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July 4, 2001

St John's Wort and Major Depression—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

JAMA. 2001;286(1):42-45. doi:10.1001/jama.286.1.42

In Reply: Although several writers take issue with the lack of a drug treatment arm in our study, the simple placebo controlled trial is a widely accepted design. A power analysis indicated that a 2-cell study of this size would yield a power greater than 0.85 to detect a 2-point difference at end point on the HAM-D. A 3-group study would have required a prohibitively large sample size.

Dr Cott and colleagues are concerned about the low placebo response rate in our study. In trials of therapy for depression, use of sensitive measures of outcome lead to higher placebo response rates.1,2 Our design was intended to minimize placebo response to detect any therapeutic advantage with St John's wort. We did note the possibility of a sampling bias in our article. A total of 33 participants dropped out of our study (after final data accounting) not the 43 originally reported.

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