• R C Shelton, M B Keller, A Gelenberg, D L Dunner, R Hirschfeld, M E Thase, J Russell, R B Lydiard, P Crits-Cristoph, R Gallop, L Todd, D Hellerstein, P Goodnick, G Keitner, S M Stahl, and U Halbreich.
• Department of Psychiatry, Vanderbilt University, Nashville Tennessee, USA. richard.shelton@mcmail.vanderbilt.edu
• JAMA. 2001 Apr 18; 285 (15): 1978-86.

ContextExtracts of St John's wort are widely used to treat depression. Although more than 2 dozen clinical trials have been conducted with St John's wort, most have significant flaws in design and do not enable meaningful interpretation.ObjectiveTo compare the efficacy and safety of a standardized extract of St John's wort with placebo in outpatients with major depression.Design And SettingRandomized, double-blind, placebo-controlled clinical trial conducted between November 1998 and January 2000 in 11 academic medical centers in the United States.ParticipantsTwo hundred adult outpatients (mean age, 42.4 years; 67.0% female; 85.9% white) diagnosed as having major depression and having a baseline Hamilton Rating Scale for Depression (HAM-D) score of at least 20.InterventionParticipants completed a 1-week, single-blind run-in of placebo, then were randomly assigned to receive either St John's wort extract (n = 98; 900 mg/d for 4 weeks, increased to 1200 mg/d in the absence of an adequate response thereafter) or placebo (n = 102) for 8 weeks.Main Outcome MeasuresThe primary outcome measure was rate of change on the HAM-D over the treatment period. Secondary measures included the Beck Depression Inventory (BDI), Hamilton Rating Scale for Anxiety (HAM-A), the Global Assessment of Function (GAF) scale, and the Clinical Global Impression-Severity and -Improvement scales (CGI-S and CGI-I).ResultsThe random coefficient analyses for the HAM-D, HAM-A, CGI-S, and CGI-I all showed significant effects for time but not for treatment or time-by-treatment interaction (for HAM-D scores, P<.001, P =.16, and P =.58, respectively). Analysis of covariance showed nonsignificant effects for BDI and GAF scores. The proportion of participants achieving an a priori definition of response did not differ between groups. The number reaching remission of illness was significantly higher with St John's wort than with placebo (P =.02), but the rates were very low in the full intention-to-treat analysis (14/98 [14.3%] vs 5/102 [4.9%], respectively). St John's wort was safe and well tolerated. Headache was the only adverse event that occurred with greater frequency with St John's wort than placebo (39/95 [41%] vs 25/100 [25%], respectively).ConclusionIn this study, St John's wort was not effective for treatment of major depression.

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