BMJ 2000;321:536-539 ( 2 September )

Papers

Comparison of St John's wort and imipramine for treating depression: randomised controlled trial

Helmut Woelk, medical director, 

Klinik für Psychiatrie und Psychotherapie, Akademisches Lehrkrankenhaus der Universität Giessen, Licher Strasse 106, D-35394 Giessen, Germany

Objectives: To compare the efficacy and tolerability of Hypericum perforatum (St John's wort extract) with imipramine in patients with mild to moderate depression.
Design: Randomised, multicentre, double blind, parallel group trial.
Setting: 40 outpatient clinics in Germany.
Participants: 324 outpatients with mild to moderate depression.
Intervention: 75 mg imipramine twice daily or 250 mg hypericum extract ZE 117 twice daily for 6 weeks.
Main outcome measures: Hamilton depression rating scale, clinical global impression scale, and patient's global impression scale.
Results: Among the 157 participants taking hypericum mean scores on the Hamilton depression scale decreased from 22.4 at baseline to 12.00 at end point; among the 167 participants taking imipramine they fell from 22.1 to 12.75. Mean clinical global impression scores at end point were 2.22 out of 7 for the hypericum group and 2.42 for the imipramine group. On the 7 point self assessments of global improvement completed by participants (score of 1 indicating "very much improved" and 7 indicating "very much deteriorated") mean scores were 2.44 in the hypericum group and 2.60 in the imipramine group. None of the differences between treatment groups were significant. However, the mean score on the anxiety-somatisation subscale of the Hamilton scale (3.79 in the hypericum group and 4.26 in the imipramine group) indicated a significant advantage for hypericum relative to imipramine. Mean scores on the 5 point scale used by participants to assess tolerability (score of 1 indicating excellent tolerability and 5 indicating very poor tolerability) were better for hypericum (1.67) than imipramine (2.35). Adverse events occurred in 62/157 (39%) participants taking hypericum and in 105/167 (63%) taking imipramine. 4 (3%) participants taking hypericum withdrew because of adverse events compared with 26 (16%) taking imipramine.
Conclusions: This Hypericum perforatum extract is therapeutically equivalent to imipramine in treating mild to moderate depression, but patients tolerate hypericum better.


© BMJ 2000
Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to StumbleUpon StumbleUpon   Add to Technorati Technorati    What's this?

This article has been cited by other articles:

  • Bell, E. C, Ravis, W. R, Chan, H. M., Lin, Y.-J. (2007). Lack of Pharmacokinetic Interaction Between St. John's Wort and Prednisone. The Annals of Pharmacotherapy 41: 1819-1824 [Abstract] [Full text]  
  • Gahlsdorf, T., Krause, R., Beal, M. W. (2007). Efficacy of St. John's Wort for Treating Mild to Moderate Depression. Complementary Health Practice Review 12: 184-195 [Abstract]  
  • Deng, G., Cassileth, B. R. (2005). Integrative Oncology: Complementary Therapies for Pain, Anxiety, and Mood Disturbance. CA Cancer J Clin 55: 109-116 [Abstract] [Full text]  
  • LINDE, K., BERNER, M., EGGER, M., MULROW, C. (2005). St John's wort for depression: Meta-analysis of randomised controlled trials. Br. J. Psychiatry 186: 99-107 [Abstract] [Full text]  
  • Schapowal, A., for the Petasites Study Group, (2004). Butterbur Ze339 for the Treatment of Intermittent Allergic Rhinitis: Dose-Dependent Efficacy in a Prospective, Randomized, Double-blind, Placebo-Controlled Study. Arch Otolaryngol Head Neck Surg 130: 1381-1386 [Abstract] [Full text]  
  • Muller, T., Mannel, M., Murck, H., Rahlfs, V. W. (2004). Treatment of Somatoform Disorders With St. John's Wort: A Randomized, Double-Blind and Placebo-Controlled Trial. Psychosom. Med. 66: 538-547 [Abstract] [Full text]  
  • Zellweger, M. J., Osterwalder, R. H., Langewitz, W., Pfisterer, M. E. (2004). Coronary artery disease and depression. Eur Heart J 25: 3-9 [Abstract] [Full text]  
  • Markowitz, J. S., Donovan, J. L., DeVane, C. L., Taylor, R. M., Ruan, Y., Wang, J.-S., Chavin, K. D. (2003). Effect of St John's Wort on Drug Metabolism by Induction of Cytochrome P450 3A4 Enzyme. JAMA 290: 1500-1504 [Abstract] [Full text]  
  • De Smet, P. A.G.M. (2002). Herbal Remedies. NEJM 347: 2046-2056 [Full text]  
  • Schneider, R. K., Levenson, J. L. (2002). Update in Psychiatry. ANN INTERN MED 137: 671-677 [Full text]  
  • Charlier, C., Pinto, E., Ansseau, M., Plomteux, G. (2002). Venlafaxine: the relationship between dose, plasma concentration and clinical response in depressive patients.. J Psychopharmacol 16: 369-372 [Abstract]  
  • Hypericum Depression Trial Study Group, (2002). Effect of Hypericum perforatum (St John's Wort) in Major Depressive Disorder: A Randomized Controlled Trial. JAMA 287: 1807-1814 [Abstract] [Full text]  
  • Schapowal, A. (2002). Randomised controlled trial of butterbur and cetirizine for treating seasonal allergic rhinitis. BMJ 324: 144-144 [Abstract] [Full text]  
  • Emanuel, A. M., Moore, T. R., Ghazvini, P. (2001). Considerations for the Use of Alternative Therapies in the Treatment of Depression. Journal of Pharmacy Practice 14: 551-559 [Abstract]  
  • Even, C., Friedman, S., Dardennes, R. (2001). Antidepressant trials generally have methodological defects. BMJ 323: 574-574 [Full text]  
  • Hotopf, M. (2001). Hypericum extract was as effective as imipramine but had fewer adverse effects in mild to moderate depressionCommentary. Evid. Based Ment. Health 4: 56-56 [Full text]  
  • Shelton, R. C., Keller, M. B., Gelenberg, A., Dunner, D. L., Hirschfeld, R., Thase, M. E., Russell, J., Lydiard, R. B., Crits-Christoph, P., Gallop, R., Todd, L., Hellerstein, D., Goodnick, P., Keitner, G., Stahl, S. M., Halbreich, U. (2001). Effectiveness of St John's Wort in Major Depression: A Randomized Controlled Trial. JAMA 285: 1978-1986 [Abstract] [Full text]  
  • Cornwall, P. L, Spira, J. L, Alkhenizan, A., Völp, A., Woelk, H (2001). Comparison of St John's wort and imipramine. BMJ 322: 493-493 [Full text]  
  • (2000). St John's Wort: More Cheerful Results for Depression. JWatch General 2000: 4-4 [Full text]  

