BMJ 1999;319:1534-1539 ( 11 December )

Papers

Hypericum extract versus imipramine or placebo in patients with moderate depression: randomised multicentre study of treatment for eight weeks

Michael Philipp, professor of psychiatry, a Ralf Kohnen, professor of psychology, b Karl-O Hiller, senior research fellow. c

a Bezirkskrankenhaus Landshut, D-84034 Landshut, Germany, b Imerem Institute for Medical Research Management and Biometrics, D-90478 Nuremberg, Germany, c Steiner Arzneimittel, D-12207 Berlin, Germany

Correspondence to: K-O Hiller kohiller.steiner{at}t-online.de

Objectives: To assess the efficacy and safety of hypericum extract (STEI 300, Steiner Arzneimittel, Berlin) compared with imipramine and placebo in patients in primary care with a current episode of moderate depression.
Design: Randomised, double blind, multicentre, parallel group trial for 8 weeks.
Setting: Trained panel of 18 general practitioners from four German states: Bavaria, Berlin, Rhineland Palatinate, and Saxony.
Participants: 263 patients (66 men, 197 women) with moderate depression according to ICD-10 (international classification of diseases, 10th revision) codes F32.1 and F33.1.
Interventions: 1050 mg hypericum extract (350 mg three times daily), 100 mg imipramine (50 mg, 25 mg, and 25 mg daily), or placebo three times daily.
Main outcome measures: Change from baseline score on the 17 item version of the Hamilton depression scale, the Hamilton anxiety scale, the clinical global impressions scale, Zung's self rating depression scale, and SF-36, and adverse events profile.
Results: Hypericum extract was more effective at reducing Hamilton depression scores than placebo and as effective as imipramine (mean -15.4 (SD 8.1), -12.1 (7.4), and -14.2 (7.3) respectively). Comparable results were found for Hamilton anxiety and clinical global impressions scales and were most pronounced for the Zung self rating depression scale. Quality of life was more improved in the standardised mental component scale of the SF-36 with both active treatments than with placebo but in the physical component scale was improved only by hypericum extract compared with placebo. The rate of adverse events with hypericum extract was in the range of the placebo group but lower than that of the imipramine group (0.5, 0.6, and 1.2 events per patient respectively).
Conclusions: At an average dose of 350 mg three times daily hypericum extract was more effective than placebo and at least as effective as 100 mg imipramine daily in the treatment of moderate depression. Treatment with hypericum extract is safe and improves quality of life.


Key messages

  • Hypericum extract (STEI 300) was effective after 4, 6, and 8 weeks of treatment in patients with moderate depression

  • Simultaneous analysis confirmed hypericum extract to be at least as efficacious as imipramine 100 mg daily after eight weeks of treatment

  • Besides better antidepressive efficacy both hypericum extract and imipramine improved quality of life

  • Patients tolerate hypericum extracts much better than they do tricyclics and therefore by improving patients' compliance hypericum extracts are promising drugs for long term treatment



© BMJ 1999
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 Technorati Technorati    What's this?

This article has been cited by other articles:

