Document Detail


A Double-blind, randomized trial of St John's wort, fluoxetine, and placebo in major depressive disorder.
MedLine Citation:
PMID:  16160619     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: This study looks to compare the antidepressant efficacy and safety of a standardized extract of St John's wort with both placebo and fluoxetine. METHOD: After a 1-week single-blind washout, patients with major depressive disorder diagnosed by Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition were randomized to 12 weeks of double-blind treatment with LI-160 St John's wort extract (900 mg/d), fluoxetine (20 mg/d), or placebo. The 17-item Hamilton Rating Scale for Depression (HAMD-17) was the primary efficacy measure, and analysis of covariance was used to compare differences in end point HAMD-17 scores across the 3 treatment groups, treating the baseline HAMD-17 as the covariate. RESULTS: One hundred thirty-five patients (57% women; mean age, 37.3 +/- 11.0; mean HAMD-17, 19.7 +/- 3.2) were randomized to double-blind treatment and were included in the intent-to-treat analyses. Analysis of covariance analyses showed lower mean HAMD-17 scores at end point in the St John's wort group (n = 45; mean +/- SD, 10.2 +/- 6.6) compared with the fluoxetine group (n = 47; 13.3 +/- 7.3; P < 0.03) and a trend toward a similar finding relative to the placebo group (n = 43; 12.6 +/- 6.4; P = 0.096). There was also a trend toward higher rates of remission (HAMD-17 <8) in the St John's wort group (38%) compared with the fluoxetine group (30%) and the placebo group (21%). Overall, St John's wort appeared to be safe and well tolerated. CONCLUSION: St John's wort was significantly more effective than fluoxetine and showed a trend toward superiority over placebo. A (25%) smaller than planned sample size is likely to account for the lack of statistical significance for the advantage (indicating a moderate effect size, d = 0.45) of St John's wort over placebo.
Authors:
Maurizio Fava; Jonathan Alpert; Andrew A Nierenberg; David Mischoulon; Michael W Otto; John Zajecka; Harald Murck; Jerrold F Rosenbaum
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of clinical psychopharmacology     Volume:  25     ISSN:  0271-0749     ISO Abbreviation:  J Clin Psychopharmacol     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-09-14     Completed Date:  2005-11-30     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8109496     Medline TA:  J Clin Psychopharmacol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  441-7     Citation Subset:  IM    
Affiliation:
Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA. mfava@partners.org
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Antidepressive Agents, Second-Generation / adverse effects,  therapeutic use*
Depressive Disorder, Major / drug therapy*,  psychology
Double-Blind Method
Endpoint Determination
Female
Fluoxetine / adverse effects,  therapeutic use*
Humans
Hypericum*
Male
Middle Aged
Phytotherapy* / adverse effects
Plant Extracts / therapeutic use
Psychiatric Status Rating Scales
Chemical
Reg. No./Substance:
0/Antidepressive Agents, Second-Generation; 0/Plant Extracts; 54910-89-3/Fluoxetine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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