St. John's Wort vs. Paroxetine for Moderate-to-Severe Depression

Hypericum perforatum (St. John's wort) extract is effective in the treatment of mild-to-moderate depression, but its efficacy in people with more severe depression is uncertain. In this randomized, controlled, double-blind trial, funded by a manufacturer of St. John's wort extract, German investigators compared hypericum with paroxetine in 251 adult outpatients who experienced moderate or severe episodes (single or recurrent) of unipolar major depression, without psychotic features, for 2 weeks to 1 year.

Initially, participants received either hypericum (900 mg daily in 3 doses) or paroxetine (20 mg daily); doses were doubled at 2 weeks for initial nonresponders (<50% decrease in depression score). At 42 days, depression scores had decreas…