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Letters |

St John's Wort and Major Depression

Ronald Brenner, MD; Subramoniam Madhusoodanan, MD; Monika Pawlowska, MD; Pal Czobor
JAMA. 2001;286(1):42-45. doi:10.1001/jama.286.1.42.
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To the Editor: Dr Shelton and colleagues1 concluded that "St John's wort was not effective for treatment of major depression." These authors may have been overly skeptical in interpreting their data. In the intent-to-treat analysis, according to the study's response criterion, 26.5% of subjects receiving St John's wort vs 18.6% of patients in the placebo group responded to treatment (P = .15), and according to the study's remission criterion, 14.3% vs 4.9% showed remission (P = .02). If one evaluates this trial in the context of other similar studies, it is noteworthy that the comparisons of St John's wort vs placebo in this study is in the same direction as studies with a positive outcome, although it does not reach statistical significance. What is surprising about these data is the low response rate to placebo. A placebo response of 20% to 30% is routine in studies of depression.2 Thus, an equally reasonable conclusion is that St John's wort was perhaps better than placebo in the treatment of major depression. A third arm with an established antidepressant might have resolved these difficulties.

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