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Herbal Supplements: Effect of Hypericum perforatum (St John’s Wort) in Major Depressive Disorder



The Journal of the American Medical Association published a controversial study showing St. John’s Wort was no better than a placebo in alleviating major depressive disorder. What is not obvious to the casual reader is that sertraline (Zoloft) was used also in the study and did no better than a placebo on the primary measures of the study. Ergo, Zoloft doesn’t work either. See: Davidson, JRT. Effect of Hypericum perforatum (St John’s Wort) in Major Depressive Disorder. JAMA, Vol. 287 No. 14, April 10, 2002.

Here is ARHP’s response to the JAMA article: Silver Spring, MD, April 9, 2002 — A study on the popular herbal remedy St. John’s wort published in the April 10 edition of the Journal of the American Medical Association (JAMA) concluded that neither St. John’s wort nor the widely prescribed antidepressant Zoloft are more effective overall than placebo in treating severe forms of depression. The American Herbal Products Association (AHPA) and the National Nutritional Foods Association (NNFA) are critical of the study saying that it ignores the traditional use of St. John’s wort and recent modern clinical trials that have demonstrated conclusively that St. Johnís wort is effective in the treatment of “mild to moderate” depression.

“This is a quintessential case of the ‘Emperor’s New Clothes,'” said Steven Dentali, Ph.D. vice president for scientific and technical affairs for AHPA. “It is inexplicable that JAMA has created such fanfare over the fact that St. Johnís wort is not shown to be effective for a condition that it was never intended to treat. The real story here is that if this study is believable it showed that a blockbuster drug, with sales of over $2 billion and prescribed to millions of Americans for severe forms of depression, may be no more effective than placebo.”

St. Johnís wort is one of the top five selling herbal products in the United States and is the number one antidepressant used in Germany for the treatment of mild to moderate depression. The new multi-million dollar National Institutes of Health study was conducted on 340 patients diagnosed as having major depression. The study broke patients into three groups assigning one group to take a leading brand of St. Johnís wort, another group to take the anti-depressant pharmaceutical Zoloft and the third group a placebo (a sugar pill). The researchers reported that neither St. Johnís wort nor Zoloft were significantly different from placebo.

“This research in no way invalidates the scores of clinical studies and analyses that have clearly demonstrated that St. John’s wort is effective for mild to moderate depression,” said Phil Harvey, Ph.D., director of science and quality assurance for NNFA. “In fact, contemporary researchers have found evidence that St. Johnís wort extracts are “therapeutically equivalent to” and “at least as effective as” some commonly prescribed antidepressant drugs. Researchers also note that people have better tolerance for the herb.”

Relevant Facts:

According to Web MD, in the U.S., approximately 10% of people suffer from major depression at any one time, and 20-25% suffer a major depressive episode at some point during their lifetimes. According to Nutrition Business Journal, St. Johnís wort sales in 2000 were $180 million. According to Med Ad News, Zoloft is the third best-selling selective serotonin reuptake inhibitor and the leading antidepressant in terms of share of new prescriptions. According to IMS Health Inc., 2000 Zoloft sales reached $2.14 billionVol. 287 No. 14, April 10, 2002.

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