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A recent clinical study published in the Journal of the American Medical Association (JAMA) concludes that the herb St. John's wort is not effective in treating "major or severe cases of depression." The study, conducted by Dr. Richard Shelton of Vanderbilt University was funded by Pfizer, a pharmaceutical company which manufactures sertraline (Zoloft), a leading anti-depressant drug.
Hyla Cass, M.D., Assistant Clinical Professor of Psychiatry at the UCLA School of Medicine, reports, "This study does not negate the many fine studies that have shown St. John's wort to be just as good as the antidepressants in treating mild to moderate depression."
Dr. Cass disputes the study's findings based on four points:
1.The majority of studies on St. John's wort and depression were for mild to moderate, not severe depression.
2.The group was too small for any valid conclusion (200 subjects). It might be seen as a preliminary study. Meanwhile, Shelton discounts the validity of the over 25 published studies, on over 1700 patients.
3.The author fails to discuss Dr. Vorbach's successful study with St. John's wort and severe depression.
4.The study design is in question because of the very low placebo response: 4.9% versus an expected 20 to 50% in other studies (and the St. John's wort group still did 3 times as well). This may be because no "active" drug was given, which may have prejudiced examiners. They would expect no effects from a dummy pill, especially since there was no chance of either pill being an "active, successful antidepressant."
The study itself was placebo-controlled, double-blind, with 200 subjects over 8 weeks, with half receiving St. John's wort and half receiving a placebo (or dummy pill). During the course of the study, neither the individual nor the researcher knew who was getting which product. The dose was 900 mg. daily for 4 weeks, increasing to 1200 mg. if there was no response, up to 8 weeks total. (Shelton et al. JAMA 2001; 285: 1978-1986)
Jerry Cott, Ph.D., former Chief of Psychopharmacology Research Program, at the National Institutes of Mental Health, makes this point: "A better-designed study would have incorporated an "active" comparison, to raise the possibility in the minds of the researchers that a particular patient may be among the 30% on the "active" medication."
According to Mark Blumenthal, founder and executive director of the nonprofit American Botanical Council, most of the previous clinical studies conducted in Europe on St. John's wort targeted only mild to moderate cases of depression, not major or severe depression, and he points out that "There is a significant body of research and clinical experience that documents the safety and efficacy of St. John's wort to treat mild to moderate cases of depression."
Dr. Cass concludes: "In my own practice, and in the many e-mails I have received from now-happy users of St. John's wort, I would agree. It may not be the "magic bullet" but it certainly has a significant role in the treatment of depression."
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