An Open-Label Trial of St. John's Wort (Hypericum perforatum) in Obsessive-Compulsive Disorder
J Clin Psychiatry 2000;61(8):575-578
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Recent interest in and evidence for
the efficacy of St. John's wort (Hypericum perforatum) for
the treatment of mild-to-moderate depression has led to
speculation about its efficacy in other disorders. Hypericum's
mechanism of action is postulated to be via inhibition of the
synaptosomal uptake of serotonin. As such, there is a suggestion
that Hypericum may be effective for obsessive-compulsive
Method: Twelve subjects were evaluated with a
primary DSM-IV diagnosis of OCD of at least 12 months' duration.
Treatment lasted for 12 weeks, with a fixed dose of 450 mg of
0.3% hypericin (a psychoactive compound in Hypericum)
twice daily (extended-release formulation). Weekly evaluations
were conducted with the Yale-Brown Obsessive Compulsive Scale
(Y-BOCS), the Patient Global Impressions of Improvement Scale,
and the Clinical Global Impressions of Improvement scale (CGI)
and monthly evaluation with the Hamilton Rating Scale for
Results: A significant change from baseline to
endpoint was found, with a mean Y-BOCS change of 7.4 points (p =
.001). Significant change occurred at 1 week (p = .020) and
continued to increase throughout the trial. At endpoint, 5 (42%)
of 12 were rated "much" or "very much
improved" on the clinician-rated CGI, 6 (50%) were
"minimally improved," and 1 (8%) had "no
change." The most common side effects reported were diarrhea
(N = 3) and restless sleep (N = 2).
Conclusion: Significant improvement was found
with Hypericum, with a drop-in Y-BOCS score similar to
that found in clinical trials. The fact that a significant change
was found as early as 1 week into treatment suggests a possible
initial placebo response, although improvement grew larger over
time. Results warrant a placebo-controlled study of Hypericum in