Posted by JohnL on August 16, 2000, at 6:04:35
In reply to St. John's Wort and Zoloft comparison and...CamW?, posted by dj on August 15, 2000, at 19:52:30
Cam's analysis is excellent. I agree completely, with the exception of one thing....SJW is actually good for severe depression. But the doses needed are 2 to 3 times higher than stated on the bottle.
Below is some good reading, though a bit long. The Researcher's comments and my own personal comments at the bottom sum it up quickly.
Effectiveness and tolerance of the hypericum extract LI 160 in comparison
with Imipramine: Randomized double-blind study with 135 outpatients .AU: Vorbach-EU; Hubner-WD; Arnoldt-KH
AD: Psychiatrische Klinik im Elisabethenstift, Darmstadt, Germany.
SO: J-Geriatr-Psychiatry-Neurol. 1994 Oct; 7 Suppl 1: S19-23Description:
135 patients, aged 18-75 years, 71 males and 64 females, were given
indistinguishable tablets of either hypericum extract LI 160 0.9 mg
(standardized hypericin content) x 3 or Imipramine 25 mg x 3 for six weeks a
randomised double-blind trial.Inclusion criteria were typical depression according to DSM-III R with a single
episode (296.2) or recurrent episodes (296.3), neurotic depression (300.4) and
adjustment disorder with depressed mood (309.0).Exclusion criteria were severe depression requiring inpatient treatment,
schizophrenia or marked agitation requiring additional medication; a known
history of attempted suicide or acute suicidal state, chronic alcohol and drug
dependency xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
psychotropic drugs, was not permitted. In addition, the patients must not have
been taking xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxarch
purposes within the previous 3 months.There was a washout phase of at least 2 weeks before the start of the study. All
non-psychotropic drugs were permitted and recorded on specific data sheets.
The patients had a thorough medical checkup with neurological status and
routine Lab-parameters at the start and end of the study.
They were questioned specifically about possible side effects.
Target parameters were the Hamilton Depression Scale (HAMD), the von
Zerssen Depression Self-rating Scale (D-S) and the Clinical Global
Impressions (CGI).Results
HAMD score
The mean HAMD fell from 20.2 to 8.8 in the hypericum group and from 19.
to 10.7 in the Imipramine group. The reduction of HAMD score was
significant with p< 0.001 in both groups. There were no statistically
significant differences between the groups.
D-S score
The mean D-S score fell from 39.6 to 27. 2 on hypericum and from 39.0 to
29.2 on Imipramine.CGI score
The CGI score for therapeutic effect rose from 1.3 to 3.1 in the hypericum
Group and from 1.2 to 2.7 in the Imipramine group.
The CGI score for change in status was slightly more positive in the hypericum
group than in the Imipramine group; 41% were greatly improved,
35% much improved, 12% slightly better and 12% experienced no change.
None of the hypericum patients experienced worsening of their condition. The
comparative results for Imipramine were 34% greatly improved, 27% much
improved, 17% slightly better, 17% unchanged, 3% somewhat worse and 2%
much worse.
The CGI score on change of illness severity also showed a trend towards better
results with hypericum. 81.8% were classified as having improved on
hypericum while 62.5% had improved on Imipramine. 18.2% were unchanged
or the same compared to 34.4% in the Imipramine group. None of the
hypericum patients and two of the Imipramine patients experienced worsening
of their condition.Effect on severe depressions:
In the subgroup with patients with a HAMD > 21 (severe depressions) there
was a statistically significant trend towards superiority of hypericum
(p< 0.05) The mean score fell from 25 to 9 in the hypericum group and from 24
to 14 in the Imipramine group (see Figure 2).ADRs
Adverse drug effects (ADRs) occurred in 8 patients on hypericum (11.9%).
Most frequent symptoms were dry mouth (4 cases) and dizziness (2 cases). 11
patients mentioned ADRs on Imipramine. Most frequent were dry mouth (9
cases), dizziness and anxiety (3 each) and constipation (2 cases). 10 of 11
symptoms were said to be mild with hypericum and 15 were classified as mild,
4 as moderate and 3 as severe on Imipamine.There were no changes in laboratory parameters or clinical status.
The researchers' comments:
The clinical efficacy of Imipramine has been demonstrated in more than 1000
therapeutic studies.The normal dose of Imipramine for outpatients is 50-150 mg/day. This study
used a dose of 75 mg because:
1. It is generally agreed upon that 50 mg is a sufficient dose for outpatient
treatment, especially with older subjects, who often require lower doses
because of slower elimination.
2. With a higher dose there would be a risk that it would be obvious which
patients were receiving which drug because of the typical side-effects on
Imipramine. This would interfere with the double-blind structure.This study did show Imipramine to have similar effects and side-effects as in
previous studies.Hypericum was clearly superior to Imipramine in terms of patient tolerance
and fewer side effects.The dose of hypericum was high in this study (2.7 mg hypericin daily). The
Authors conclude that more studies are needed to determine the dose-response
effect with hypericum in order to find the optimum dose of treatment for
different conditions.Personal Comments: Note LI160 is the same as Kira, Movana, Perika, or
Ricola containing .3% hypericin and minimum 3%hyperforin. The dose
used in this study was 2700mg which is nine 300mg doses per day. The
usual dose is just three 300mg doses per day. This dose was effective in
severe depression-not limited to mild or moderate. Any study needs
100 or more participants to be scientifically relevant. This study had
135 participants.
poster:JohnL
thread:43007
URL: http://www.dr-bob.org/babble/20000811/msgs/43051.html