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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: There are 3 reasons why the results from Davidson and colleagues1 may vary from systematic reviews of multiple smaller trials.2,3 First, hypericum (or the specific extract in the tested dose) might generally be effective in treating major depressive disorder but ineffective among a particularly unresponsive sample of patients. The lack of an effect of sertaline over placebo raises this possibility, and the fact that the placebo group experienced a higher response rate in this trial than in other hypericum trials does not negate the possibility that this patient population was insensitive to either sertaline or hypericum. We believe that the authors downplay the potential problem of sensitivity of their trial by overinterpreting the significant superiority of sertaline over placebo in one secondary outcome measure. The lack of any trend in favor of hypericum makes it unlikely that low sensitivity alone explains the clearly negative result.

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