Your patients are using it, but does it work?

Depressive disorders are serious illnesses that cause enormous personal suffering and a high economic burden. The World Health Organization projects that major depression will be the second leading cause of disability worldwide by the year 2020. Most depressed patients are treated in primary care and the most common treatment is antidepressant medication. Despite rapid growth in antidepressant prescribing, outcomes are often poor and patients are increasingly using complementary and alternative medicine such as St John's wort (SJW). In 2002, 12% of US adults reported using SJW within the past 12 months.1 Should we encourage our patients to try St John's wort for depression?

Szegedi et al conducted a methodologically sophisticated study to determine whether SJW was about as good as and no worse than paroxetine in patients with moderate to severe major depression. The study produced surprising results.

Szegedi et al conducted a methodologically sophisticated study (p 160) designed to determine whether SJW was about as good as and no worse than paroxetine in patients with moderate to severe major depression. An active control, non-inferiority trial is appropriate when there are …