St John's wort has long been known as an effective herbal treatment for mild depression but the latest study is the first to suggest that it may have equal effectiveness with one of the biggest-selling pharmaceutical treatments for moderate to severe depression.
Researchers who asked 301 people with depression to take part in the trial found that half of those given St John's wort for six weeks reported an improvement in their symptoms, compared with only one third given Seroxat.
Neither group knew which drug they were taking, but those given Seroxat also reported more side-effects.
Seroxat has been at the centre of allegations that in some patients it causes agitation at the start of treatment and withdrawal effects in those trying to come off it. An investigation by the Medicines and Healthcare Regulatory Authority concluded last year that it should be avoided in mild depression, because of the side-effects. The authority ordered a ban on its use in patients under 18.
The study is published in the online version of the British Medical Journal. The researchers from Germany say: "Our results support the use of [St John's wort extract] as an alternative to standard antidepressants in moderate to severe depression, especially as it is well tolerated." They add that the drug should be assessed for long-term treatment, because many patients suffer chronic depression and the "favourable ratio between efficacy and tolerability" of St John's wort makes it an "interesting option" in these patients.
In 2004, about 19 million prescriptions for antidepressants were issued to about 3.5 million patients at a total cost of pounds 400m in the UK.
In recommendations issued in December, the Nat- ional Institute for Clinical Excellence (Nice) said that given the well-known side-effects of such drugs, including anxiety, insomnia, headaches and stomach complaints, alternative treatments should be considered for people with mild depression.
Nice recommended that counselling including cognitive behavioural therapy should be considered. But the Royal College of GPs said the shortage of counsellors and psychotherapists meant this was impractical. "GPs often feel they have little choice but to prescribe antidepressants," a spokesman said.
In Germany, where St John's wort is a prescription drug, it outsells Prozac by four to one.
One drawback is that St John's wort interacts with several prescription medicines to reduce their effectiveness.Reuse content