Use of hypericum as antidepressant

doi:10.1136/bmj.320.7242.1141/a

BMJ 2000;320:1141 ( 22 April )

Letters

Use of hypericum as antidepressant

Valid measure of antidepressant efficacy in primary care is needed

Naturalistic studies are needed

Use of placebo in depression trial was unethical

Active substances must be identified

The herbalist will see you now

Safety in overdose needs to be established

Authors' reply

Valid measure of antidepressant efficacy in primary care is needed

The first 150 words of the full text of this article appear below.

EDITOR $---$ The study by Philipp et al comparing hypericum extract and imipramine or placebo seems to show that hypericum is aseffective at treating moderate depression as imipramine.¹ Thisimpression is strengthened by the design of the study, which isdouble blind, randomised, and placebo controlled, using a widelyused medication as a comparator and using globally accepted depressionscales including the Hamilton depression score. Linde and Berner,however, in the accompanying commentary question the efficacyof hypericum because of its use in comparatively large doses andits comparison with low doses of standard antidepressants.¹They believe that these, together with the effect of unblindingon outcome, should be taken into account in the analysis of theresults. The basis of this criticism is the lack of universalconsensus on how the effects of antidepressant drugs should bemeasured in primary care. Difficulty arises because lower dosesare often . . . [Full text of this article]

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Rapid Responses:

Read all Rapid Responses

Placebo group not unethical: Lewis Mehl-Madrona
bmj.com, 23 Apr 2000 [Full text]
St.John's Wort and common sense: Joel Simon Hochman
bmj.com, 25 Apr 2000 [Full text]
Herb Pharming: T P L Watts
bmj.com, 26 Apr 2000 [Full text]
Understandable conflict: Paulo Quadros
bmj.com, 27 Apr 2000 [Full text]
The use of medicinal herbs is not "complementary medicine": Peter von Kaehne
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Re: Understandable conflict: Lucio Sibilia, MD
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