I've been following the literature on Hypericum perforatum (St. John's wort) for some time. I am absolutely surprised at how little "press time" is given to successful SJW trials, whereas negative outcomes receive massive publicity. I'd like to present some of those positive studies.....
The follow-up maintenance phase for the above-referenced BMJ study has been published, and the numbers for the St. John's wort group were better than those of paroxetine in the longer trial, as well:
http://www.ncbi.nlm.nih.gov/entrez/q..._uids=17124643
There have been studies which show superiority of hypericum over fluoxetine (Prozac):
http://www.ncbi.nlm.nih.gov/entrez/q..._uids=16160619
http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15458612
http://www.ncbi.nlm.nih.gov/entrez/q..._uids=10759336
It should be noted that a recent Brazilian study showed no benefit from SJW versus placebo, but that fluoxetine (active comparator) also failed in that comparison:
http://www.ncbi.nlm.nih.gov/entrez/q..._uids=16612487
When active comparators also do not exceed placebo response rates, one must question methodology first. Let's just say that there are more questions raised than answers provided.
Another recent study show non-inferiority of SJW compared to citalopram (Celexa):
http://www.ncbi.nlm.nih.gov/entrez/q..._uids=16555167
Many successful comparisons have been made with sertraline (Zoloft), unlike the negative JAMA study:
http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15744631
http://www.ncbi.nlm.nih.gov/entrez/q..._uids=12053635
http://www.ncbi.nlm.nih.gov/entrez/q..._uids=10823363
Over the years, many comparisons with the quintessential tricyclic imipramine (Tofranil) have shown equivalence or superiority of SJW:
http://www.ncbi.nlm.nih.gov/entrez/q..._uids=10968813
http://www.ncbi.nlm.nih.gov/entrez/q..._uids=10591711
http://www.ncbi.nlm.nih.gov/entrez/q...t_uids=9342765
http://www.ncbi.nlm.nih.gov/entrez/q...t_uids=7857502
With respect to the negative JAMA-published trial, the methodological flaws in that study are legendary. Most interesting was that the active comparator, sertraline, also led to lower remission rates than did placebo, but only the SJW results were emphasized in both the journal article (an incredibly unscientific lapse) and the lay press. Surely, the complete failure of an FDA-approved antidepressant was more note-worthy?
In the above references, SJW extracts were identified by cryptic letter/number codes. LI 160 is marketed in North America as Kira. WS5570/72/73 is Perika. I don't know the brand names of the others.
Given the number of unpublished studies which failed to show efficacy of prescription meds (FDA archives), I suspect that publication bias is responsible for the number of negative articles about SJW. It may be an herb, and it may act by unknown mechanisms (one completely novel global reuptake inhibitor effect, and three others which influence serotonin in a more targetted manner, already identified), but it has similar efficacy to other major antidepressant medications, and is less likely than any of them to produce side effects (higher tolerability). It also has no known toxic threshold, making overdose unlikely.
Just my analysis, as food for thought.....
Lar