| Sumario: | Question: Are extracts of Hypericum perforatum (St John's wort [SJW]) more effective than placebo and as effective as low dose antidepressants for mild to moderate depressive disorders? Data sources: Studies were identified by searching Medline (from 1983), PsycLIT (1987-97), Embase/Excerpta Medica (from 1989), the clinical trial registry of the Cochrane Collaboration Depression, Anxiety, and Neurosis Group, the Cochrane Field for Complementary Medicine, and the private database Phytodok (Munich); by scanning bibliographies of relevant articles; and by contacting authors and pharmaceutical companies. Study selection: Studies were selected if they were randomised controlled trials that compared SJW with placebo or other antidepressants in patients with depressive disorders. Studies with physiological outcome measures only were excluded. Data extraction: 2 reviewers extracted data on study characteristics and results and assessed the quality of each study. Missing or additional data were obtained from authors or sponsors. Main results: 27 of 45 studies involving 2291 patients with mild to moderate depression met the inclusion criteria. 17 trials compared SJW with placebo and 10 with antidepressants. Follow up ranged from 2 to 12 weeks in 26 studies {mean 5.5 wks}, and 1 study had an unknown length of follow up. More patients responded to SJW than to placebo (14 studies, {p < 0.001}) (table). No differences in responder rate (treatment group response rate/control group response rate) occurred for SJW compared with low dose antidepressants (5 studies, [p=0.791) (table). Side effects were fewer with SJW than with low dose antidepressants (7 studies, weighted event rate 28% v 45%, p=0.002}. Conclusions: St John's wort (SJW) is more effective than placebo for patients with mild to moderate depressive disorders. SJW and low dose antidepressants had similar effectiveness, but SJW had fewer side effects. [Original article accession number: 2000006960 (research, systematic review, tables/charts)]
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