Rapid Responses:

Read all Rapid Responses

Inconclusive result
Arthur Rifkin
bmj.com, 2 Sep 2000 [Full text]
Do these results apply in the "New World" ?
Paul Kepkay
bmj.com, 2 Sep 2000 [Full text]
Drug Treatment in Depression
Salvador Vale
bmj.com, 2 Sep 2000 [Full text]
compared to what?
James L Spira
bmj.com, 2 Sep 2000 [Full text]
How much more evidence is needed?
Ron Law
bmj.com, 1 Sep 2000 [Full text]
Patient preference needs to be taken into account in treating depression
Andrew Thornett
bmj.com, 2 Sep 2000 [Full text]
Misleading research
Judith Ronat
bmj.com, 2 Sep 2000 [Full text]
St. John’s wort: Questions not answered yet.
Abdullah Alkhenizan
bmj.com, 3 Sep 2000 [Full text]
Some questions
Ruti Guttman
bmj.com, 3 Sep 2000 [Full text]
Re: Carefully during summer with this plant extract
Regina Stroebele
bmj.com, 3 Sep 2000 [Full text]
Depressed and confused
Stephen Senn
bmj.com, 3 Sep 2000 [Full text]
Re: Do these results apply in the "New World" ?
Syd Baumel
bmj.com, 7 Sep 2000 [Full text]
quibble if you will
Brian F Walker
bmj.com, 4 Sep 2000 [Full text]
Effects of St John's wort
Wei Wei Ong
bmj.com, 5 Sep 2000 [Full text]
Remission is the important outcome
Peter L Cornwall
bmj.com, 7 Sep 2000 [Full text]
comparison of St Johns Wort
Graham Curtis Jenkins
bmj.com, 19 Sep 2000 [Full text]
Comparison of St John's Wort and Imipramine for treating depression: randomised controlled trial.
Mark C Dale
bmj.com, 19 Sep 2000 [Full text]
St John’s Wort – have you asked your patients?
Lynn Riddell
bmj.com, 20 Sep 2000 [Full text]
Differences in St. John's Wort Extracts?
Vincent E Pearson
bmj.com, 20 Sep 2000 [Full text]
Elimination-time for ZE 117
Ole Stubsgaard
bmj.com, 25 Sep 2000 [Full text]
Assay sensitivity questionable
Andreas Völp
bmj.com, 29 Sep 2000 [Full text]
Comparison of st. john's wort and imipramine
Andrew Sandor
bmj.com, 2 Oct 2000 [Full text]
longterm effects of SJW
Piet Bakx
bmj.com, 5 Oct 2000 [Full text]
Hyperforin content in hypericum extract ZE 117?
Anette Gemal Jensen
bmj.com, 30 Nov 2000 [Full text]
SEEING THE MOTE IN THE EYE OF THE SAINT JOHN'S WORT SUPPORTER
Christian Even
bmj.com, 27 Jul 2001 [Full text]
Access jobs at BMJ Careers
Whats new online at Student BMJ