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[Meta-analysis of effectiveness and tolerability of treatment of mild to moderate depression with St. John's Wort].
Fortschr Neurol Psychiatr 2004; 72(6):330-43FN

Abstract

After anxiety, depression is one of the most common psychiatric diseases, showing a lifetime prevalence of 4.4 - 18 %. St. John's Wort is a herbal antidepressant combining a long tradition of use with well-proven medical research. We conducted a meta-analysis to review St. John's Wort's place in the treatment of depression. A comprehensive literature search was conducted for studies comparing effectiveness and tolerability of St. John's Wort with either placebo or synthetic antidepressant. Thirty studies met the inclusion as well as the quality criteria and were included in the meta-analysis. Four studies consisted of all three arms and were thus included in both analyses. Our results demonstrated a significant advantage for St. John's Wort compared to placebo (n = 2129, RR = 0.66, 95 % CI 0.57 - 0.78, p < 0.00001, NNT = 4.2 95 % CI 3.0 - 6.6, mean response: 53.3 vs. 32.7 %). Compared to synthetic antidepressants St. John's Wort demonstrated similar effectiveness (n = 2231, RR = 0.96, 95 % CI 0.85 - 1.08, p = 0.5, mean response: 53.2 % vs. 51.3 %). In the sub-group of mild to moderate depression, corresponding with the indication for St. John's Wort assigned by the German health authority, the herbal antidepressant showed better results against the synthetic antidepressants (n = 1166, RR = 0.85, 95 % CI 0.75 - 0.97, p = 0.01, NNT = 14.3, 95 % CI 8.3 - 100, mean response 59.5 vs. 52.9 %). This result viewed together with St. John's Wort's favourable side-effects profile, leading to a lower rate of drop-outs, suggests treatment with St. John's Wort should be attempted for milder forms of depression. Funnel plot analysis suggested publication bias could exist for the comparison with placebo. To put this in a perspective the fail-safe-N-test calculated that 423 studies with no effect would be needed to negate the presented result for placebo studies.

Authors+Show Affiliations

Humboldt Universität zu Berlin, Institut für Klinische Pharmakologie.No affiliation info availableNo affiliation info available

Pub Type(s)

English Abstract
Journal Article
Meta-Analysis

Language

ger

PubMed ID

15211398

Citation

Röder, Claudia, et al. "[Meta-analysis of Effectiveness and Tolerability of Treatment of Mild to Moderate Depression With St. John's Wort]." Fortschritte Der Neurologie-Psychiatrie, vol. 72, no. 6, 2004, pp. 330-43.
Röder C, Schaefer M, Leucht S. [Meta-analysis of effectiveness and tolerability of treatment of mild to moderate depression with St. John's Wort]. Fortschr Neurol Psychiatr. 2004;72(6):330-43.
Röder, C., Schaefer, M., & Leucht, S. (2004). [Meta-analysis of effectiveness and tolerability of treatment of mild to moderate depression with St. John's Wort]. Fortschritte Der Neurologie-Psychiatrie, 72(6), pp. 330-43.
Röder C, Schaefer M, Leucht S. [Meta-analysis of Effectiveness and Tolerability of Treatment of Mild to Moderate Depression With St. John's Wort]. Fortschr Neurol Psychiatr. 2004;72(6):330-43. PubMed PMID: 15211398.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Meta-analysis of effectiveness and tolerability of treatment of mild to moderate depression with St. John's Wort]. AU - Röder,Claudia, AU - Schaefer,Marion, AU - Leucht,S, PY - 2004/6/24/pubmed PY - 2004/8/24/medline PY - 2004/6/24/entrez SP - 330 EP - 43 JF - Fortschritte der Neurologie-Psychiatrie JO - Fortschr Neurol Psychiatr VL - 72 IS - 6 N2 - After anxiety, depression is one of the most common psychiatric diseases, showing a lifetime prevalence of 4.4 - 18 %. St. John's Wort is a herbal antidepressant combining a long tradition of use with well-proven medical research. We conducted a meta-analysis to review St. John's Wort's place in the treatment of depression. A comprehensive literature search was conducted for studies comparing effectiveness and tolerability of St. John's Wort with either placebo or synthetic antidepressant. Thirty studies met the inclusion as well as the quality criteria and were included in the meta-analysis. Four studies consisted of all three arms and were thus included in both analyses. Our results demonstrated a significant advantage for St. John's Wort compared to placebo (n = 2129, RR = 0.66, 95 % CI 0.57 - 0.78, p < 0.00001, NNT = 4.2 95 % CI 3.0 - 6.6, mean response: 53.3 vs. 32.7 %). Compared to synthetic antidepressants St. John's Wort demonstrated similar effectiveness (n = 2231, RR = 0.96, 95 % CI 0.85 - 1.08, p = 0.5, mean response: 53.2 % vs. 51.3 %). In the sub-group of mild to moderate depression, corresponding with the indication for St. John's Wort assigned by the German health authority, the herbal antidepressant showed better results against the synthetic antidepressants (n = 1166, RR = 0.85, 95 % CI 0.75 - 0.97, p = 0.01, NNT = 14.3, 95 % CI 8.3 - 100, mean response 59.5 vs. 52.9 %). This result viewed together with St. John's Wort's favourable side-effects profile, leading to a lower rate of drop-outs, suggests treatment with St. John's Wort should be attempted for milder forms of depression. Funnel plot analysis suggested publication bias could exist for the comparison with placebo. To put this in a perspective the fail-safe-N-test calculated that 423 studies with no effect would be needed to negate the presented result for placebo studies. SN - 0720-4299 UR - https://www.unboundmedicine.com/medline/citation/15211398/[Meta_analysis_of_effectiveness_and_tolerability_of_treatment_of_mild_to_moderate_depression_with_St__John's_Wort]_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-2003-812513 DB - PRIME DP - Unbound Medicine ER -