Medication ineffective for mild depression?

In a recent clinical trial, both St. John’s Wort and the antidepressant drug citalopram failed to outperform a placebo in relieving symptoms of minor depression. The study, which is consistent with earlier research, does not support the use of medications for mild depression.

St. John's Wort extract has been used medicinally for centuries and is widely used to treat depression. Evidence from clinical trials of St. John's Wort has failed to show effectiveness for treatment of major depression; but other research has raised the question as to whether the herb might offer benefit for people with less severe depression.

The recent study focused exclusively on minor depression and was carried out by Mark Hyman Rapaport, M.D., and colleagues at the Cedars-Sinai Medical Center and David Geffen School of Medicine in Los Angeles; the Massachusetts General Hospital, in Boston; and the University of Pittsburgh.

Participants in the study had suffered with minor depression for at least six months to two years. Minor depression was defined as having two to four of the symptoms used to diagnose major depression. For the study, at least one of the symptoms needed to include depressed mood or anhedonia (no pleasure found in previously enjoyable activities).

Participants were randomly assigned to receive St. John’s Wort, citalopram, or a placebo (a sugar pill). None of the participants, nor the treatment staff, knew which treatment was given to whom. Seventy-three volunteers completed the trial.

Results indicate that no treatment worked better than another. Participants in all three groups showed improvements in their symptoms over the course of the study, and in measures of quality of life and psychological well-being.

Although minor depression is considered to be a less severe condition than major depression, research suggests it has many implications for health and well-being that extend beyond the symptoms themselves, including lost time at work, social problems, and possibly a greater risk of developing major depression.

The authors note that the reason there was no difference found between St. John’s Wort, citalopram, and placebo was not because the study was too small to detect a variation, but because volunteers taking placebo experienced considerable improvement in feelings of well-being. In other words, just participating in the study had a positive effect.

Reference

Rapaport, M.H., Nierenberg, A.A., Howland, R., Dording, C., Schettler, P.J., and Mischoulon, D. The treatment of minor depression with St. John's Wort or citalopram: Failure to show benefit over placebo. Journal of Psychiatric Research 45:931-941, 2011.

Resources

Journeys has a section  of the website devoted to information on treatments, including St.Johns Wort and complementary therapies.