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Treatment of Major Depression With St. John's Wort (Hypericum)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
ClinicalTrials.gov Identifier: NCT00005013
Recruitment Status : Completed
First Posted : April 3, 2000
Last Update Posted : April 8, 2014
National Center for Complementary and Integrative Health (NCCIH)
Information provided by:
National Institute of Mental Health (NIMH)

Brief Summary:

The purpose of this trial is to study the acute efficacy and safety of a standardized extract of the herb Hypericum perforatum (St. John's Wort), called hypericum for purposes of this trial, in the treatment of patients with major depression.

Clinical depression is a serious medical disorder that can be debilitating and can lead to suicide. There is growing public interest in claims that hypericum may be an effective treatment for depression. Although it is widely prescribed in Europe, no studies of its long-term use have been conducted, and published studies have treated different types of patients and have used several different doses. The toxicity and side effects of hypericum appear to be substantially less than those of standard tricyclic antidepressant medications, and thus hypericum may be more acceptable to patients. In addition, the cost is significantly less than standard antidepressant medications. Published studies assessed acute efficacy and lasted between 4 and 12 weeks (most being 4-6 weeks). The longer-term effects of hypericum have not been evaluated. There is a need for a large-scale, controlled clinical trial to assess whether Hypericum has a significant therapeutic effect in patients with clinical depression.

Patients are assigned randomly (like tossing a coin) to receive St. John's wort, Sertraline (Zoloft), or a placebo (sugar pill) for 8 weeks. This is a double-blind study, meaning neither the patient nor the doctor will know which treatment is being assigned. Patients who respond well to the treatment will continue on the assigned treatment for an additional 4 months. Patients will have regular follow-up visits to monitor their symptoms and any side effects they experience.

Condition or disease Intervention/treatment Phase
Major Depression Drug: Sertraline Drug: Hypericum perforatum (St. John's wort) Not Applicable

Detailed Description:

This trial will determine the acute antidepressant efficacy of a standardized extract of hypericum (St. John's Wort) for the treatment of major depressive disorder.

For this trial, the primary efficacy analysis will be evaluated at 8 weeks. For observational purposes, a 4-month double blind continuation (6 months total treatment) in treatment responders would enable an approximation of the effectiveness of maintenance treatment with this medication. No published studies have included a selective serotonin re-uptake inhibitor (SSRI) comparator. While this trial will not compare the efficacy of hypericum to an SSRI, having an SSRI arm of sertraline (Zoloft) will allow an evaluation of the validity of the trial.

336 eligible patients will be randomly assigned to double-blind treatment with hypericum, sertraline, or placebo following a one-week placebo lead-in period (between screening and baseline). All treatment groups will consist of 112 patients and will be followed for an eight-week period. Treatment responders will be continued on the randomly assigned treatment arm for an additional 18 weeks.

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Study Type : Interventional  (Clinical Trial)
Allocation: Randomized
Masking: Double
Primary Purpose: Treatment
Official Title: A Placebo Controlled Clinical Trial of a Standardized Extract of Hypericum Perforatum in Major Depressive Disorder
Study Start Date : December 1998
Actual Study Completion Date : July 2001

Resource links provided by the National Library of Medicine

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Major depression assessed by Structured Clinical Interview for DSM-IV Axis I Disorders (SCID; First et al, 1995)
  • Minimum score greater than or equal to 20 on the 17-item Hamilton Depression (HAM-D) Scale at screen and at baseline
  • GAF of 60 or less (moderate symptoms) at screen and at baseline
  • HAM-D cannot decrease by 25% or more between screening and baseline
  • Capacity to give informed consent and to follow study procedures.
  • Abstinence or effective method of contraception throughout the study

Exclusion Criteria:

