Trial reportBMJ (Clinical research ed.)2005
Acute treatment of moderate to severe depression with hypericum extract WS 5570 (St John's wort): randomised controlled double blind non-inferiority trial versus paroxetine.
Trial report in BMJ (Clinical research ed.), 2005. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 42 papers, 7 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
42 citing papers in PubMed, 7 syntheses or guidelines pooled it, 218 citations in OpenAlex.
- Understanding the research landscape of over-the-counter herbal products, dietary supplements, and medications evaluated for depressive symptoms in adults: a scoping review.Frontiers in pharmacology · 2025Pooled it
- Current state of research on the clinical benefits of herbal medicines for non-life-threatening ailments.Frontiers in pharmacology · 2023Pooled it
- Hypericum perforatum as a cognitive enhancer in rodents: A meta-analysis.Scientific reports · 2016Pooled it
- A systematic review of St. John's wort for major depressive disorder.Systematic reviews · 2016Pooled it
- Paroxetine versus other anti-depressive agents for depression.The Cochrane database of systematic reviews · 2014Pooled it
- St John's wort for major depression.The Cochrane database of systematic reviews · 2008Pooled it
- The effect of St John's wort extracts on CYP3A: a systematic review of prospective clinical trials.British journal of clinical pharmacology · 2006Pooled it
- Hypericum perforatum extract modulates cortical plasticity in humans.Psychopharmacology · 2018Trial
- Efficacy of Hypericum extract WS(®) 5570 compared with paroxetine in patients with a moderate major depressive episode - a subgroup analysis.International journal of psychiatry in clinical practice · 2016Trial
- Comparative Effectiveness of Cognitive Therapy and Dynamic Psychotherapy for Major Depressive Disorder in a Community Mental Health Setting: A Randomized Clinical Noninferiority Trial.JAMA psychiatry · 2016Trial
- Study protocol: Hybrid Type I cost-effectiveness and implementation study of interpersonal psychotherapy (IPT) for men and women prisoners with major depression.Contemporary clinical trials · 2016Trial
- Smartphone-Supported versus Full Behavioural Activation for Depression: A Randomised Controlled Trial.PloS one · 2015Trial
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- Trial
- Effects of treatment with a commercially available St John's Wort product (Movina) on cholesterol levels in patients with hypercholesterolemia treated with simvastatin.Scandinavian journal of primary health care · 2007Trial
- Placebo controlled continuation treatment with Hypericum extract WS 5570 after recovery from a mild or moderate depressive episode.Wiener medizinische Wochenschrift (1946) · 2007Trial
- Trial
- Hyperforin as a Multifunctional Specialized Metabolite of Natural Origin for Chronic Diseases: From Molecular Mechanisms to Clinical Translation.Current issues in molecular biology · 2026Review
- Plants with Potential Importance in Supporting the Treatment of Depression: Current Trends, and Research.Pharmaceuticals (Basel, Switzerland) · 2024Review
- A Bayesian Reanalysis of a Trial of Psilocybin versus Escitalopram for Depression.Psychedelic medicine (New Rochelle, N.Y.) · 2023Article
Corrections and comments
- Commented on by
- Commented on by
- Erratum issuedDosage error in article text
Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo investigate the efficacy of hypericum extract WS 5570 (St John's wort) compared with paroxetine in patients with moderate to severe major depression.
designRandomised double blind, double dummy, reference controlled, multicentre non-inferiority trial.
setting21 psychiatric primary care practices in Germany.
participants251 adult outpatients with acute major depression with total score > or = 22 on the 17 item Hamilton depression scale.
interventions900 mg/day hypericum extract WS 5570 three times a day or 20 mg paroxetine once a day for six weeks. In initial non-responders doses were increased to 1800 mg/day hypericum or 40 mg/day paroxetine after two weeks.
main outcome measuresChange in score on Hamilton depression scale from baseline to day 42 (primary outcome). Secondary measures were change in scores on Montgomery-Asberg depression rating scale, clinical global impressions, and Beck depression inventory.
resultsThe Hamilton depression total score decreased by mean 14.4 (SD 8.8) points, corresponding to 56.6% (SD 34.3%) of the baseline value, in the hypericum group and by 11.4 (SD 8.6) points (44.8% (SD 33.5%) of baseline value) in the paroxetine group (intention to treat analysis; similar results were observed in the per protocol analysis). The intention to treat analysis (lower one sided 97.5% confidence limit 1.5 points for the difference hypericum minus paroxetine) and the per protocol analysis (lower confidence limit 0.7 points) showed non-inferiority of hypericum and statistical superiority over paroxetine. The lower limits in both cases exceeded the pre-specified non-inferiority margin of -2.5 points and the superiority margin of 0. The incidence of adverse events was 0.035 and 0.060 events per day of exposure for hypericum and paroxetine, respectively.
conclusionsIn the treatment of moderate to severe major depression, hypericum extract WS 5570 is at least as effective as paroxetine and is better tolerated.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.