ST-JOHN WORT FOR DEPRESSION - AN OVERVIEW AND METAANALYSIS OF RANDOMIZED CLINICAL-TRIALS

Objective-To investigate if extracts of Hypericum perforatum (St John' s wort) are more effective than placebo in the treatment of depression , are as effective as standard antidepressive treatment, and have fewe r side effects than standard antidepressant drugs. Design-Systematic r eview and meta-analysis of trials revealed by searches. Trials-23 rand omised trials including a total of 1757 outpatients with mainly mild o r moderately severe depressive disorders: 15 (14 testing single prepar ations and one a combination with other plant extracts) were placebo c ontrolled, and eight (six testing single preparations and two combinat ions) compared hypericum with another drug treatment. Main outcome mea sures-A pooled estimate of the responder rate ratio (responder rate in treatment group/responder rate in control group), and numbers of pati ents reporting and dropping out for side effects. Results-Hypericum ex tracts were significantly superior to placebo (ratio = 2.67; 95% confi dence interval 1.78 to 4.01) and similarly effective as standard antid epressants (single preparations 1.10; 0.93 to 1.31, combinations 1.52; 0.78 to 2.94). There were two (0.8%) drop outs for side effects with hypericum and seven (3.0%) with standard antidepressant drugs. Side ef fects occurred in 50 (19.8%) patients on hypericum and 84 (52.8%) pati ents on standard antidepressants. Conclusion-There is evidence that ex tracts of hypericum are more effective than placebo for the treatment of mild to moderately severe depressive disorders. Further studies com paring extracts with standard antidepressants in well defined groups o f patients and comparing different extracts and doses are needed.