February 17, 2005
Herbal extract, St. John's wort, shows comparable efficacy to common
antidepressant
~a summary of the article, as published in the journal, BMJ,
doi:10.1136/bmj.38356.655266.82 (published 11 February 2005)
Acute treatment of moderate to severe depression with hypericum extract
WS 5570 (St. John's Wort): randomized controlled double blind
non-inferiority trial versus paroxetine.
by A. Szegedi, R. Kohnen, A. Dienel, M. Kieser
Hypericum extract WS 5570, also known as St John's wort, appears to be
as effective as the selective serotonin reuptake inhibitor paroxetine
for the treatment of moderate-to-severe depression, researchers report.
The team, led by A Szegedi from Charité-Universitätsmedizin Berlin in
Germany, and colleagues compared the treatment benefits of hypericum
extract and paroxetine in 251 patients aged between 18 and 70 years with
acute major depression. All the participants had a Hamilton Depression
Rating (HAM-D) Scale score of 22 or above.
The patients were randomly assigned to receive either 900 mg/day of
hypericum extract WS 5570 three times a day or 20 mg of paroxetine once
a day for 6 weeks. Among those who did not initially respond to
treatment, the doses of hypericum and risperidone were increased to 1800
mg/day and 50 mg/day, respectively.
Scores on the HAM-D scale decreased by an average of 14.4 points in
patients taking hypericum extract and by an average of 11.4 points among
those given paroxetine.
Moreover, at the end of treatment, 71% of patients taking hypericum
extract were considered to have responded to treatment, defined as a 50%
or greater decrease in score on the HAM-D scale, compared with 60% of
paroxetine-treated patients. The respective remission rates were 50% and
35%.
Compared with paroxetine, hypericum extract was also associated with a
superior tolerability profile, with paroxetine-treated patients
suffering 269 adverse effects, while those given hypericum extract
experienced 172 unwanted effects. Stomach disorders were the most common
effects reported in both treatment groups.
"We have shown that hypericum extract WS 5570 is at least as effective
as paroxetine over 6 weeks of acute treatment in outpatients with
moderate or severe unipolar major depression," the researchers write in
an early online issue of the British Medical Journal.
They are now assessing the long-term efficacy of the hypericum extract,
for which the team says the drug could be an interesting option,
"because of its favorable ratio between efficacy and tolerability in the
ongoing continuation phase."
BMJ 2005; Early online publication
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