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St. John's Wort Passes Muster

St. John's wort (Hypericum perforatum) is as effective as the most commonly used German medication in treating moderate depression, according to a study conducted by Michael Philipp, M.D., professor of psychiatry at Bezirkskrankenhaus Landshut in Germany.

In this double-blind, randomized, placebo-controlled study, 66 men and 197 women aged 18 to 65 with moderate depression were given either 1,050 mg/day St. John's wort extract, 100 mg/day imipramine (a tricyclic antidepressant) or a placebo for eight weeks. Before treatment and after weeks six and eight, subjects' depression levels were determined using a variety of clinical measures including the Hamilton depression and anxiety scales and Zung's self-rating depression scale.

All three groups improved during the study. Improvement with St. John's wort and imipramine, however, was significantly better than with placebo. St. John's wort was as effective as imipramine for every measure, and even more so for two measures—quality of life and severity of depression. St. John's wort was also well tolerated, unlike imipramine, which can exacerbate existing cardiovascular problems.

Although the study was well run, it did not compare St. John's wort to serotonin reuptake inhibitors (SRIs) such as Prozac, which are the treatments of choice in the United States. Tricyclic antidepressants including imipramine are still used in Germany because they are cheaper. In addition, the 1,050-mg dose used in this study, equivalent to 6 g raw herb, is higher than the 900 mg/day typically recommended for moderate depression.

—British Medical Journal 1999
Dec 11;319:1534-9.