Hypericum & Depression

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Studies Comparing Hypericum with Synthetic Drugs

Summary and general comments

There are at least eight randomized, double-blind studies comparing the antidepressant and anxiolytic effect of Hypericum perforatum to reference medications. The reference substances were Imipramine (2 studies), Amitryptilin (2 studies), Diazepam (2 studies) Maprotiline, and Desipramine . There is also one study comparing hypericum and Maprotiline regarding their effect on EEG and evoked potentials in healthy volunteers
that will be referred in another section.
Two of the studies against Desipramine and diazepam were conducted with a combination preparation of hypericum and Valeria.
Generally one has found a comparable antidepressant and anxiolytic effect of hypericin to low-to medium dose treatment with synthetic antidepressants, and a more benign side-effect profile. It is interesting to note that side effects generally are more common when hypericum is compared to reference substances than when it is compared to a placebo.
In many of the placebo-controlled studies the amount of "side effects" and dropouts because of adverse drug reactions were more frequent in the placebo than in the hypericum groups! This clearly demonstrates the vast importance of suggestions and expectations for treatment results with moderately to mildly depressed patients. It also clearly demonstrates the difficulties in deciding whether physical complaints during treatment are due to side effects or are secondary to the depression.
It has also been demonstrated that the role of placebo and suggestions decreases with severity of depression.
Hypericum proved superior to Imipramine in a moderate dose on severe depressions (HAMD>21) in the study by Vorbach et al. This contradicts the findings of other researchers, who only recommend hypericum for the treatment of mild to moderate depressions. More studies are needed to further investigate this.
It is also interesting to note the long-range effects of hypericum. It seems obvious that the effect continues to accumulate over a long time so that studies conducted over a longer period of time (6 weeks) generally show more significant effects. More studies that follow hypericum treatment for a longer period of time are needed in order to investigate the true therapeutic opportunities.
All the researchers involved clearly recommend hypericum for the treatment of mild to moderate depressions in outpatient clinics due to its broad therapeutic window, benign effect-side-effect profile and good compliance.
In this book we will take a further look at four of these studies.
The results of the studies are summarized in Table 2.

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