Comparison of St John's wort and imipramine for treating depression: randomised controlled trial
St John's wort is as effective as imipramine - one of the most commonly used antidepressants - and should be considered as a first line treatment in patients with mild to moderate depression, according to the largest ever study of St John's wort published this week in the BMJ.
Over 300 patients in Germany with mild to moderate depression were randomly treated with either St John's wort extract or imipramine for six weeks. Throughout the treatment period, progress was measured using a series of standard rating scales, along with patients' self assessments. The results show that the two treatments were "therapeutically equivalent" with regard to overall effect on depression. However, patients seemed to tolerate St John's wort better than imipramine, with side effects such as dry mouth, sweating and dizziness, reported in 39% of patients taking St John's wort compared to 63% taking imipramine. As a result, only 3% of patients taking St John's wort stopped treatment compared to 16% of patients on imipramine.
These results, along with other recently published trials, provide compelling evidence that St John's wort extract is as effective as standard antidepressants, says the author. In view of its superior safety record, St John's wort should be considered for first line treatment in mild to moderate depression, especially in general practice where the milder forms of depression are most commonly seen, he concludes.
Contact:
Helmut Woelk, Medical Director, Akademisches Lehrkrankenhaus der Universitat Giessen, Germany