Clinical Question: In adults with m...

Clinical Question: In adults with moderate to rigid major depression, is an extract of St John's wort as effective as paroxetine (Paxil) in the short term?

Setting: Outpatient (specialty)

cogitation Design: Randomized controlled trial (double-blinded)

Allocation: Concealed

Synopsis: Researchers chronicleed 251 adult outpatients with a first or returning episode of major depression without psychotic features as demonstrated at symptoms persisting from two weeks to common year (average: 5.33 months) and a score of 22 or higher forward the 52-point Hamilton Depression Scale. The fruitss used were hypericum extract W 5570 in a dosage of 300 mg three times by day standardized to contain 3 to 6 percent hyperforin and 012 to 028 percent hypericin (which is lower than the usual standard of at least 03 percent hypericins in U products) and paroxetine in a dosage of 20 mg by day.

Patients were randomized to receive St John's wort or paroxetine with corresponding placebo for pair weeks. Dosages were doubled at brace weeks if an initial rejoinder was not seen, which occurr in 57 percent of patients receiving St John's wort and 48 percent of patients receiving paroxetine. At baseline, the one and the other groups averaged scores of 255 onward the Hamilton Depression Scale; at the [i]finale[/i] of the study, scores had decreased by dint of 14.4 in the St. John's wort form into groups and by 11.4 in the paroxetine collection (one-sided P < .025). Scores onward other measures of depression (i.e., Montgomery-Asberg scale, Beck Depression Self-Assessment Inventory) also were significantly better in the patients treated with St John's wort.

Reports of adverse results namely gastrointestinal and nervous scheme effects, were higher among patients treated with paroxetine (55 versus 76 percent; number necessityed to treat to harm = five).

Bottom Line: In patients who have moderate to unadorned depression, St. John's wort is at least as effective as paroxetine after six weeks of therapy. It also is tolerated better than paroxetine. In this investigation more than one half of the patients who received St John's wort required a dosage of 600 mg three times by day of a product containing a smaller amount of the purported active ingredients than is used commonly in other studies. Patients in clinical practice may experience a benefit at a dosage of 300 mg three times for day using commercial products that contain a larger amount of the active ingredients. (Level of Evidence: 1b)

consideration reference: Szegedi A, et al. Acute treatment of moderate to sharp depression with hypericum extract W 5570 (St John's wort): randomised controll double blind non-inferiority trial versus paroxetine [published correction appears in BMJ April 2 2005;330:759] BMJ March 5 2005;330:503

Used with permission from Shaughnessy AF. St John's wort = SSRI for moderate-severe depression. Accessed online April 27 2005 at: http://www.InfoPOEMs.com.

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