In a recent clinical trial, both St. John’s Wort and the antidepressant drug citalopram (brand name Celexa) failed to outperform a placebo in relieving symptoms of minor depression. The study, consistent with earlier research, does not support the use of medications for mild depression..
The 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.
Volunteers in the study had suffered with minor depression for at least six months to two years. Minor depression was defined as the individual exhibiting 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 outperformed any other; participants in all three groups displayed improvements in symptoms over the course of the study, and in measures of quality of life and psychological well-being.
In all three treatment groups — including those treated with placebo — patients frequently reported side effects. Fewer of the St. John’s Wort recipients reported that side effects were distressing (40 vs. 60 percent); however, St. John’s Wort participants reported more sleep and gastrointestinal issues than those who took placebo.
Furthermore, before any treatment was given, over half of the subjects responded affirmatively when asked if they had any of a large list of physical or psychological problems. This suggests the importance of assessing both physical and psychological symptoms before the onset of any treatment; otherwise, these symptoms could be interpreted as medication-related.
Although minor depression is considered a less severe condition than major depression, research suggests it has 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.
Finding safe and effective treatments for minor depression is still an essential goal; more research on non-pharmacologic treatment is needed to identify the best psychotherapies for minor depression.
This study was funded by the National Institute of Mental Health and the National Center for Complementary and Alternative Medicine, National Institutes of Health.