Potential treatment for subthreshold and mild depression: A comparison of St. John's wort extracts and fluoxetine

Subthreshold depressive disturbances and depressive episodes of mild severi ty are frequently associated with disability and socioeconomic burden, and often show an increase in symptomatology over time if untreated. Thus, ther e is an urgent need for antidepressant active compounds that are more readi ly available than those that must be obtained by prescription. To get an im pression of the efficacy of the widely used phytopharmaceutical St. John's wort, the antidepressant efficacy in mild depressive disorders was compared with that of the standard antidepressant fluoxetine, The present overview includes controlled trials of fluoxetine in depression with a mean initial score on the Hamilton Rating Scale for Depression (HAM-D) less than or equa l to 24, which were compared to the respective studies on St, John's wort. The mean HAM-D reduction of all St. John's wort studies was 10.2 (52.9%), a nd the respective figures for fluoxetine were 12.5 points and 55.5%, Thus, no relevant efficacy difference between the groups of investigations was fo und based on the studies included. The most important restrictions of this overview are no meta-analysis was performed, the studies were performed wit h heterogeneous methodological standards, and the St. John's wort extracts used were very different. However, St. John's wort might be a treatment opt ion to reduce symptoms in patients not suffering from full-blown depressive disorder, Copyright (C) 2000 by W.B, Saunders Company.