Abstract
Special quantified extracts from Hypericum perforatum (available in pharmacies only) have been recognised on a European level(1) as a safe and effective treatment option in the treatment of mild to moderate depression. While the efficacy of such Hypericum extracts has been proven to be equivalent to that of chemical antidepressants such as SSRIs and tricyclic antidepressants, their tolerability profile is clearly superior.
Hypericum extract has a multifactor mode of action found to be relevant in the treatment of depression. Pharmacological studies have demonstrated that hyperforin and rutin play a major role in the mechanism of action and also hypericin contributes to the activity.2,3
A number of well-controlled clinical studies with Hypericum special quanitified extracts (available only in pharmacies) were performed. The Cochrane Review(4) for Hypericum perforatum high quality extracts summarizes 29 high quality trials, thereof 18 placebo-controlled studies as well as 17 comparator trials and concludes a superior efficacy of Hypericum extract over placebo, similar efficacy as typical standard antidepressants like TCA and SSRI, less side effects and better tolerability than standard antidepressants.5-10
St. John’s wort extracts can therefore be considered to be a safe and effective first-line treatment of mild to moderate depression, however, special attention has to be drawn to the quality of the extracts as the safety and efficacy can not be judged for Hypericum products sold outside the pharmacies.
Over de spreker
Medical Director Clinic for Psychiatry, Psychotherapy and Psychosomatic Medicin Castle of Werneck; Würzburg Medical College, Germany
hans-peter.volz@kh-schloss-werneck.de
Referenties
1. Community herbal monograph on Hypericum perforatum L., herba (well-established medicinal use), Doc. Ref.: EMA/HMPC/101304/2008
2. Müller WE et al: Hyperforin – antidepressant activity by a novel mechanism of action; Pharmacopsychiatry 2001
3. Nöldner and Schötz: Rutin is essential for antidepressant activity of St. John’s wort extracts (forced swimming test); Planta Med. 2002
4. Linde K., Berner M. M., Kriston L., St John’s wort for major depression (Intervention Review). 2008, The Cochrane Collaboration, www.cochrane.de
5. S. Kasper, H.-P. Volz, H.J. Möller, A. Dienel, M. Kieser. Continuation and long-term maintenance treatment with hypericum extract WS® 5570
6. S. Kasper, I.-G. Anghelescu, A. Szegedi, A. Dienel, M. Kieser: Superior efficacy of St. John's wort extract WS® 5570 compared with placebo in patients with major depression: A randomized, double-blind, placebo-controlled, multi-center trial, BMC Medicine 2006
7. A Szegedi, R Kohnen, A Dienel, M Kieser: Acute treatment of moderate to severe depression with hypericum extract WS® 5570 (St John’s wort): randomised controlled double blind non-inferiority trial versus paroxetine; BMJ 2005
8. Y. Lecrubier, G. Clerc, R. Didi, M. Kieser: Efficacy of St. John's Wort extract WS® 5570 in major depression: A double-blind placebo-controlled trial, The American Journal of Psychiatry 2002
9. Gastpar M., Singer A., Zeller K.: Comparative efficacy and safety of a once daily dosage of Hypericum extract STW 3-VI and citalopram in patients with moderate depression: a double-blind, randomised, multicenter, placebo-controlled study, Pharmacopsychiatry, 2006
10. Uebelhack R., Grünwald J., Graubaum H.-J., Busch R.: Efficacy and Tolerability of Hypericum Extract STW 3-VI in Patients With Moderate Depression: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial. Advances in Therapy, 2004