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July 24/31, 2002

St John's Wort and Depression

Author Affiliations

Copyright 2002 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2002

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

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.

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