Pharmacopsychiatry 2001; 34(Suppl1): 38-41
DOI: 10.1055/s-2001-15459
Original Paper
© Georg Thieme Verlag Stuttgart · New York

Differential Therapy of mild to moderate Depressive Episodes
(ICD-10 F 32.0; F 32.1) with St. John's Wort

M. Friede, H.-H. Henneicke von Zepelin, J. Freudenstein
  • Schaper & Brümmer GmbH & Co. KG, Salzgitter, Germany
Further Information

Publication History

Publication Date:
31 December 2001 (online)

The purpose of this report was to evaluate specific depressive symptoms that are most suitable for a therapy with the Ze 117 St. John's wort extract. We examined the antidepressant efficacy and drug safety of Ze 117 and fluoxetine in a multicentric prospective randomized double-blind parallel group comparison according to generally accepted guidelines such as the Declaration of Helsinki and GCP [15]. We treated outpatients (n = 240; Ze 117: 126; fluoxetine: 114) with mild to moderate depressive episodes (ICD-10: F 32.0, F 32.1; HAMD range: 16 - 24) with either two tablets St John's wort (Ze 117; 500 mg extract/day) or fluoxetine (20 mg/day) for 6 weeks. Antidepressant efficacy was evaluated with the validated HAMD psychometric method. A validated analysis of HAMD subscores was made to verify the efficacy for certain depressive symptoms.

The main results were:

  • The HAMD responder rate [1] was 60 % in the Ze 117 group compared to 40 % in the fluoxetine group (p = 0.005).

  • Particularly, there was a marked decrease of depressive agitation (pre-post comparison: 46 %) and anxiety symptoms (44 %) during the therapy with St. John's wort. Depressive obstruction (44 %) and sleep disorders (43 %) were reduced during the treatment, too. There were no statistically significant differences between the treatment groups.

  • Adverse events occurred in 28 patients (25 %) in the fluoxetine group and in 18 (14 %) of the St. John's wort group (p < 0.07).

St. John's wort extract is a clinically effective equivalent to fluoxetine regarding overall depressive symptoms and main symptoms of depressive episodes. An especially interesting overall observation is that Ze 117 is particularly effective in depressive patients suffering from anxiety symptoms. St. John's wort revealed better safety and tolerability data than fluoxetine.

References

  • 1 Angst J, Bech P, Boyer P. Consensus on the methodology of clinical trials of antidepressants, Zurich, March 1988 Report of the consensus committee.  Pharmacopsychiatry. 1989;  22 3-7
  • 2 Angst J, Dobler A. The Zurich study, VI: A continuum from depression to anxiety disorders?.  Europ Arch Psychiatry Neurol Sci. 1985;  235 179-186
  • 3 Bowen R, Kohout J. The relationship between agoraphobia and primary effective disorders.  Can J Psychiatry. 1979;  24 317-322
  • 4 Cassano G, Savino N. Depressive syndromes with concurrent anxiety disorders.  Medicographica. 1994;  16 8-11
  • 5 Fawcett J, Kravitz H. Anxiety syndromes and their relationships to depressive illness.  J Clin Psychiatry. 1983;  44 8-11
  • 6 Friede M, Wüstenberg P. Johanniskraut zur Therapie von Angstsyndromen bei depressiven Verstimmungen.  Zeitschrift für Phytotherapie. 1998;  19 309-317
  • 7 Friede M ., Henneicke-von Z epelin, H.-H., Freudenstein J. Differential therapy of depressive episodes with Hyperici herba.  Archivos de Medicina. 2000;  1 60
  • 8 Frost L, Moffit T, McGee R. Neuropsychological correlates of psychopathology in an unselected cohort of young adolescents.  J Abnorm Psychol. 1989;  93 307-313
  • 9 Hamilton M. A rating scale for depression.  J Neurol Neurosurg Psychiatr. 1960;  23 56-62
  • 10 Hamilton M. Development of a rating scale for primary depressive illness.  Br J Soc Clin Psychol. 1967;  6 278-296
  • 11 Käufeler R ., Meier B, Brattström A. Wirksamkeit des Johanniskraut-Extraktes Ze 117 in adäquater Dosierung im Vergleich zu Placebo, Imipramin und Fluoxetin. Abstractbook: 10. Jahrestagung d. Gesellschaft f. Phytotherapie, Münster 11.-13. 11. 1999: 84-86
  • 12 Klerman G. Anxiety and depression. In: Burrows G. (ed.) Handbook of Studies on Depression. New York: Exerpta Medica 1977: 504
  • 13 Linde K, Ramirez G, Mulrow C D. St. John's wort for depression an overview and metanalysis of randomised clinical trials.  Br Med J. 1996;  313 253-258
  • 14 Meier B, Liske E, Rosinus V. Wirksamkeit und Verträglichkeit eines standardisierten Johanniskraut-Vollextraktes (Ze 117) bei Patienten mit depressiver Symptomatik unterschiedlicher Schweregrade - eine Anwendungsbeobachtung.  Forschende Komplementärmedizin. 1997;  4 87-93
  • 15 Notes for Guidance On Good Clinical Practice. Topic E6 1/17/1997. Location: ICH 1997
  • 16 Schrader E, Meier B, Brattström A. Hypericum treatment of mild-moderate depression in a placebo-controlled study: a prospective, double-blind, randomized, placebo-controlled, multicentre study.  Hum Psychopharmacol. 1998;  13 163-169
  • 17 Schrader E. Equivalence of St. John's wort extract (Ze 117) and fluoxetine: a randomized, controlled study in mild-moderate depression.  International Clinical Psychopharmacology. 2000;  15 61-68
  • 18 van Valkenberg C, Akiskal H, Puzantian V. et al . Anxious depression: clinical, family history and naturalistic outcome: comparisons with panic and major depressive disorders.  J Affect Disorders. 1984;  6 67-82

Dr. rer. nat. Michael Friede

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