GIESSEN, GERMANY. Extracts of St. John's wort (Hypericum perforatum) was first used in ancient Greece to treat "demonic possession". It is now a prescription drug in most of continental Europe and is the most popular antidepressant in Germany. Perhaps as many as 23 trials of St. John's wort have been published, but many of them have been criticized for poor design and execution. German medical doctors now weigh in with a major, double-blind, randomized, controlled trial that compares St. John's wort to the commonly used tricyclic antidepressant imipramine (Tofranil). The study took place in 40 psychiatric, internal medicine, and general medicine practices in Germany between June 1997 and April 1998 and involved 324 outpatients with mild to moderate depression. One hundred and fifty-seven of the patients were given hypericum extract (standardized to 0.2 per cent hypericin) in the form of 250 mg film-coated tablets taken twice daily. The remaining 167 patients received two 75 mg imipramine tablets daily. The participants were evaluated weekly for six weeks using the Hamilton depression scale. In the St. John's wort group the depression score decreased from 22.4 at baseline to 12.0 after six weeks. In the imipramine group the score went from 22.1 to 12.75. St. John's wort was found to be significantly better than imipramine in the treatment of anxiety-related parameters and was much better tolerated than imipramine (39 per cent adverse events in the St. John's wort group compared to 63 per cent in the imipramine group). The researchers conclude that Hypericum perforatum extract is therapeutically equivalent to imipramine in treating mild to moderate depression, is better than imipramine in relieving anxiety associated with depression, and is significantly better tolerated by patients.
Woelk, Helmut. Comparison of St. John's wort and imipramine for treating depression: randomised controlled trial. British Medical Journal, Vol. 321, September 2, 2000, pp. 536-39