216
12
Hypericum Depression Trial Study Group, “Effect of Hypericum Perforatum (St. John’s wort) in Major Depressive
Disorder: A Randomized Controlled Trial,” JAMA 287:1807-1814 (2002). On the two primary outcome measures,
neither sertraline nor H perforatum was significantly different from placebo. The random regression parameter
estimate for mean (SE) change in HAM-D total score from baseline to week eight (with a greater decline indicating
more improvement) was -9.20 (0.67) (95% confidence interval [CI], -10.51 to -7.89) for placebo vs. - 8.68 (0.68)
(95% CI, -10.01 to -7.35) for H perforatum (P =.59) and -10.53 (0.72) (95% CI, -11.94 to -9.12) for sertraline (P =.18).
Full response occurred in 31.9% of the placebo-treated patients vs 23.9% of the H perforatum-treated patients (P
=.21) and 24.8% of sertraline-treated patients (P =.26). Sertraline was better than placebo on the CGI improvement
scale (P =.02), which was a secondary measure in this study. Adverse-effect profiles for H perforatum and
sertraline differed relative to placebo. http://www.ncbi.nlm.nih.gov/pubmed/11939866
(^13) Szegedi, A., Kohnen, R., Dienel, A.& Kieser, M., “Acute Treatment of Moderate to Severe Depression With
Hypericum Extract WS 5570 (St. John’s wort): Randomized Controlled Double Blind Non-inferiority Trial vs.
Paroxetine,” British Medical Journal 330:759 (2005).
(^14) Id.
(^15) Muskin, P.R., Gerbarg, P.L., and Brown, R.P., Complementary and Integrative Therapies for Psychiatric Disorders,
Psychiatric Clinics of North America, copyright Elsevier, Inc., Philadelphia ( 2013 ) (“Brown et al. II”) at 67.
(^16) Id.
(^17) Mayo Clinic, op. cit.
(^18) Mischoulon and Rosenbaum, op. cit. at 34.
(^19) Natural Standard Herb and Supplement Guide: An Evidence-based Reference, “St. Johns wort,” at 685
(^20) Mischoulon and Rosenbaum, op. cit. at 34.
(^21) E.g., Murphy, P.A., Kern, S.E., Stanczyk, F.Z. & Westhoff, C.L., “Interaction of St.John’s Wort with Oral
Contraceptives: Effects on the Pharmacokinetics of Norethindrone and Ethinyl Estradiol, Ovarian Activity and
Breakthrough Bleeding,” Contraception 71(6):402-8 (2005).
(^22) Brown, et al. at 33.
(^23) Muskin, P.R., Gerbarg, P.L., and Brown, R.P., Brown et al. II, op. cit. at 70.
(^24) Id.