title: The treatment of minor depression with St. John's Wort or citalopram: failure to show benefit over placebo.
abstract: This paper presents new data addressing two important controversies in psychiatry: the construct of Minor Depression (MinD) and the efficacy of St. John's Wort for milder forms of depressive disorders. Data are from a three-arm, 12 week, randomized clinical trial of investigating the efficacy of St. John's Wort (810 mg/day), citalopram (20 mg/day), or placebo for acute treatment of MinD. Due to a high placebo response on all outcome measures, neither St. John's Wort nor citalopram separated from placebo on change in depressive symptom severity, quality of life, or well-being. However, systematic assessment of potential adverse effects (AEs) led to three important observations: (1) prior to the administration of study compound, 60% of subjects endorsed items that would be characterized as AEs once study compound was administered, (2) St. John's Wort and citalopram were each associated with a significant number of new or worsening AEs during treatment, and (3) using a structured interview for identifying AEs at baseline and during treatment is informative. MinD was not responsive to either a conventional antidepressant or a nutraceutical, and both compounds were associated with a notable side effects burden. Other treatment approaches for MinD should be investigated.
authors.affiliation: Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA. mark.rapaport@cshs.org
authors.forename: Mark Hyman
authors.initials: MH
authors.lastname: Rapaport
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Nierenberg
authors.forename: Robert
authors.initials: R
authors.lastname: Howland
authors.forename: Christina
authors.initials: C
authors.lastname: Dording
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Schettler
authors.forename: David
authors.initials: D
authors.lastname: Mischoulon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015283:Citalopram / Q000009:adverse effects / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D020902:Hypericum; D008297:Male; D008875:Middle Aged; D008517:Phytotherapy; D010936:Plant Extracts / Q000009:adverse effects / Q000627:therapeutic use*; D011788:Quality of Life / Q000523:psychology; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D010936:Plant Extracts; D015283:Citalopram