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St John's Wort Really Does Help Depression

Although a number of studies have tested the efficacy of hypericum (an extract of St John's wort) for depression, they have been criticized consistently for methodological deficiencies (see JW Nov 1 1999, p. 169, accession number 991012001, and J Nerv Ment Dis 1999; 187:532). This randomized trial from Germany involved 263 moderately depressed patients selected from primary care practices. Patients were randomly assigned to receive placebo, hypericum extract (1050 mg daily), or imipramine (100 mg daily) for 8 weeks.

On a standard depression rating scale, hypericum and imipramine were similar (and significantly better than placebo) at reducing depressive symptoms. Half of the placebo patients showed improvement, compared with 74 percent of the hypericum group and 71 percent of the imipramine group. On 2 quality-of-life scales (physical and mental functioning), hypericum was significantly better than placebo and somewhat better than imipramine. Adverse events occurred in 19 percent of the placebo group, 22 percent of the hypericum group, and 46 percent of the imipramine group.

Comment: In moderately depressed patients, hypericum might well be a reasonable first-line therapeutic alternative to more usual medications. However, there is still much variability in the composition of hypericum products, which makes it difficult to predict the response to any particular brand.

— KI Marton

Published in Journal Watch General Medicine January 11, 2000

Citation(s):

Philipp M et al. Hypericum extract versus imipramine or placebo in patients with moderate depression: Randomised multicentre study of treatment for eight weeks. BMJ 1999 Dec 11 319 1534-1538.

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