07.01.05
An editorial published in the May 14th issue of the British Medical Journal (BMJ) indicated that St. John’s Wort (SJW) be used for minor depression only because its efficacy for severe depression, and even moderate forms of depression, remains in doubt. This editorial was penned in response to a recent study that compared SJW and paroxetine, a selective serotonin reuptake inhibitor (SSRI), which demonstrated surprising results. In the study, patients randomized to SJW showed greater symptom reduction than patients taking immediate release paroxetine. At six weeks, 71% of SJW patients, compared to 60% of paroxetine patients, showed a 50% or greater reduction in depressive symptoms. In addition, significantly fewer patients taking SJW experienced adverse effects. According to the editorial, a recent meta-analysis conducted on randomized, double-blind trials of SJW concluded that the current evidence is inconsistent and confusing. The six trials analyzed, which all compared SJW to an SSRI in patients with major depression, showed no difference in response rates between the two treatments. And even if the recent trial comparing SJW and paroxetine was included in the meta-analysis, the rate ratio would not change significantly. The BMJ editorial concluded that SJW should not be considered a first or second choice for U.S. patients with moderate to severe major depression. However, for patients with minor depression, where the evidence for SJW is more robust and standard antidepressants have not been proved efficacious, the lower cost and lower side effect profile make SJW a reasonable option for patients who are able to locate quality preparations. (BMJ, May 14, 2005;330:E350-351.)