St Johns Wort (Hypericum perforatum) versus sertraline and placebo in major depressive disorder : continuation data from a 26-week RCT

Introduction: Hypericum perforatum (St Johns wort: SJW) has been extensively studied as an antidepressant in short-term trials, however little research has been conducted on longer-term efficacy. Methods: Our objective was to analyze the continuation data from a 26-week randomized, double-blind, controlled study of SJW (LI-160) vs. sertraline and placebo in major depressive disorder. 124 participant "responderso" continued treatment after week 8, until week 26. They continued randomly assigned SJW (900-1500mg), sertraline (50-100mg) or matching placebo. Results: At week 26, on the primary outcome, Hamilton depression rating scale (HAM-D) completer scores were: SJW (6.6+4.5), sertraline (7.1+5.4) and placebo (5.7+5.4) with a significant effect for time (p=0.036). Comparisons between all treatments were however non-significant (p=0.61). This effect was mirrored on the other outcomes: the BDI, CGI-severity, CGI-improvement, and on intention-to-treat analyses. Conclusion: While the continuation data revealed an equivocal outcome between treatments at week 26, both SJW and sertraline were still therapeutically effective, with a pronounced "placebo-effecto" impeding a significant result at week 26.