St. John’s Wort as effective as chemical antidepressants
in long-term therapy too
According to the “Arzneiverordnungsreport 2005” (Medical Prescribing Report for 2005”), doctors in Germany are now prescribing antidepressant medication twice as often as they were 10 years ago and three times as often as in 1990. An especially strong trend is evident in the prescription of selective serotonin reuptake inhibitors (SSRIs): over a 12-month period the number of prescriptions for the active substance citalopram increased by 18.8 percent, and that for sertraline products rose by 15.2 percent. While the efficacy of the SSRIs is solidly established, the list of their potential adverse effects is alarmingly long. This is in contrast to St. John’s Wort extracts, which – as current studies have shown – are as effective as chemical antidepressants in long-term therapy too.
At a recent meeting in Munich, Prof. Dr. Markus Gastpar from the Clinic for Psychiatry and Psychotherapy in Essen presented findings from two comparative studies.
In a short-term study lasting for 6 weeks, 388 patients with moderately severe depression received a single daily dose of dummy medication (placebo) or 20 mg of the SSRI citalopram or 900 mg of the St. John’s Wort extract STW 3-VI. The efficacy of treatment was assessed using the internationally familiar Hamilton Depression (HAM-D) Scale. The study findings were as follows:
- Both the SSRI and STW 3-VI were significantly superior to placebo. The herbal medicine and the synthetic product were comparable in terms of the number of patients who experienced an improvement in depressive mood.
- St. John’s Wort was clearly superior in terms of tolerability: Adverse effects were reported by only 17.2 percent of patients treated with St. John’s Wort, an incidence level comparable to that reported in the placebo group. By contrast, adverse drug effects were reported by just over half (53.2 percent) of the patients who received citalopram.
In a second study Professor Gastpar compared the St. John’s Wort extract STW 3 with the SSRI sertraline in long-term therapy over 24 weeks. In this study 241 patients with moderately severe depression were treated either with 600 mg STW 3 or with 50 mg sertraline.
- From the outset STW 3 was found to be equivalent in therapeutic terms to sertraline: after 24 weeks 84 percent of the St. John’s Wort patients had responded to therapy, compared with 81 percent in the sertraline group.
- After only 8 weeks the HAM-D symptom score in both treatment groups had fallen from 23 points at baseline to 9 points with STW 3 and to 8 points with sertraline. After 20 weeks the HAM-D score in both groups was 7 points.
CRNM 14/2005 – 21 October 2005