  • Soelberg, J., Jorgensen, L. B., Jager, A. K. (2007). Hyperforin Accumulates in the Translucent Glands of Hypericum perforatum. ANN BOT (LOND) 99: 1097-1100 [Abstract] [Full text]  
  • Arroll, B., Macgillivray, S., Ogston, S., Reid, I., Sullivan, F., Williams, B., Crombie, I. (2005). Efficacy and Tolerability of Tricyclic Antidepressants and SSRIs Compared With Placebo for Treatment of Depression in Primary Care: A Meta-Analysis. Ann Fam Med 3: 449-456 [Abstract] [Full text]  
  • Szegedi, A, Kohnen, R, Dienel, A, Kieser, M (2005). Acute treatment of moderate to severe depression with hypericum extract WS 5570 (St John's wort): randomised controlled double blind non-inferiority trial versus paroxetine. BMJ 330: 503- [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]  
  • Fochtmann, L. J., Gelenberg, A. J. (2005). Guideline Watch: Practice Guideline for the Treatment of Patients With Major Depressive Disorder, 2nd Edition. Focus 3: 34-42 [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]  
  • (2003). Mild depression in general practice: time for a rethink?. DTB 41: 60-64 [Abstract] [Full text]  
  • Zuess, J. (2003). An Integrative Approach to Depression: Part 2--Assessment and Treatment. Complementary Health Practice Review 8: 99-115 [Abstract]  
  • De Smet, P. A.G.M. (2002). Herbal Remedies. NEJM 347: 2046-2056 [Full text]  
  • Jonas, W., Wheatley, D., Spielmans, G. I., Volp, A., Linde, K., Melchart, D., Mulrow, C. D., Berner, M., Cott, J., Wisner, K. L., Davidson, J. R. T., Kupfer, D. J., Frank, E. (2002). St John's Wort and Depression. JAMA 288: 446-449 [Full text]  
  • 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]  
  • MONCRIEFF, J. (2002). The antidepressant debate. Br. J. Psychiatry 180: 193-194 [Full text]  
  • Ernst, E. (2002). The Risk-Benefit Profile of Commonly Used Herbal Therapies: Ginkgo, St. John's Wort, Ginseng, Echinacea, Saw Palmetto, and Kava. ANN INTERN MED 136: 42-53 [Abstract] [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]  
  • Nathan, P. J. (2001). Hypericum perforatum (St John's Wort): a non-selective reuptake inhibitor? A review of the recent advances in its pharmacology. J Psychopharmacol 15: 47-54 [Abstract]  
  • Dowrick, C. (2001). Advances in psychiatric treatment in primary care. Adv. Psychiatr. Treat. 7: 1-8 [Full text]  
  • Woelk, H. (2000). Comparison of St John's wort and imipramine for treating depression: randomised controlled trial. BMJ 321: 536-539 [Abstract] [Full text]  
  • Morriss, R. K (2000). Hypericum extract was better than placebo and equivalent to imipramine for moderate depression. Evid. Based Ment. Health 3: 85-85 [Full text]  
  • Vermeire, E. (2000). Hypericum extract was better than placebo and equivalent to imipramine for moderate depression. Evid. Based Med. 5: 116-116 [Full text]  
  • Maidment, I. (2000). The use of St John's Wort in the treatment of depression. Psychiatr. Bull. 24: 232-234 [Abstract] [Full text]  
  • Williams, J. W. Jr., Mulrow, C. D., Chiquette, E., Noel, P. H., Aguilar, C., Cornell, J. (2000). A Systematic Review of Newer Pharmacotherapies for Depression in Adults: Evidence Report Summary: Clinical Guideline, Part 2. ANN INTERN MED 132: 743-756 [Abstract] [Full text]  
  • (2000). Robin Goodfellow. Rheumatology (Oxford) 39: 572-572 [Full text]  
  • Thornett, A., Walton, M., Vickers, A., Gorski, T., Menkes, D. B, Balfour, P., Philipp, M., Kohnen, R., Hiller, K.-O (2000). Use of hypericum as antidepressant. BMJ 320: 1141a-1141 [Full text]  
  • (2000). St. John's Wort for Depression -- Again. JWatch Psychiatry 2000: 12-12 [Full text]  
  • (2000). St. John's Wort vs. Imipramine for Moderate Depression. JWatch Women's Health 2000: 12-12 [Full text]  
  • (2000). St John's Wort Really Does Help Depression. JWatch General 2000: 1-1 [Full text]  

Rapid Responses:

Read all Rapid Responses

What is a valid measure of antidepressant efficacy in primary care?
Andrew Thornett
bmj.com, 10 Dec 1999 [Full text]
comments on the controlled trial of hypericum in depressive illness
Alan M W Porter
bmj.com, 13 Dec 1999 [Full text]
Naturalistic studies are needed
Mike Walton
bmj.com, 13 Dec 1999 [Full text]
Use of placebo in depression trial unethical
Andrew Vickers
bmj.com, 5 Jan 2000 [Full text]
The herbalist will see you now
David B Menkes
bmj.com, 6 Jan 2000 [Full text]
Much work still needed on St. John's Wort
Tim Gorski
bmj.com, 16 Jan 2000 [Full text]
St. John Wort
M E J Wise
bmj.com, 11 Aug 2000 [Full text]
Drug interaction of tea containing St. John´s wort with ciclosporin
Dominik M Alscher
bmj.com, 14 Jun 2001 [Full text]
Doc2Doc Vacancy
Access jobs at BMJ Careers
Whats new online at Student BMJ