Efficacy and tolerability of Hypericum perforatum in major depressive disorder in comparison with selective serotonin reuptake inhibitors: A meta-analysis |
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| Authors: | Roja Rahimi Shekoufeh Nikfar Mohammad Abdollahi |
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| Institution: | 1. Faculty of Pharmacy, and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran;2. Drug Selecting Committee, Food & Drug Organization, and Food & Drug Laboratory Research Center, Ministry of Health and Medical Education, Tehran, Iran;1. Center for Health Services Research, School of Public Health, University of Texas Health Science Center at Houston, United States;2. Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, United States;1. Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Str 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands;2. Department of Medical Genetics, University Medical Center Utrecht, KC04.084.2, PO Box 85090, 3508 GA Utrecht, The Netherlands;1. Department of pathology, Christian medical college and hospital, 632004 Vellore, Tamil Nadu, India;2. Molecular pathology laboratory, department of pathology, Christian medical college and hospital, 632004 Vellore, Tamil Nadu, India;3. Head and neck surgery, Christian medical college and hospital, 632004 Vellore, Tamil Nadu, India;1. Department of Medicine, Internal Medicine, CHUV and Faculty of Biology and Medicine, Lausanne, Switzerland;2. Institute of Social and Preventive Medicine (IUMSP), CHUV and Faculty of Biology and Medicine, Lausanne, Switzerland;1. Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran;2. Department of Infectious Diseases, Pediatrics Center of Excellence, Children''s Medical Center, Tehran University of Medical Sciences, Tehran, Iran;3. Department of Microbiology, Tehran University of Medical Sciences, Tehran, Iran;4. School of Medicine, Tehran University of Medical Sciences, Tehran, Iran |
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| Abstract: | Hypericum perforatum is a medicinal plant with established antidepressant properties. The aim of this meta-analysis was to compare the efficacy and tolerability of this antidepressant with selective serotonin reuptake inhibitors (SSRIs) as a group of standard antidepressants. For this purpose, Pubmed, Embase, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were searched for studies comparing efficacy and/or tolerability of Hypericum with SSRIs in the management of major depressive disorder (MDD). The search terms were: “Hypericum” or “St. John's wort” and “fluoxetine”, “paroxetine”, “citalopram”, “serteraline”, “escitalopram”, or “fluvoxamine”. Data were collected from 1966 to 2008 (up to June). “Clinical response”, “remission”, “mean reduction in Hamilton Rating Scale for Depression (HAMD) score from baseline”, “total adverse events”, and “withdrawals due to adverse events” were the key outcomes of interest.Thirteen randomized placebo controlled clinical trials met our criteria and were included. Comparison of SSRIs with placebo yielded a significant relative risk (RR) of 1.22 (95% confidence interval: 1.03–1.45, P = 0.02) for clinical response (n = 4), a non significant RR of 0.96 (95% CI: 0.71–1.29, P = 0.76) for remission (n = 4), and a significant effect size weighted mean difference (wmd+)] of 1.33 (95% CI: 1.15–1.51, P < 0.0001) for mean reduction in HAMD score from baseline (n = 3).Comparison of Hypericum with SSRIs yielded a non significant relative risk (RR) of 0.99 (95% confidence interval: 0.91–1.08, P = 0.83) for clinical response, a non significant RR of 1.1 (95% CI: 0.90–1.35, P = 0.35) for remission, and a non-significant wmd+ of 0.32 (95% CI: ? 1.28–0.64, P = 0.52) for mean reduction in HAMD score from baseline, a non significant RR of 0.85 (95% CI: 0.7–1.04, P = 0.11) for any adverse events, and a significant RR of 0.53 (95% CI: 0.35–0.82, P = 0.004) for withdrawals due to adverse events.Hypericum does not differ from SSRIs according to efficacy and adverse events in MDD. Lower withdrawal from study due to adverse events by Hypericum is an advantage in management of MDD. |
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