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RAPID RESPONSE FROM BMJ.COM

Several studies have shown that St John’s wort is at least as effective as TCAs and SSRIs in the treatment of depression. This research adds to our knowledge only in suggesting that St John’s wort may be as effective in the treatment of severe depression. However, one detects a hidden agenda in this paper. The paper is as much about suggesting that St John’s wort is more user friendly than other antidepressants. This being so, we should question why the researchers chose to test St John’s wort against paroxetine (Paxil). Of all the SSRIs, Paxil has the worst reputation, with survivors groups around the world, accusations of a link with suicide, law suits, and enough adverse event reports to cause regulators around the world to alter their safety advice. Whether or not these allegations are true, the researchers behind this paper must have known that the Paxil users in the trial would report a high number of adverse events, and that, consequently, St John’s wort would appear considerably better tolerated by comparison. The fact remains that St John’s wort can have unpleasant side effects, and can be fatal if combined with some blood pressure drugs. What we do not have from this paper, or, as yet, from any other research is data for safety and efficacy from full-scale medical trials of the kind we would insist upon for any prescription medicine. It is perhaps not surprising to find that the research was funded by Dr William Schwabe Pharmaceuticals, a major global supplier of so-called “herbal remedies” which can be legally sold as food additives with no requirement to provide patient safety information or warnings about interactions with other medicines.