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St. John's wort as effective as paroxetine

BERLIN, GERMANY. Extracts of St. John’s wort (Hypericum perforatum) have been found to be effective in the treatment of mild to moderate depression. However, its benefits in the treatment of more severe depression are still disputed. Now a group of German researchers reports the results of a major double-blind, randomized clinical trial of St. John’s wort designed to evaluate its efficacy in comparison to paroxetine in patients with severe, major depression.

The study involved a total of 221 adult outpatients who had been diagnosed with acute major depression (a score above 22 on the 17-item Hamilton depression scale) and were being treated at 21 German psychiatric clinics. The patients were randomized to receive either 20 mg paroxetine (Paxil) once a day for 6 weeks, or 3 capsules per day each containing 300 mg of hypericum extract WS 5570 standardized to 3-6% hyperforin and 0.12-0.28% hypericin (supplied by Dr. Willmar Schwabe Pharmaceuticals, Karlsruhe). The doses for participants who did not respond within 2 weeks were increased to 40 mg/day of paroxetine and 1800 mg/day of hypericum respectively.

At the end of the 6-week trial period the Hamilton depression scores had dropped by 14.4 points (56.6%) in the hypericum group as compared to a drop of 11.4 points (44.8%) in the paroxetine group. The incidence of adverse events (mostly gastrointestinal complaints, dry mouth and nausea) was 0.035 events per day in the hypericum group and 0.060 events per day in the paroxetine group. The researchers conclude that St. John’s wort (hypericum) is at least as effective as paroxetine in the treatment of severe major depression and is better tolerated. NOTE: The study was funded by Dr. Willmar Schwabe Pharmaceuticals, the manufacturer of WS 5570.
Szegedi, A, et al. Acute treatment of moderate to severe depression with hypericum extract WS 5570 (St John’s wort): randomised controlled double blind non-inferiority trial versus paroxetine. British Medical Journal, BMJ, doi:10.1136/bmj.38356.655266.82 (published 11 February 2005)

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