Depression care: An extract of the herb, St John's wort, is as effective as standard drug treatment for moderate to severe depression, according to a German study.
The trial found patients who were given a manufactured extract of hypericum (St John's wort) showed improvements in their symptoms which were at least as good as those given paroxetine (Seroxat).
The study reported in the current issue of the British Medical Journal was carried out in 21 psychiatric primary care practices in Germany. Extract of hypericum perforatum (St John's wort) was previously found to be more effective than placebo and as effective as several tricyclic antidepressants or fluoxetine (Prozac) in the treatment of mild to moderate depression.
However, up to now, the value of hypericum extract in the treatment of patients with more severe depression was disputed, according to lead author of the study, A Szegedi of the Department of Psychiatry and Psychotherapy at Charité-Universitatmedizin Berlin. "The results indicate that in a group of patients in whom the appropriateness of hypericum extract was previously disputed, the antidepressant efficacy of the herbal drug is at least comparable with the effect of one of the leading synthetic antidepressants," the authors said.
The patients in the trial showed a reduction in their depressive symptoms as measured by an internationally recognised depression scale. The trial monitored patients for side effects and found fewer patients reported fewer adverse effects in the hypericum group - 55 per cent taking hypericum reported 172 adverse events as compared with 76 per cent of patients taking paroxetine who in total reported 269 adverse events.
Commenting on the study, medical herbalist Helen McCormack said, "I tend not to treat people with severe depression with St John's wort but it could be effective for severe depression in high dosages. Then you have to ask whether you keep patients on such high dosage. Really, we need to be addressing depression in the wider social context and look at services and the use of talking therapies that can be very valuable. There is no point in just having a race between a pharmaceutical drug and a herbal extract which will be more like a drug in the end."
Medical herbalists prescribe St John's wort in whole herb form, following the holistic principle that the various constituents of the herb all play a valuable role in the remedy.
Erica Murray of the Irish Association of Health Stores said: "We've known all along that St John's wort is a safe and effective remedy for lowness of mood and that is what the over-the-counter herb was sold for before it was made prescription only by the Irish Medicines Board [ IMB] in 2000. Now, following this study, I would like the IMB to revisit St John's Wort under the Traditional Herbal Medicinal Products Directive and also look at dosage."
The IMB made St John's wort a prescription-only herbal medicine as it considered self-diagnosis and self-treatment inappropriate for depression. It said St John's wort interacted with common prescription medications such as antidepressants, warfarin and the contraceptive pill."
"As this study appears to support medicinal use of St John's wort in the treatment of depression, St John's wort would be required to be authorised as a medicinal product," an IMB spokeswoman said. The traditional medicines directive would not cover St John's wort because the legislation is envisaged to cover medicines suitable for minor self-limiting conditions suitable for self-medication without the intervention of a healthcare professional, she said.
