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July NaN, 2002

St John's Wort and Depression

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;288(4):446-449. doi:10.1001/jama.288.4.446

To the Editor: Dr Davidson and colleagues1 report the unlikely finding that neither hypericum nor sertraline was more effective than placebo in improving scores on the Hamilton Depression Rating Scale (HAM-D), which may suggest a flaw in the study design. From Table 1, the "duration of current depression [emphasis added]" was less than 6 months in only 34% of the patients admitted to the trial but 6 to 24 months in 34% and more than 24 months in 32%. These data imply that this group of patients had relatively long-term chronic depression. It is possible that many of these patients were already treatment resistant, which may be responsible for the apparent lack of response to sertraline, a finding that is at variance with the considerable literature on this antidepressant. The same conclusion may also apply to hypericum, for which at least 27 double-blind placebo-controlled trials have demonstrated an antidepressant effect.2

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