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Psychiatric Briefs

Primary Care Companion J Clin Psychiatry 2001;3(3):146-148

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​​Background: Extracts of St. John’s wort (Hypericum perforatum) are widely used to treat depressive disorders. Although an extensive literature purports the effectiveness of St. John’s wort in treating depression, most studies involving this herbal remedy have been compromised by methodological shortcomings. This multicenter, randomized, double-blind, placebocontrolled trial was conducted to ascertain the efficacy, safety, and tolerability of a standardized preparation of St. John’s wort in the treatment of DSM-IV major depressive disorder. Method: After a 1-week placebo run-in, 200 adult outpatients (mean age = 42 years; 67.0% female, 85.9% white) with major depression who had a baseline Hamilton Rating Scale for Depression (HAM-D) score ³ 20 were randomly assigned to receive 8 weeks of treatment with either St. John’s wort (N = 98; 900 mg/day for 4 weeks and increased to 1200 mg/day in absence of adequate response) or placebo (N = 102). In addition to the primary outcome measure of rate of change on the HAM-D, other outcome measures included the Beck Depression Inventory (BDI), the Hamilton Rating Scale for Anxiety (HAM-A), the Global Assessment of Function (GAF), and the Clinical Global Impressions-Severity of Illness and -Improvement scales (CGIS and CGI-I). Results: Although St. John’s wort was safe and well-tolerated, no significant effect was found for treatment (p = .16) or time-by-treatment interaction (p = .58) as measured by HAM-D scores, and nonsignificant effects were found for BDI and GAF scores. No difference in the proportion of subjects responding to treatment was found between groups. Although significantly more St. John’s wort–treated subjects than placebotreated subjects achieved remission (p = .02), the rates in both groups were low (St. John’s wort, 14/98 [14.3%]; placebo, 5/102 [4.9%]). Conclusion: This study did not find St. John’s wort to be effective for the treatment of major depressive disorder.