St John's wort as an antidepressantBMJ 1996; 313 doi: http://dx.doi.org/10.1136/bmj.313.7052.241 (Published 03 August 1996) Cite this as: BMJ 1996;313:241
- Peter A G M De Smet,
- Willem A Nolen
- Clinical pharmacologist Royal Dutch Association for the Advancement of Pharmacy, 2514 JL The Hague, Netherlands
- Psychiatrist HC Rumke Group, Academic Hospital, Utrecht, Netherlands
Longer term studies are needed before it can be recommended in major depression
Among the many remarkable differences between German and British medicine is the extensive use of herbal medicines in Germany. An example is the use of Hypericum perforatum (St John's wort) for psychological complaints. In 1994 German physicians prescribed almost 66 million daily doses of preparations containing hypericum alone, worth a total of DM61m (£26m).1 In this issue Linde et al (p 253) conclude from a meta-analysis that hypericum extracts are more effective than placebo for treating mild to moderately severe depressive disorders.2 How should this evidence be weighed?
Diagnostically, depressive disorders form a heterogeneous group which includes major depression as well as depressive states not satisfying the criteria for the full syndrome. These diagnostic types are defined not by severity but by clusters of symptoms and by the length of time they last. Since the efficacy of antidepressants in major depression is well documented, this syndrome is useful when considering treatment with antidepressants. Antidepressant drugs are particularly recommended for moderate and more severe forms of major depression. …