Effect of Hypericum perforatum (St John's Wort) in Major Depressive Disorder

Davidson, Jonathan; Gadde, Kishore M.; Fairbank, John A.; Krishnan, K. Ranga Rama; Califf, Robert M.; Binanay, Cynthia; Parker, Corette B.; Pugh, Norma; Hartwell, Tyler; Vitiello, Benedetto; Ritz, Louise; Severe, Joanne B.; Cole, Jonathan O.; Battista, Charles De; Doraiswamy, P. Murali; Feighner, John P.; Keck, Paul E.; Kelsey, Jeffrey E.; Lin, Khae Ming; Londborg, Peter D.; Nemeroff, Charles B.; Schatzberg, Alan F.; Sheehan, David V.; Srivastava, Ram; Taylor, Leslie; Trivedi, Madhukar H.; Weisler, Richard H.

doi:10.1001/jama.287.14.1807

Cited by 413 publications

(36 citation statements)

References 21 publications

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“…In other words, all arms - Hypericum, Sertraline, and placebo - improved statistically to the same degree. When this study was published in JAMA [10], most of the press reported (inaccurately) that Hypericum had been proven by the NIH not to work [11]. Sales of Hypericum dropped.…”

Section: The Battle Over Sciencementioning

confidence: 99%

The Evolution of Complementary and Alternative Medicine (CAM) in the USA over the Last 20 Years

et al. 2013

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Medical practices that reside outside the mainstream medical structures have existed for centuries, often waxing and waning in prominence and use for various reasons. Recently, there has been a resurgence in interest and use of such practices in the USA generally referred to under the label of ‘complementary and alternative medicine' (CAM). In this article we summarize some of the highlight events that punctuated this resurgence over the last 20 years. As in the past, social forces affecting these trends circulate around power, resources, and scope of practice. However, a prominent feature of this dynamic is a discussion about the role of science and ‘evidence-based medicine' in addressing pluralistic healthcare-related practices. In the early years of this period, attempts to formulate the place of CAM practices as they relate to epistemology, nonconventional assumptions about health and healing, and the complexity of understanding ‘whole systems' were discussed and often examined. Less attention is being paid to those core assumptions in more recent times. The focus now seems to be on how CAM practices can be judiciously and effectively ‘integrated' into mainstream medicine. Examples of how this dynamic is evolving are described.

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Section: The Battle Over Sciencementioning

confidence: 99%

The Evolution of Complementary and Alternative Medicine (CAM) in the USA over the Last 20 Years

et al. 2013

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“…The Hypericum Depression Trial Study Group (HDTSG) [19]conducted a double-blind, randomized trial comparing St. John’s wort (Hypericum perforatum) , sertraline, or inert pill placebo in the treatment of 340 outpatients with major depression. Sertraline and St. John’s wort were not significantly different from placebo in changes on the HAMD by 8 weeks, nor did the two active conditions differ from placebo in rates of full responders.…”

Section: Placebo Response In Antidepressant Trialsmentioning

confidence: 99%

“…The HDTSG [19]trial holds important implications for pharmacotherapy research in depression. The study emphasizes the importance of including both active and inactive comparison treatments when testing antidepressants.…”

Section: Placebo Response In Antidepressant Trialsmentioning

confidence: 99%

“…This circular reasoning renders tests of antidepressants unfalsifiable by defining away the concept of placebo, when results are unfavorable to the active medication under study. For example, if an inert placebo condition had not been included in the St. John’s wort study [19], the authors may have reached the erroneous conclusion that the supplement was an effective treatment in the study, because it was not different than the antidepressant. Neither drug was more effective than placebo in this trial.…”

Section: Are Active Placebos the Answer?mentioning

confidence: 99%

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Methodological Issues in Clinical Trials of Antidepressant Medications: Perspectives from Psychotherapy Outcome Research

Gaudiano

Herbert

2004

Psychother Psychosom

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Despite their widespread use, the specific efficacy of antidepressant medications has been a source of debate in recent years. Examination of the literature reveals that a significant proportion of the benefit produced in antidepressant trials is duplicated in pill placebo conditions. Furthermore, early trials utilizing active placebos, or medications that mimic the common side effects of antidepressants, showed even smaller differences as compared with active medications. We examine issues surrounding the use of placebo control conditions in antidepressant trials, including the pros and cons of active placebos. We conclude that similar challenges are faced by psychotherapy outcome researchers who have focused more on the separation of specific from nonspecific treatment factors and on the effects of researcher allegiance and patient expectancy on outcome. Within this context, recommendations for improving future antidepressant research are discussed.

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“…At the very least the third of patients recruited from primary care should have been offered the option of a wait and see or a placebo option. For an example of the importance of this, see an April 2002 JAMA study9 which compared the effectiveness of sertraline, St John’s wort and a placebo in depressed patients. In this study, the placebo-treated patients had a 31.9% rate of remission of symptoms—about the same as with citalopram in level one of STAR*D. (Also interestingly, the criterion for inclusion in the JAMA study was a HAMDRS score of 20 or higher, while in STAR*D it was only 14 or higher).…”

Section: The Absence Of a “Placebo”mentioning

confidence: 99%

The STAR*D trial: the 300 lb gorilla is in the room, but does it block all the light?

Hatcher¹

2008

Evid Based Mental Health

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Effect of Hypericum perforatum (St John's Wort) in Major Depressive Disorder

Abstract: This study fails to support the efficacy of H perforatum in moderately severe major depression. The result may be due to low assay sensitivity of the trial, but the complete absence of trends suggestive of efficacy for H perforatum is noteworthy.

Cited by 413 publications

References 21 publications

The Evolution of Complementary and Alternative Medicine (CAM) in the USA over the Last 20 Years

The Evolution of Complementary and Alternative Medicine (CAM) in the USA over the Last 20 Years

Methodological Issues in Clinical Trials of Antidepressant Medications: Perspectives from Psychotherapy Outcome Research

The STAR*D trial: the 300 lb gorilla is in the room, but does it block all the light?

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