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St John's Wort May be an Effective Anti-depressant

 

People suffering from severe depression could find St John's wort as effective a treatment as prescribed drugs but with fewer side effects, a new study suggests. The finding adds to existing evidence that extracts from the herb can be used against mild and moderate depression.

The herb is commercially available but the amount of the active compounds can vary greatly. So to compare St John's wort to the widely-prescribed antidepressant paroxetine, Meinhard Kieser and his colleagues from Dr Willmar Schwabe Pharmaceuticals in Karlsruhe, Germany, used an extract of the herb.

The researchers assessed improvement during treatment using a standard scale called the Hamilton depression scale. "Healthy people have a score lower than 10 on the scale, while those with depression have a score of at least 14 and the severely depressed around 24 or 25," explains Angelika Dienel, one of the team.

 

At the end of a six week trial, hypericum decreased Hamilton depression scores by an average of 14, compared with a decrease of 11 among patients taking paroxetine, suggesting that the St John's wort extract is at least as effective against severe depression.

St. John's Wort : No placebo

To select people for the study, 301 volunteers with a Hamilton depression score of at least 22 took a placebo for up to seven days, and those that showed improvement were excluded. It would be have been unethical to give severely depressed people a placebo for the entire study - which lasted six weeks - so no placebo control group was used.

The remaining 251 patients were randomised to take either hypericum or paroxetine. After two weeks the dose was doubled in people whose Hamilton scores did not decrease by at least 20%.

As well as similar improvements in their depression, the hypericum group also reported fewer side effects than those on paroxetine. Just 55% of the group complained of diarrhoea, nausea, dizziness, sweating or upper abdominal pain among others, compared with 76% of the paroxetine group. But people who took the extract were more likely to have upper abdominal pain: 10% compared with 7% of paroxetine users.

However GlaxoSmithKline, which makes paroxetine, points out that a single study cannot adequately assess safety, while paroxetine has 13 years of data behind it, and has been through clinical studies involving 24,000 people.

Drug interference

Previous studies in severely depressed people have failed to show that St John's wort has any effect over that of placebo, so larger studies may be needed to confirm its potential.

People should talk to their doctor before taking St John's wort in any form, because it can interfere with other drugs, says Amelia Mustapha of the UK's Depression Alliance. She says that despite earlier evidence of its use against mild depression, there is still no licensed form of the herb.

"Doctors could prescribe it as they prescribe books or exercise but they don't feel comfortable doing it because it isn't standardised," she says. "You can get St John's wort teabags with little or no extract in them and how are people to know the difference?"

Journal reference: British Medical Journal (DOI: 10.1136/bmj.38356.655266.82)

Feb. 11, 2005                                                                  NewScientist.com News Service                                                    Katherine Davis

Webpage by Paul Susic  MA Licensed Psychologist   Ph.D. Candidate  (Health and Geriatric Psychologist) 

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