  • Scores greater than 2 on the "suicide" item of HAM-D, or history of suicide attempt(s) in the past 12 months
  • Current suicidal or homicidal risk, as determined by the investigator
  • Women of childbearing age who are pregnant, planning pregnancy in the next 6 months, breast-feeding, or not using medically acceptable means of birth control (hormonal treatment such as birth control pill, injection or implant, IUD, or double barrier of condom and diaphragm together is acceptable; primary use of condom, sponge or diaphragm alone (single barrier) is not acceptable because these may carry a higher rate of failure when used alone
  • Clinically significant liver disease (such as hepatitis, cirrhosis, etc); or clinically significant elevation of liver enzyme tests (two times the upper limit of normal; asymptomatic Gilbert's syndrome is not an exclusion). 4. Serious or unstable medical illness. 5. History of seizure disorder (other than febrile).
  • Any of the following DSM-IV diagnoses by SCID: current (within past 6 months) alcohol or other substance abuse disorder; schizophrenia, schizo-affective, or other psychotic disorder; bipolar disorder; current panic disorder or obsessive compulsive disorder; history of psychotic features of affective disorder (mood congruent or incongruent)
  • Clinical or laboratory evidence of untreated or unstable thyroid disorder
  • Failed to respond to at least two adequate antidepressant trials (defined as 6 weeks or more treatment with either greater than or equal to 150 mg imipramine, or tricyclic equivalent), or greater than or equal to 60 mg of phenelzine, or MAOI equivalent, or greater than or equal to 100 mg of sertraline, or its SSRI equivalent
  • Have taken sertraline or any form of hypericum during this current episode of depression at any dose level, daily, for at least one month, within the past 6 months
  • Current (within past 6 months) use of other prescription or non-prescription drugs, including anticonvulsants and other medications with significant psychotropic properties, antiretroviral medications, cyclosporine, digoxin, coumadin, dietary supplements, natural remedies, and botanical preparations (eg, hypericum, kava, valerian)
  • Have had other investigational drugs within 30 days or other psychotropic medication within 21 days of baseline (6 weeks for fluoxetine)
  • Known allergy or hypersensitivity to the study medications
  • Positive drug urine screen
  • Have been in psychotherapy for 2 months or less at the time of enrollment into the study
  • Receiving psychotherapies which are specifically designed to treat depression, eg, interpersonal psychotherapy during the study period
  • Mental retardation or cognitive impairment, or any disorder that might interfere with their ability to consent or follow study procedures and requirements

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00005013

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United States, California
Feighner Research Institute
San Diego, California, United States, 92121
Stanford Univ School of Medicine
Stanford, California, United States, 94305
Harbor-UCLA Rsch and Education Inst
Torrance, California, United States, 90502
United States, Florida
Univ of South Florida College of Med
Tampa, Florida, United States, 33613
United States, Georgia
Emory Mood and Anxiety Disorders Clinical Trials Program
Atlanta, Georgia, United States, 30329
United States, Massachusetts
McLean Hospital
Belmont, Massachusetts, United States, 02478
United States, New York
Eastside Comprehensive Medical Services
New York, New York, United States, 10021
United States, North Carolina
Duke Univ Med Ctr
Durham, North Carolina, United States, 27710
United States, Ohio
Univ of Cincinnati Medical Ctr
Cincinnati, Ohio, United States, 45267
United States, Texas
Univ of Texas Southwestern Med Ctr
Dallas, Texas, United States, 75235
United States, Washington
Seattle Clinical Research Center
Seattle, Washington, United States, 98104
United States, Wisconsin
Dean Foundation for Hlth Rsch and Education
Middleton, Wisconsin, United States, 53562
Sponsors and Collaborators
National Institute of Mental Health (NIMH)
National Center for Complementary and Integrative Health (NCCIH)
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Principal Investigator: Jonathan Davidson Duke Univ Med Ctr
Publications of Results:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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ClinicalTrials.gov Identifier: NCT00005013    
Other Study ID Numbers: N01 MH70007
First Posted: April 3, 2000    Key Record Dates
Last Update Posted: April 8, 2014
Last Verified: March 2006
Keywords provided by National Institute of Mental Health (NIMH):
Antidepressive Agents
Depressive Disorder
Medicine, Herbal
Plant Extracts
Alternative Medicine
Additional relevant MeSH terms:
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Depressive Disorder
Depressive Disorder, Major
Behavioral Symptoms
Mood Disorders
Mental Disorders
Antidepressive Agents
Psychotropic Drugs
Selective Serotonin Reuptake Inhibitors
Neurotransmitter Uptake Inhibitors
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action
Neurotransmitter Agents
Serotonin Agents
Physiological Effects of Drugs