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April 10, 2002


Report in JAMA Says Evidence Sketchy for St. John's Wort

In an article coming out in the April 11 Journal of the American Medical Association, a group of researchers, including faculty of the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine, have concluded that St. John's wort (hypericum) should not be used as a treatment for major depression until further testing shows that it is effective. St. John's wort, an herbal supplement, is widely used by the public as an over-the-counter medication for depression, but it is not labeled as a drug and has never been evaluated or approved by the U.S. Food and Drug Administration (FDA).

The double-blind, randomized study was conducted by twelve community and academic psychiatric research facilities around the country. Study participants were 18 years of age or older with moderate to severe depression. The participants were given placebo, an approved anti-depressant, Zoloft (sertraline), or St. John's wort for eight weeks. Those who responded continued in the study for another 18 weeks.

There was little difference in improvement of depressive symptoms between the placebo group (31.9%), the Zoloft group (24.8%) and the St. John's wort group (23.9%).

"These findings demonstrate that the use of St. John's Wort by the general public to treat depression is probably not advisable at this time," said Charles Nemeroff, M.D., Ph.D., Reunette W. Harris Professor and Chairman of the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine.

"St. John's wort has been reported to have significant effects on the actions of concurrently prescribed medications that can be deleterious to patients. Additionally, depression is a serious, and possibly deadly, disorder caused by an imbalance in the chemistry of the brain. Unfortunately, the stigma connected with depression is still so widespread that many Americans either remain untreated, or head to the health food store to pick up a supplement that they think can help. Until data is available that proves the efficacy of a product, patients should be encouraged to see their family doctor before using any type of self-medication."

St. John's wort is made from extracts of Hypericum perforatum, a plant native to Europe and parts of Asia and Africa that blooms in late June, close to the birthday of St. John the Baptist. The plant is known as Klamath weed in Oregon and elsewhere in the Pacific Northwest where it has begun to grow wild. Tests in Europe have suggested that St. John's wort has the potential to relieve depression without the side effects of pharmaceutical products. It is the most widely prescribed antidepressant in Germany and prescribed throughout Europe for depression, anxiety and sleep disorders.

The study was supported by the National Center for Complementary and Alternative Medicine and the National Institute of Mental Health, Lichtwer Pharma A.G. (Berlin, Germany) and Pfizer, Inc. (New York).

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