
- 頭痛、倦怠
- 性功能障礙
- 效果退去後的失落感/情緒反彈
🏷️ 社群熱議品牌
依論壇被提及頻率，非銷售或品質排序。
- DHC 蝶翠詩（聖約翰草精華，日本代購）
- GNC Herbal Plus（聖約翰草萃取 300mg，iHerb/海外）
⚠️ 列出僅代表「TW 社群討論度高」，不代表本站推薦或背書。本站不販售任何產品、無導購連結。
- 心理治療（CBT／人際治療）
- 抗憂鬱藥物（SSRI 等）
- 規律運動
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