Wednesday, July 16, 2008

St. John's Wort and Depression

More Evidence to Support The Use of St. John's Wort in Depression

A recent article publsihed in the December 11th issue of the British Medical Journal examined the effectiveness of St. John's Wort versus imipramine and placebo in the treatment of moderate depression. In this multicenter trial conducted in Germany, 263 patients were randomized to receive either St. John's Wort (350 mg three times per day), imipramine (50 mg in the morning, 25 mg midday and 25 mg at night) or placebo (administered 3 times per day)for an 8 week treatment period. Patients were subsequently monitored and outcomes were assessed by utilizing the Hamilton depression and anxiety scales, the clinical global improvement scale, Zung's self-rating depression scale and an adverse event profile (The assessment scales denoted above are common tools in research and clinical practice for objectively assessing depression/anxiety parameters).

Scores obtained on all depression scales at 4, 6 and 8 weeks after initiation of treatment demonstrated equivalence between St. John's Wort and imipramine with a clear benefit of both over placebo. The rate of adverse events was similar between the placebo and St. John's Wort groups, both being less than the imipramine group.

This study, similar to many others conducted with St. John's Wort, demonstrates its efficacy in the management of moderate depression. Moreover, this trial provides evidence for a favorable adverse event profile for St. John's Wort as well. Independently, this trial is not large scale given the study population of 263 patients; however, the results are consistent with previous randomized controlled trials utilizing this herbal extract. Such reproducibility lends further justification for the utilization of St. John's Wort in patients exhibiting mild to moderate depressive symptoms.

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