|
|
A study came out this week indicating that placebo is more effective than Zoloft or St. John’s Wort. I thought, “So what’s new?”
But there seems to be an interest here because not everyone realizes yet that increasing serotonin is the worst thing you could do for someone who is depressed since his or her serotonin levels are already too high. What is low is their ability to metabolize serotonin--exactly what antidepressants lower even further. So one should conclude that ANYTHING that increases serotonin would only make the depression worse after the initial high caused by the shock of the initial serotonin increase.
This morning several of our directors have made some very valid points that should be applied to this information that I thought you would find to be of interest:
In paragraph eight of this study, it states, “Overall, 32 percent of the placebo group ended up with better scores on key tests of depression severity, compared with 24 percent of patients taking St. John’s Wort and25 percent taking Zoloft.”
Another notes that detractors of the study claimed that Zoloft doses were too low to show much of a beneficial effect. Yet, even at the tested levels (100mg), Zoloft had the highest adverse effects with nearly half the patients suffering from diarrhea or nausea. Scary to think what the adverse effects would have been at Pfizer’s higher dosages!
Dr. Ann Blake Tracy
To view this study in its entirety, click on our Studies page at
http://www.drugawareness.org/Archives/Studies/JAMA_Vol._287_No._14.html
|
|
|
For treating moderately severe depression, a sugar pill worked better than a popular herbal supplement and rivaled the prescription antidepressant Zoloft on most measures of effectiveness, according to a new study.
The research, led by Duke University Medical Center physicians, cannot rule out the possibility that the herbal supplement, St. John’s wort, relieves milder depression. But the findings suggest that people with serious symptoms should consult a therapist rather than simply self-medicate with the herb.
“I don’t recommend self-medicating with anything if you are suffering from a major depression,” said Duke University psychiatrist Jonathan R. Davidson, an author of the study in today’s Journal of the American Medical Association.
The study also illustrates a well-known problem with studies of treatments for depression: the placebo effect is a powerful factor that must be taken into account.
“When people who are depressed get help, they feel more hopeful, and that alone can lead to improvement,” Davidson said.
Indeed, in another article in the journal, Columbia University researchers analyzed clinical trials of antidepressants over the last 20 years and found that patients’ response to placebo has been increasing. This may mean that less severely depressed patients are volunteering for studies, or that they enter studies with a greater awareness that depression is treatable, Columbia psychiatrist Timothy Walsh said.
“It is crucial to have a placebo group,” Walsh said. “If they [Duke researchers] hadn’t had a placebo group, they might have reached a very different conclusion. We’d be hearing that St. John’s wort is as good as Zoloft.”
In the study, 340 patients from 12 psychiatric clinics across the country were randomly assigned to take placebo, St. John’s wort (the plant hypericum), or Zoloft (known chemically as sertraline) for eight weeks. Overall, 32 percent of the placebo group ended up with better scores on key tests of depression severity, compared with 24 percent of patients taking St. John’s wort and 25 percent taking Zoloft. The tests measured depressive symptoms such as insomnia, anxiety and loss of appetite.
Although Zoloft fell short on this overall measure, it was more effective than placebo or St. John’s wort on a scale that measured patients’ clinical improvement. In addition, 23 percent of patients on Zoloft showed a partial response, compared with only 14 percent on the herb and 11 percent on placebo.
The researchers speculate that the Zoloft doses and duration may have been too limited to show maximum effect. None of the patients took more than 100 mg, which is half of the highest dose recommended by Pfizer, the manufacturer.
Zoloft caused the most adverse effects, with 40 percent of patients experiencing temporary diarrhea and nausea. The desire to avoid side effects is a big reason many people turn to herbal supplements. But St. John’s wort is not free of such problems.
“Several studies have shown that St. John’s wort interacts dangerously with several medications such as those used to treat HIV/AIDS, certain cardiac conditions, and even those that keep the body from rejecting organs after transplant,” said Robert Califf, director of the Duke Clinical Research Institute.
A study presented this week at a San Francisco cancer conference also found the herb may reduce the effectiveness of irinotecan, a commonly used cancer drug.
|
