Copyright 2002 American Medical Association. All Rights Reserved.
Applicable FARS/DFARS Restrictions Apply to Government Use.2002
To the Editor: What can be learned from the
considerable research effort of Dr Davidson and colleagues?1
Could this trial serve as a model of difficulties in carrying out antidepressant
trials in which the average failure rate is 50%?2
Although most studies of hypericum enrolled patients with mild to moderate
depression, a score of at least 20 (moderate to severe) on the 17-item HAM-D
was chosen for this investigation. It is commonly believed that severely depressed
patients will be less likely to respond to placebo and that their inclusion
in a clinical trial will increase the drug effect size, but data do not support
this.3 Antidepressant trials with investigational
drugs routinely use 17 on the 17-item Hamilton scale as a criterion for entry
level to trials and avoid the use of chronically depressed patients. Walsh
et al3 reported a mean Hamilton entry score
of 16.7 for published trials. Furthermore, the duration of the current episode
in the study by Davidson et al was lengthy (36% had been depressed for more
than 2 years). Thus the question of the efficacy of hypericum in major depression
was not resolved by this study.
Cott J, Wisner KL. St John's Wort and Depression. JAMA. 2002;288(4):446–449. doi:10.1001/jama.288.4.446
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