The Pharmaceutical Journal
Vol 268 No 7193 p487-492
13 April 2002

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Journal of the American Medical Association (jama.ama-assn.org)

St John's wort effect not proven for major depression

Hypericum perforatum (St John's wort) should not be used as a substitute for standard clinical care of proven efficacy, including antidepressant medication and specific psychotherapies, say researchers.

Dr Jonathan Davidson, Duke University Medical Centre, North Carolina, and colleagues randomly assigned 340 patients to receive an extract of hypericum, placebo or sertraline (Lustral) for eight weeks and doses were based on clinical response. A further 18 weeks of treatment was given to those responding to treatment after eight weeks.

Neither hypericum nor sertraline could be differentiated from placebo when assessed using primary efficacy measures. However, sertraline was found to be superior to placebo on the Clinical Global Impressions Scale for Improvement, a measure of depression. The researchers add that hypericum and sertraline were associated with more adverse events than placebo.

The researchers point out that "without a placebo, hypericum could easily have been considered as effective as sertraline, as some studies have done with respect to active antidepressants". They add that "without sertraline as an active comparator, the results would have been interpreted as evidence for the lack of efficacy of hypericum" (JAMA 2002;287:1807).

In an accompanying editorial Dr David Kupfer and Dr Ellen Frank, department of psychiatry, University of Pittsburgh Medical School, say that the study represents "an excellent example of why it is critical to include both placebo and active comparators in trials of agents for which efficacy is unproven" (ibid, p1853).