From Forbes:

Herbal Treatment Outdoes Paxil
By Ed Edelson
HealthDay Reporter

FRIDAY, Feb. 11 (HealthDay News) -- An extract of the herb St. John's
wort was found to be slightly more effective than the widely
prescribed antidepressant Paxil for people with moderate to severe
depression, a short-term German study found.

The results fly in the face of a large-scale, carefully controlled
U.S. trial, reported in 2002, that found a St. John's wort extract was
no more effective than a placebo for people with moderately severe
depression. The earlier study found statistically significant
improvement in patients who took the antidepressant Zoloft, compared
to those who took a placebo.

The German results were strikingly different. The study included 251
people with a score of 22 or higher on the Hamilton Depression Scale,
a widely accepted measure of the condition. The Hamilton score
decreased by 14.4 points for patients who took three daily doses of
the St. John's wort extract for six weeks, compared to a reduction of
11.4 points for patients who took Paxil. There were also fewer adverse
side effects in the St. John's wort group than in the Paxil group.

The research was financed by the company that markets the extract. The
findings appear in the Feb. 12 issue of the British Medical Journal,
whose reports are "refereed," meaning their validity is checked by
medical experts.

The difference between the German and U.S. results could be explained
by a difference in the severity of the condition among participants in
the two trials, said Kirstin Stolp, a pharmacist with Dr. Willmar
Schwabe Pharmaceuticals, the maker of the extract used in the new
study.

"Patients in their [the U.S.] study had a more chronic condition, with
the duration of their current episodes of depression much longer than
in ours," she said. "Also, patients in the American trial in large
part had not responded to several previous attempts at treatment. Our
trial included only patients who had only one treatment without
response."

The extract used in the German trial is marketed in European countries
under the brand name Neuroplant VO, said Dr. Jochen Muehlhoff,
marketing information manager for the company. It is sold in the
United States as a dietary supplement by Nature's Way products under
the brand name Perika, "for promoting a positive mood, rather than a
drug for the treatment of depression," he said.

European regulators have approved the product for treatment of "major
depression of mild to moderate severity," Muehlhoff said. The newly
reported trial "shows for the first time that also severely depressed
patients significantly benefit from treatment," he added.

Dr. Carol Kleinman, a spokeswoman for the American Psychiatric
Association, said the brevity of the German study was a matter of
concern.

"I noticed that it was only for six weeks," she said. "Paroxetine [the
generic name for Paxil] usually is not completely effective in that
period. If the study went out in time a little further, the effects of
the treatments might distinguish themselves. Paroxetine needs eight
weeks to be fully effective."

Nevertheless, Kleinman said, "I think I would be comfortable in
prescribing St. John's wort for mild depression, if it was for someone
I could follow closely. Some people prefer what they call natural
substances. But for moderate to severe depression, it does not work as
well."

Kleinman said she is not currently prescribing St. John's wort for any
of her patients.

However, Dr. Uriel Halbreich, a professor of psychiatry at the State
University of New York at Buffalo, who took part in an earlier U.S.
trial of St. John's wort, said he "definitely would not prescribe St.
John's wort."

While he called the results of the German trial "quite impressive,"
Halbreich said there are practical difficulties in the use of St.
John's wort, particularly for persons who take an extract on their
own.

"If you go to a drug store or vitamin or supplement store, you find a
lot of brands, and they are different from each other," he said. "Even
with a very reputable German manufacturer, there are differences in
activity."

Another problem is the potential for adverse reactions with other
medications, Halbreich said. "I would not recommend it to a patient
because of the inability to control for drug-drug interactions. Many
people who would get the medication without a prescription are taking
many other medications. I would advise any patient to be careful of
what they take."

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