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Review: St John’s wort superior to placebo and similar to antidepressants for major depression but with fewer side effects

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QUESTION

Question:

Is St John’s wort (hypericum) an effective treatment for major depression?

Outcomes:

Proportion of responders at end of treatment or at study endpoint if treatment was longer than 6 weeks (based on score improvements on Hamilton Rating Scale for Depression (HAMD), the Clinical Global Impression index (CGI), rating as at least “much improved” on global improvement subscale, Depression Scale von Zerssen (DS) or any other clinical response measure); safety (proportion of dropouts due to adverse events).

METHODS

Design:

Systematic review with meta-analysis.

Data sources:

Clinical Trials Register of the Cochrane Collaboration Depression, Anxiety and Neurosis Group (search to July 2007), Cochrane Field for Complementary Medicine database, MEDLINE (1983–2008), EMBASE (1989–2008), PsycLIT and PsycINDEX (1987–1997), Phytodok (private database, Munich), hand search of bibliographies.

Study selection and analysis:

Two reviewers assessed studies. Inclusion criteria: randomised, controlled, double blind trials of hypericum extracts versus placebo or versus standard antidepressants in people with major depression (DSM-IV or ICD-10). Exclusion criteria: people aged under 16 years, studies of hypericum in combination with other herbs, trials …

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