By Judith Moser, MD
BARCELONA, Spain -- September 1, 2008 -- In patients with moderate depression, the traditional herbal remedy St. John's Wort works as effectively as the modern antidepressant duloxetine, according to a Greek study presented here at the 21st European College of Neuropsychopharmacology Congress (ECNP). In patients with severe depressive symptoms, however, only duloxetine made a significant difference in the study.
St. John's Wort has traditionally been used as an herbal agent against mild to moderate depression. Its mechanism of action has not been completely clarified; the flavonoid hyperforin, which is a component of the plant, presumably acts as a reabsorption inhibitor of norepinephrine, serotonin, dopamine, L-glutamate, and gamma-aminobutyric acid.
In the study, the effects of St. John's Wort on mild, moderate, and severe depression were compared with those of the new antidepressant duloxetine, which exerts its effects via both the serotonergic and the noradrenergic systems.
"Forty outpatients who suffered from depression according to the DSM-IV [Diagnostic and Statistical Manual of Mental Disorders, 4th Edition] diagnostic criteria were selected," reported principal investigator Christos Istikoglou, MD, Psychiatric Department, Asklepeion General Hospital of Voula, Athens, Greece, here on September 1, 2008.
Twenty patients received St. John's Wort at a dosage of 900 mg QD, whereas the remaining 20 participants were treated with duloxetine 60 30 mg QD.
In order to evaluate the severity of the depressive symptoms, patient assessments by means of the Hamilton Rating Scale for Depression (HAM-D) and the Montgomery-Asberg Depression Rating Scale (MADRS) were performed on days 1, 15, 30, and 45 as well as after 2 and 3 months.
"In the group of patients suffering from moderate depression, we did not find any statistically significant differences between the 2 treatment groups," Dr. Istikoglou said.
However, in the patients diagnosed with serious depression, treatment with St. John's Wort did not cause any substantial symptomatic improvement. "In this group, duloxetine contributed to a considerable symptom reduction according to the HAM-D and MADRS scales, proving the role that duloxetine plays in the treatment of serious depression," Dr. Istikoglou emphasised (P .01).
Funding for this study was provided by Vianex.
[Presentation title: Comparative Study on the Effectiveness of Anti-Depressing Treatment Between St. John's Wort and Duloxetine. Abstract P2a008]
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