Posted by sdb on June 28, 2006, at 16:29:03
In reply to Re: hypericum - paroxetine panic maze study (long), posted by sdb on June 27, 2006, at 18:44:55
Thanks Bob for cleaning the hypericum to alternative to keep order and quality (what I think is important and a priority as a moderator)
substitute act not self-interview. Only read this if you are interested. No trigger content.
The neuropharmacology studies definately prove that sjw does many things in the brains. From
these studies I shortly frequented, were many differences of the substances of an sjw abstract itself. Maybe there could be a problem of inconsistency, dosages and non compliance (to wait 6 weeks for an effect!). After all that some of these sjw abstracts can work is assured. And for some of the pbabble it works or worked. Feel free to articulate what your are thinking about.sdb, OOAB
(owner of a brain)Here's a meta-analysis from the
British Medical Journal:
http://bmj.bmjjournals.com/cgi/content/full/313/7052/253Review article, Klaus Linde, MD:
http://bjp.rcpsych.org/cgi/content/full/186/2/99Negative Jama abstract:
JAMA. 2002 Apr 10;287(14):1807-14. Related Articles, Links
Click here to read
Comment in:* Evid Based Ment Health. 2002 Nov;5(4):111.
* JAMA. 2002 Apr 10;287(14):1853-4.
* JAMA. 2002 Jul 24-31;288(4):446-7; author reply 448-9.
* JAMA. 2002 Jul 24-31;288(4):446; author reply 448-9.
* JAMA. 2002 Jul 24-31;288(4):446; author reply 448-9.
* JAMA. 2002 Jul 24-31;288(4):447-8; author reply 448-9.
* JAMA. 2002 Jul 24-31;288(4):447; author reply 448-9.
* JAMA. 2002 Jul 24-31;288(4):448; author reply 448-9.Some positive abstracts:
Effect of Hypericum perforatum (St John's wort) in major depressive disorder: a randomized controlled trial.
Hypericum Depression Trial Study Group.
CONTEXT: Extracts of Hypericum perforatum (St John's wort) are widely used for the treatment of depression of varying severity. Their efficacy in major depressive disorder, however, has not been conclusively demonstrated. OBJECTIVE: To test the efficacy and safety of a well-characterized H perforatum extract (LI-160) in major depressive disorder. DESIGN AND SETTING: Double-blind, randomized, placebo-controlled trial conducted in 12 academic and community psychiatric research clinics in the United States. PARTICIPANTS: Adult outpatients (n = 340) recruited between December 1998 and June 2000 with major depression and a baseline total score on the Hamilton Depression Scale (HAM-D) of at least 20. INTERVENTIONS: Patients were randomly assigned to receive H perforatum, placebo, or sertraline (as an active comparator) for 8 weeks. Based on clinical response, the daily dose of H perforatum could range from 900 to 1500 mg and that of sertraline from 50 to 100 mg. Responders at week 8 could continue blinded treatment for another 18 weeks. MAIN OUTCOME MEASURES: Change in the HAM-D total score from baseline to 8 weeks; rates of full response, determined by the HAM-D and Clinical Global Impressions (CGI) scores. RESULTS: On the 2 primary outcome measures, neither sertraline nor H perforatum was significantly different from placebo. The random regression parameter estimate for mean (SE) change in HAM-D total score from baseline to week 8 (with a greater decline indicating more improvement) was -9.20 (0.67) (95% confidence interval [CI], -10.51 to -7.89) for placebo vs -8.68 (0.68) (95% CI, -10.01 to -7.35) for H perforatum (P =.59) and -10.53 (0.72) (95% CI, -11.94 to -9.12) for sertraline (P =.18). Full response occurred in 31.9% of the placebo-treated patients vs 23.9% of the H perforatum-treated patients (P =.21) and 24.8% of sertraline-treated patients (P =.26). Sertraline was better than placebo on the CGI improvement scale (P =.02), which was a secondary measure in this study. Adverse-effect profiles for H perforatum and sertraline differed relative to placebo. CONCLUSION: This study fails to support the efficacy of H perforatum in moderately severe major depression. The result may be due to low assay sensitivity of the trial, but the complete absence of trends suggestive of efficacy for H perforatum is noteworthy.
[Hypericum perforatum extract in treatment of mild to moderate depression. Clinical and pharmacological aspects]
[Article in German]
Laakmann G, Jahn G, Schule C.
Psychiatrische Klinik der Universitat Munchen, Nussbaumstrasse 7, 80336 Munchen. Prof.Laakmann@psy.med.uni-muenchen.de
For many years, hypericum extracts have been used in the treatment of depressive disorders. The therapeutical use of these extracts has been predominantly justified for a long time by the clinical evidence of efficacy and only partly by results of scientific studies. The aim of the present investigation is to perform a meta-analysis of the placebo- and verum-controlled studies carried out till now, to examine the relevance of hyperforin and hypericin for the clinical efficacy of St. John's Wort, to discuss biochemical and pharmacoendocrinological studies investigating the mechanism of action, and to describe side effects and interactions of hypericum extracts. In particular during recent years, methodologically quite sophisticated studies have been performed. The comprehensive evaluation of all studies available suggests a significant superiority of hypericum extracts over placebo, despite the negative results of two recently published American trials, and a therapeutic efficacy comparable to that of synthetic antidepressants in mildly to moderately depressed patients. Furthermore, it has been suggested in preclinical and clinical studies that the content of hyperforin but not of hypericin decisively contributes to the antidepressant efficacy of hypericum extracts. Hyperforin has been demonstrated in biochemical investigations--like synthetic antidepressants--to inhibit the reuptake of the neurotransmitters norepinephrine, serotonin, and dopamine. Hypericum extracts can be regarded as well tolerated, and they extend the variety of pharmacotherapeutical options in the treatment of depression, especially in outpatients. However, interactions in combination treatments are possible by interference with the cytochrom P450 system, thereby changing plasma levels of other medications.
