Primary Care Companion J Clin Psychiatry 2001;3(3):146-148
© Copyright 2014 Physicians Postgraduate Press, Inc.
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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.
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
This study did not find St. John’s wort to
be effective for the treatment of major depressive disorder.