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    Username: Password: © Newswise. All Rights Reserved. Source: Released: Thu 02-Oct-2008, 08:45 ET Embargo expired: Tue 07-Oct-2008, 19:00 ET St. Johns Wort Helps Some Patients With Major Depression Libraries Medical News Keywords ALTERNATIVE MEDICINE, DEPRESSION, ST. JOHNS WORT Contact Information Available for logged-in reporters only Description The herbal medicine St. John's wort appears to work just as well as some prescribed antidepressants for treating patients with major depression, a new review finds. However, patients in German-speaking countries might experience the best benefits. Newswise — The herbal medicine St. Johns wort appears to work just as well as some prescribed antidepressants for treating patients with major depression, a new review finds. However, patients in German-speaking countries might experience the best benefits. While there is public interest in the United States about whether St. Johns wort adequately treats depression, in some countries, like Germany, doctors commonly prescribe it for mild symptoms. Authors of the review found that studies with German patients did, in fact, have the best results. The most striking finding from our review is that trials from German-speaking countries have clearly more positive effects, both compared to placebo and standard antidepressants, than trials from elsewhere, said lead reviewer Klaus Linde of the Centre for Complementary Medicine Research at Technical University in Munich. In principle, we can say that hypericum extracts work in German-speaking countries, but we are less certain for other countries. The review appears in the current issue of The Cochrane Library , a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic. A person could be experiencing major depression when depression symptoms interfere with his or her ability to work, sleep, eat and take pleasure in activities previously enjoyed. The symptoms usually last for at least two weeks, but can often last longer than several months. St. Johns wort (an extract of the plant Hypericum perforatum L.) is an herbal alternative for patients who do not want prescribed antidepressants. Exactly how the herb works to treat depression is unclear, partly because the extracts can contain at least seven groups of components, according to the reviewers. There is also no regulation on what the extract must contain. There is no patent protection on herbs; therefore, more or less anyone can market hypericum extracts, Linde said. The products on the market vary enormously in their quality and content in active ingredients. Linde added that consumers should be aware that many St. John's wort products on the market have very low concentrations (such as dosages of less than 300 milligrams per day), and therefore, probably act only by placebo effects. In the United States, the National Center for Complementary and Alternative Medicine (NCCAM), a division of the National Institutes of Health, reports that St. Johns wort is of minimal benefit in treating major depression. A study co-funded by NCCAM, found St. Johns wort to be no more effective than placebo in treating major depression of moderate severity. Linde and his colleagues wrote a previous Cochrane review in 2005 on St Johns wort and concluded that it did reduce symptoms of mild to moderate depression. The significant difference between the 2005 review and the current one is the reviewers now include only studies restricted to major depression, while the older version included all depressive disorders. Compared to 2005, the evidence that hypericum extracts are effective is better now, said Linde. The new version also for the first time shows significantly fewer side effects associated with hypericum extracts compared to selective serotonin reuptake inhibitors. The current review evaluated 29 studies from a variety of countrieswith 5,489 patientsand all trials were randomized and double blind. The reviewers compared treatment of patients with major depression with extracts of St. Johns wort for four to 12 weeks with either placebo or tri- or tetracyclic antidepressants and selective serotonin reuptake inhibitors. According to the reviewers, the St. Johns wort products tested in the trials were high- quality products and the daily extract dosages were between 500 and 1,200 milligrams. The Cochrane reviewers concluded the available evidence suggests that hypericum extracts are superior to placebo in treating patients with major depressions and are similarly effective as standard antidepressants. John Williams, M.D., director of the Duke Evidence-based Practice Center at Duke University and Durham VA Medical Center, has also done research on the use of St. Johns wort for depression and disagreed that patients with major depression should turn to the product. Given the inconsistent evidence about efficacy in major depression and the questionable quality of over-the-counter products, St. Johns wort should not be a first or second choice for U.S. patients with moderate to severe major depression, he said. Williams added, however, that for patients with minor depression, where the evidence for St. Johns wort is more robust, it might be an option for patients who can find quality products. The review disclosed that each author has received speaking or travel reimbursement fees from German drug manufacturer Schwabe. The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit for more information. Linde K, Berner MM, Kriston L. St Johns wort for major depression. Cochrane Database of Systematic Reviews 2008, Issue 4. . All Rights Reserved.