To the Editor: Dr Shelton and colleagues1 found that St John's wort (Hypericum
perforatum) was ineffective to treat chronic major depression. St John's
wort, however, is generally recommended for use in mild-to-moderate depressive
disorders. From the study design, it is unclear whether any medication would
have been effective in this sample since no patient received conventional
antidepressant medications and an unusually low placebo response rate occurred
(18.6%, as compared with the usual 30% to 50% placebo response in other trials
on depression). We find no evidence in this study that precludes potential
benefits for patients who were less severely and chronically depressed. In
fact, according to one definition of remission, a significantly greater percentage
of patients responded to St John's wort (14.3%) than to placebo (4.9%), even
in this study.
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