Efficacy of St. John's wort extract WS 5570 in major depression: a double-blind, placebo-controlled trial.
Lecrubier Y, Clerc G, Didi R, Kieser M.
Unite Institut National de la Sante et de la Recherche Medicale 302, Hopital Pitie Salpetriere, Paris, France. lecru@ext.jussieu.fr
OBJECTIVE: In a double-blind, randomized, placebo-controlled trial with 375 patients the authors investigated the antidepressant efficacy and safety of 300 mg t.i.d. of hydroalcoholic Hypericum perforatum extract WS 5570. METHOD: The study participants were male and female adult outpatients with mild to moderate major depression (single or recurrent episode, DSM-IV criteria). After a single-blind placebo run-in phase, the patients were randomly assigned, 186 to WS 5570 and 189 to placebo, after which they received double-blind treatment for 6 weeks. Follow-up visits were held after 1, 2, 4, and 6 weeks. The primary outcome measure was the change from baseline in the total score on the 17-item Hamilton Depression Rating Scale. In addition, analyses of responders (patients with at least a 50% reduction in Hamilton total score) and patients with remissions (patients with a total score of 6 or less on the Hamilton scale at treatment end) were carried out, and subscale/subgroup analyses were conducted. The design included an adaptive interim analysis performed after random assignment of 169 patients with options for group size adjustment or early termination. RESULTS: Compared to placebo, WS 5570 produced a significantly greater reduction in total score on the Hamilton depression scale and significantly more patients with treatment response or remission. It was more effective in patients with higher baseline Hamilton scores and led to global reduction of depression-related core symptoms, assessed with the melancholia subscale of the Hamilton scale. The placebo and WS 5570 groups had comparable adverse events. CONCLUSIONS: H. perforatum extract WS 5570 was found to be safe and more effective than placebo for the treatment of mild to moderate depression.
St John's wort for depression.
: Cochrane Database Syst Rev. 2005 Apr 18;(2):CD000448.Linde K, Mulrow CD, Berner M, Egger M.
Centre for Complementary Medicine Research, Department of Internal Medicine II, Technische Universitat Munchen, Kaiserstr. 9, Munich, Germany, 80801. Klaus.Linde@lrz.tu-muenchen.de
BACKGROUND: Extracts of the plant Hypericum perforatum L. (popularly called St. John's wort) have been used in folk medicine for a long time for a range of indications including depressive disorders. OBJECTIVES: To investigate whether extracts of hypericum are more effective than placebo and as effective as standard antidepressants in the treatment of depressive disorders in adults; and whether they have have less adverse effects than standard antidepressant drugs. SEARCH STRATEGY: Trials were searched in computerized databases (Cochrane Collaboration Depression, Anxiety & Neurosis Group Clinical Trials Registers; PubMed); by checking bibliographies of pertinent articles; and by contacting manufacturers and researchers. SELECTION CRITERIA: Trials were included if they: (1) were randomized and double-blind; (2) included patients with depressive disorders; (3) compared extracts of St. John's wort with placebo or standard antidepressants; and (4) included clinical outcomes such as scales assessing depressive symptoms. DATA COLLECTION AND ANALYSIS: Information on patients, interventions, outcomes and results was extracted by at least two independent reviewers using a standard form. The main outcome measure for comparing the effectiveness of hypericum with placebo and standard antidepressants was the responder rate ratio (responder rate in treatment group/responder rate in control group). The main outcome measure for adverse effects was the number of patients dropping out for adverse effects. MAIN RESULTS: A total of 37 trials, including 26 comparisons with placebo and 14 comparisons with synthetic standard antidepressants, met the inclusion criteria. Results of placebo-controlled trials showed marked heterogeneity. In trials restricted to patients with major depression, the combined response rate ratio (RR) for hypericum extracts compared with placebo from six larger trials was 1.15 (95% confidence interval (CI), 1.02-1.29) and from six smaller trials was 2.06 (95% CI, 1.65 to 2.59). In trials not restricted to patients with major depression, the RR from six larger trials was 1.71 (95% CI, 1.40-2.09) and from five smaller trials was 6.13 (95% CI, 3.63 to 10.38). Trials comparing hypericum extracts and standard antidepressants were statistically homogeneous. Compared with selective serotonin reuptake inhibitors (SSRIs) and tri- or tetracyclic antidepressants, respectively, RRs were 0.98 (95% CI, 0.85-1.12; six trials) and 1.03 (95% CI, 0.93-1.14; seven trials). Patients given hypericum extracts dropped out of trials due to adverse effects less frequently than those given older antidepressants (Odds ratio (OR) 0.25; 95% CI, 0.14-0.45); such comparisons were in the same direction, but not statistically significantly different, between hypericum extracts and SSRIs (OR 0.60, 95% CI, 0.31-1.15). AUTHORS' CONCLUSIONS: Current evidence regarding hypericum extracts is inconsistent and confusing. In patients who meet criteria for major depression, several recent placebo-controlled trials suggest that the tested hypericum extracts have minimal beneficial effects while other trials suggest that hypericum and standard antidepressants have similar beneficial effects. As the preparations available on the market might vary considerably in their pharmaceutical quality, the results of this review apply only to the products tested in the included studies.
poster:sdb
thread:662077
URL: http://www.dr-bob.org/babble/alter/20060601/msgs/662314.html