Robert Provino and Larisa A. J. Barnes
Aim To compare the safety and efficacy of Withania somnifera (Withania) and Hypericum perforatum (St John’s wort, SJW) in the treatment of stress and anxiety in order to inform clinical practice.
Methods Integrative review methodology was followed. Four databases (CINAHL, AMED, ProQuest and MEDLINE) were searched to obtain peer-reviewed journal articles examining Withania or SJW for the treatment of anxiety and/or stress. Searches to identify herb–drug reactions (HDRs) and adverse drug reactions (ADRs) associated with the use of these herbs in the treatment of anxiety and stress were also performed. Human studies, written in English, published between 2010 and 2020 were included. In vitro, animal and paediatric studies were excluded. Studies were screened by title, abstract and full text and assessed against the aims of the review.
Results After duplicates were removed, 781 studies were screened by title and abstract, leaving 64 to be screened by full text; 16 studies met the inclusion criteria. Studies showed Withania to be a safe and effective treatment for anxiety and stress. No HDRs were identified for Withania, and reported ADRs were infrequent and mild. Key safety issues with SJW include an increased risk of psychosis in susceptible individuals, multiple known HDRs, and a higher incidence of ADRs.
Conclusion Withania is a safe and effective treatment for stress and anxiety and has a superior safety profile to SJW. Given the high rates of self-prescription, and the possibilities of ADRs and HDRs identified with SJW, healthcare practitioners should enquire about SJW use with all patients.