St. John’s Wort In
The NewsSt. John’s Wort is in the news again due to a recent study published in the Journal of the American Medical Association (JAMA), which pinned the herb as ineffective in treating severe forms of depression. The study, which was sponsored by the National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health (NIH), was conducted to determine the efficacy and safety of Hypericum peforatum (the active ingredient in St. John’s Wort) in major depressive disorder. Patients (340) were randomly assigned to receive H. perforatum (900-1500 mg), placebo or sertraline, also known as Zoloft® (50-100 mg), for eight weeks. Researchers concluded that the study failed to support the efficacy of H. perforatum in moderately severe major depression and that results may be due to low assay sensitivity of the trial.
As a result of the study, AHPA, the American Botanical Council (ABC), Austin, TX, and the National Nutrition Foods Association (NNFA), Newport Beach, CA, have issued a response. ABC said although the study was conducted in patients with moderate to severe forms of depression, the herb has been tested and used mainly in patients with less severe forms of depression. Dr. Steven Dentali, vice president of scientific and technical affairs for AHPA agreed. “It is inexplicable that JAMA has created such fanfare over the fact that St. John’s Wort is not shown to be effective for a condition that it was never intended to treat,” he said. Dr. Phil Harvey, director of science and quality assurance for NNFA added, “This research in no way invalidates the scores of clinical studies and analyses that have clearly demonstrated that St. John’s Wort is effective for mild to moderate depression.” In addition, Dr. Steven Bratman, a physician and co-author of the Natural Pharmacy: Clinical Evaluation of Medicinal Herbs, based in Fort Collins, CO, took issue with the authors of the study when they used a secondary outcome measure to conclude that sertraline was more effective than placebo and therefore better than St. John’s Wort. “According to the standard rules of interpreting clinical studies, one should take only the primary outcome measures as meaningful,” he explained. “On those measures, neither sertraline nor St. John’s Wort was effective. Digging into secondary measures is widely accepted as being inappropriate.”