Comparison of an extract of hypericum (LI 160) and sertraline in the treatment of depression: A double-blind, randomized pilot study

Background: Hypericum (St. John's wort) has been shown to be as efficacious and well tolerated as standard antidepressants in the treatment of depress ion but has not been compared with selective serotonin reuptake inhibitors (SSRIs). Objective: This study compared hypericum and the SSRI sertraline in the tre atment of depression. Methods: In a double-blind, randomized study conducted in a community hospi tal, 30 male and female outpatients (19 women, 11 men; mean age, 45.5 years ) with mild to moderate depression received 600 mg/d of a standardized extr act of hypericum (LI 160) or 50 mg/d sertraline for 1 week, followed by hyp ericum 900 mg/d or sertraline 75 mg/d for 6 weeks. Results: The severity of symptoms, as assessed by scores on the Hamilton Ra ting Scale for Depression (HAM-D) and the Clinical Global Impression scale, was significantly reduced in both treatment groups (P < 0.01). Clinical re sponse (defined as a greater than or equal to 50% reduction in HAM-D scores ) was noted in 47% of patients receiving hypericum and 40% of those receivi ng sertraline. The difference was not statistically significant. Both agent s were well tolerated. A post hoc power analysis indicated that failure to reach statistical significance between treatments resulted primarily from a n absence of clinical differences rather than the small sample size. Conclusion: The hypericum extract was at least as effective as sertraline i n the treatment of mild to moderate depression in a small group of outpatie nts.