| Disease | META-ANALYSIS OF 3 DOUBLE-BLIND, RANDOMIZED TRIALS INCLUDING A TOTAL OF 594 ADULT OUT-PATIENTS SUFFERING FROM MAJOR DEPRESSION ACCORDING TO DSM-IV CRITERIA, WHO RECEIVED WELL-CHARACTERIZED HYPERICUM EXTRACT PREPARATIONS OR PLACEBO FOR 6 WEEKS. THE MAIN OUTCOME MEASURE WAS THE PREDICTION OF A SUSTAINED ≥ 50 % DECREASE OF THE HAMILTON DEPRESSION SCALE (HAM-D) TOTAL SCORE VERSUS BASELINE (‘SUSTAINED RESPONSE’) BY THE PRESENCE OF ≥20 % HAM-D TOTAL SCORE IMPROVEMENT AFTER 1 AND 2 WEEKS OF TREATMENT (‘EARLY IMPROVEMENT’). RESULTS: FOR HYPERICUM EXTRACT, EARLY IMPROVEMENT HAD A SENSITIVITY OF 87 % (95 % CONFIDENCE INTERVAL [CI], 82-93 %) AND A SPECIFICITY OF 54 % (95 % CI, 45-62 %) AT DAY 14, AND A SENSITIVITY OF 43 % (95 % CI, 35-51 %) AND A SPECIFICITY OF 86 % (95 % CI, 80-92 %) AT DAY 7 FOR PREDICTING SUSTAINED RESPONSE. AFTER 2 WEEKS OF TREATMENT, 78 % (95 % CI, 69-87 %) OF THE PATIENTS WHO FAILED TO IMPROVE DID NOT SHOW SUSTAINED RESPONSE LATER DURING TREATMENT. CONCLUSION: A SUBSTANTIAL FRACTION OF THE PATIENTS TREATED WITH HYPERICUM EXTRACTS SHOWED A MEANINGFUL REDUCTION OF DEPRESSIVE SYMPTOMS DURING THE FIRST TWO WEEKS OF TREATMENT (EARLY IMPROVEMENT), WHICH WAS FOUND TO BE A SENSITIVE PREDICTOR OF SUSTAINED RESPONSE. THE RESULTS DETERMINED FOR THE HERBAL EXTRACTS WERE COMPARABLE TO THOSE FOR EFFECTIVE SYNTHETIC ANTIDEPRESSANTS INVESTIGATED PREVIOUSLY. |