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synthetic, and effectively confining advocacy of St. John’s wort to people with mild to
moderate depression.
The Natural Standard endorses the use of St. John’s wort only for mild to moderate
depression, which it ranks as “A,” “Strong scientific evidence for this use." It relegates
all other uses to category C, “Unclear scientific evidence for this use.” These include
anxiety disorder, moderate to severe depressive disorder, obsessive-compulsive
disorder, seasonal affective disorder, and social phobia.
The Schwabe study published in 2005^13 is the most persuasive evidence that St. John’s
wort may be effective for more severe depression. It used doses of 1800 mg per day of
the Schwabe St. John’s wort formula (WS 5570) compared to 40 mg daily of paroxetine
(Paxil) in 251 participants with moderate to severe depression. Over a six-week period,
HAM-D scales decreased by a mean of 14.4 for the St. John’s wort formula group and
11.4 for the paroxetine group, a significant improvement in effectiveness over the
SSRI. In the continuation phase (after successful acute treatment), both the St. John’s
wort formula and the SSRI group had similar continued efficacy and similar
improvements in HAM-D scores, without statistically significant differences in
continuation phase outcomes or relapse prevention.^14 71% of patients with moderate
to severe oppression responded to the Schwabe St. John’s wort formula, in
comparison to only 60% given paroxetine (Paxil).
Thus, according to Mischoulon and Rosenbaum there may be a role for St. John’s wort
in the treatment of more severe depression, although the difference between German
and American studies remains striking, and more studies will be needed to bridge the
gap. In particular, the use of different formulas makes it difficult to compare results. The
studies have generally used a 0.3% hypericin or hyperforin, but the actual active
ingredient is unknown, and proprietary mixes are not disclosed. Among other initiatives
to clarify the research record, the Schwabe formula should be further tested in cases of
moderate to severe depression to determine whether the company’s positive results
can be replicated.