Download PDF
Pharmacopsychiatry 2012; 45(07): 275-278
DOI: 10.1055/s-0032-1306348
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

St John’s Wort (Hypericum perforatum) versus Sertraline and Placebo in Major Depressive Disorder: Continuation Data from a 26-Week RCT

J. Sarris
1   Department of Psychiatry, The University of Melbourne, Melbourne, Australia
2   Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Australia
,
M. Fava
3   Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
,
I. Schweitzer
1   Department of Psychiatry, The University of Melbourne, Melbourne, Australia
,
D. Mischoulon
3   Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
› Author Affiliations
Further Information

Publication History

received 16 January 2012
revised 12 February 2012

accepted 21 February 2012

Publication Date:
16 May 2012 (online)

Also available at
    Permissions and Reprints

Abstract

Introduction:

Hypericum perforatum (St John’s wort: SJW) has been extensively studied as an antidepressant in short-term trials, however little research has been conducted on longer-term efficacy.

Methods:

Our objective was to analyze the continuation data from a 26-week randomized, double-blind, controlled study of SJW (LI-160) vs. sertraline and placebo in major depressive disorder. 124 participant “responders” continued treatment after week 8, until week 26. They continued randomly assigned SJW (900–1 500 mg), sertraline (50–100 mg) or matching placebo.

Results:

At week 26, on the primary outcome, Hamilton depression rating scale (HAM-D) completer scores were: SJW (6.6±4.5), sertraline (7.1±5.4) and placebo (5.7±5.4) with a significant effect for time (p=0.036). Comparisons between all treatments were however non-significant (p=0.61). This effect was mirrored on the other outcomes: the BDI, CGI-severity, CGI-improvement, and on intention-to-treat analyses.

Conclusion:

While the continuation data revealed an equivocal outcome between treatments at week 26, both SJW and sertraline were still therapeutically effective, with a pronounced “placebo-effect” impeding a significant result at week 26.

Key words

St John’s wort - Hypericum perforatum - sertraline - antidepressants - randomized controlled trial - depression - herbal medicine
 

  • References

  • 1 Muller W-E. Current St John’s wort research from mode of action to clinical efficacy. Pharmacol Res 2003; 47: 101-109
    CrossrefPubMedGoogle Scholar
  • 2 Sarris J, Panossian A, Schweitzer I et al. Herbal medicine for depression, anxiety and insomnia: A review of psychopharmacology and clinical evidence. Eur Neuropsychopharmacol 2011; in press
    PubMedGoogle Scholar
  • 3 Kasper S, Gastpar M, Möller HJ et al. Better tolerability of St. John’s wort extract WS 5570 compared to treatment with SSRIs: a reanalysis of data from controlled clinical trials in acute major depression. Int Clin Psychopharmacol 2010; 25: 204-213
    CrossrefPubMedGoogle Scholar
  • 4 Linde K, Berner M, Kriston L. St John’s wort for major depression. Cochrane Database Syst Rev 2008; (04) CD000448
    PubMedGoogle Scholar
  • 5 Sarris J, Kavanagh D-J. Kava and St John’s wort: current evidence for use in mood and anxiety disorders. J Altern Complement Med 2009; 15: 827-836
    CrossrefPubMedGoogle Scholar
  • 6 Fava M, Alpert J, Nierenberg AA et al. A double-blind, randomized trial of St John’s wort, fluoxetine, and placebo in major depressive disorder. J Clin Psychopharmacol 2005; 25: 441-447
    CrossrefPubMedGoogle Scholar
  • 7 Shelton R-C, Keller MB, Gelenberg A et al. Effectiveness of St John’s wort in major depression: a randomized controlled trial. JAMA 2001; 285: 1978-1986
    CrossrefPubMedGoogle Scholar
  • 8 Hypericum Depression Trial Study Group . Effect of Hypericum perforatum (St John’s wort) in major depressive disorder: a randomized controlled trial. JAMA 2002; 287: 1807-1814
    CrossrefPubMedGoogle Scholar
  • 9 Kasper S, Volz HP, Möller HJ et al. Continuation and long-term maintenance treatment with Hypericum extract WS 5570 after recovery from an acute episode of moderate depression – a double-blind, randomized, placebo controlled long-term trial. Eur Neuropsychopharmacol 2008; 18: 803-813
    CrossrefPubMedGoogle Scholar
  • 10 Gastpar M, Singer A, Zeller K. Efficacy and tolerability of hypericum extract STW3 in long-term treatment with a once-daily dosage in comparison with sertraline. Pharmacopsychiatry 2005; 38: 78-86
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23: 56-62
    CrossrefPubMedGoogle Scholar
  • 12 Beck A-T, Ward C, Mendelson M. Beck Depression Inventory (BDI). Arch Gen Psychiatry 1961; 4: 561-571
    CrossrefPubMedGoogle Scholar
  • 13 Endicott J, Spitzer RL, Fleiss JL et al. The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry 1961; 33: 766-771
    PubMedGoogle Scholar
  • 14 Guy W, Bonato R-E. CGI: Clinical Global Impressions. Manual for the ECDEU Assessment Battery. 2. Rev ed. Chevy Chase, MD: National Institute of Mental Health; 1970. (12-1-12-6)
    Google Scholar
  • 15 Trivedi M-H, Fava M, Wisniewski SR et al. Medication augmentation after the failure of SSRIs for depression. N Engl J Med 2006; 354: 1243-1252
    CrossrefPubMedGoogle Scholar
  • 16 Fournier J, DeRubeis RJ, Hollon SD et al. Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA 2010; 303: 47-53
    CrossrefPubMedGoogle Scholar