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St John's wort for major depression

  • Review
  • Intervention

Authors

  • Klaus Linde,

    Corresponding author
    1. Technische Universität München / Klinikum rechts der Isar, Institut für Allgemeinmedizin / Institute of General Practice, München, Germany
    • Klaus Linde, Institut für Allgemeinmedizin / Institute of General Practice, Technische Universität München / Klinikum rechts der Isar, Wolfgangstr. 8, München, 81667, Germany. Klaus.Linde@lrz.tu-muenchen.de.

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  • Michael M Berner,

    1. University Medical Center Freiburg, Department of Psychiatry and Psychotherapy, Freiburg im Breisgau, Germany
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  • Levente Kriston

    1. University Medical Center Freiburg, Department of Psychiatry and Psychotherapy, Freiburg im Breisgau, Germany
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Abstract

Background

In some countries extracts of the plant Hypericum perforatum L. (popularly called St. John's wort) are widely used for treating patients with depressive symptoms.

Objectives

To investigate whether extracts of hypericum are more effective than placebo and as effective as standard antidepressants in the treatment of major depression; and whether they have fewer adverse effects than standard antidepressant drugs.

Search methods

Trials were searched in computerised databases, by checking bibliographies of relevant articles, and by contacting manufacturers and researchers.

Selection criteria

Trials were included if they: (1) were randomised and double-blind; (2) included patients with major depression; (3) compared extracts of St. John's wort with placebo or standard antidepressants; (4) included clinical outcomes assessing depressive symptoms.

Data collection and analysis

At least two independent reviewers extracted information from study reports. The main outcome measure for assessing effectiveness was the responder rate ratio (the relative risk of having a response to treatment). The main outcome measure for adverse effects was the number of patients dropping out due to adverse effects.

Main results

A total of 29 trials (5489 patients) including 18 comparisons with placebo and 17 comparisons with synthetic standard antidepressants met the inclusion criteria. Results of placebo-controlled trials showed marked heterogeneity. In nine larger trials the combined response rate ratio (RR) for hypericum extracts compared with placebo was 1.28 (95% confidence interval (CI), 1.10 to 1.49) and from nine smaller trials was 1.87 (95% CI, 1.22 to 2.87). Results of trials comparing hypericum extracts and standard antidepressants were statistically homogeneous. Compared with tri- or tetracyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs), respectively, RRs were 1.02 (95% CI, 0.90 to 1.15; 5 trials) and 1.00 (95% CI, 0.90 to 1.11; 12 trials). Both in placebo-controlled trials and in comparisons with standard antidepressants, trials from German-speaking countries reported findings more favourable to hypericum. Patients given hypericum extracts dropped out of trials due to adverse effects less frequently than those given older antidepressants (odds ratio (OR) 0.24; 95% CI, 0.13 to 0.46) or SSRIs (OR 0.53, 95% CI, 0.34-0.83).

Authors' conclusions

The available evidence suggests that the hypericum extracts tested in the included trials a) are superior to placebo in patients with major depression; b) are similarly effective as standard antidepressants; c) and have fewer side effects than standard antidepressants. The association of country of origin and precision with effects sizes complicates the interpretation.

摘要

背景

以聖約翰草(St John's wort)治療憂鬱症

在某些國家,金絲桃的萃取物(植物名Hypericum perforatum ,其俗名為聖約翰草)被廣泛使用在治療憂鬱症狀

目標

為了調查是否金絲桃的萃取物比安慰劑來的更有效,及是否如同一般標準治療憂鬱症的抗憂鬱劑效果;是否副作用比標準抗憂鬱劑來的少

搜尋策略

在電腦數據庫中搜尋試驗,藉由確認相關文章的目錄,及藉著聯繫製造者和研究者

選擇標準

符合以下條件的試驗被納入:(1)隨機且雙盲 (2)納入的病人患有憂鬱症(3) 聖約翰草的萃取物與安慰劑或是標準的抗憂鬱劑做比較(4) 憂鬱症狀包含在臨床預後評估內

資料收集與分析

至少有兩位獨立的文獻回顧者從研究報告擷取資訊。有兩項主要結果的量測:評估有效性的量測方式是以反應率比例(responder rate ratio)(指對治療反應的相對風險)。副作用的量測方式是以因副作用退出研究的病人數目而定

主要結論

總共有29個試驗(5489名病患)符合納入準則,其中包括18個與安慰劑相比的研究,17個與合成的標準抗憂鬱劑相較。以安慰劑做控制組的試驗結果發現明顯的異質性。在9個大型試驗中,合併後的反應率,以聖約翰草與安慰劑相較,為1.28 (95% confidence interval (CI), 1.10 to 1.49),另9個小型試驗為1.87 (95% CI, 1.22 to 2.87). 聖約翰草與標準抗憂鬱劑相較的試驗結果呈現統計學上的一致性。與三環抗憂鬱劑(tri or tetracyclic antidepressants)和 selective serotonin reuptake inhibitors (SSRIs)相較,RR分別為1.02 (95% CI, 0.90 to 1.15; 5 個試驗) 及1.00 (95% CI, 0.90 to 1.11; 12 個試驗).

作者結論

現有的證據暗示納入試驗中的聖約翰草a)治療憂鬱病人優於安慰劑b)與標準抗憂鬱症的效果類似c)比標準抗憂鬱症的副作用少。國家出處和效應值(effects sizes)的準確性間的關聯性使得結果的解讀複雜化

翻譯人

本摘要由彰化基督教醫院李冠瑩翻譯

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

憂鬱症的特點是幾乎整天都有憂鬱心情以及/或對於幾乎所有的活動失去興趣或喜樂同時還合併其他各種症狀,且持續至少兩週期間。聖約翰草的萃取物(植物學名Hypericum perforatum)被廣泛使用在憂鬱症的治療。我們回顧了29個研究,5489名憂鬱症病人,比較以聖約翰草的萃取物,安慰劑及標準抗憂鬱劑治療4∼12週。研究來自於不同國家,數種不同的聖約翰草的萃取物,大部分納入的病人為輕度到中度的憂鬱症狀。整體而言,聖約翰草的萃取物效果優於安慰劑,與標準抗憂鬱劑效果相似,且副作用更少。然而,德語系國家的研究結果對聖約翰草的萃取物較有利,在德語系國家,此種植物已有悠久歷史,常由醫師開立處方,而其他國家的研究結果似乎不太有效。 這項差異可歸因於納入的病人條件是不同類型的憂鬱症,但不能排除一些較小的研究,來自德語系國家,是有缺陷的報告且過於樂觀的結果。受憂鬱症所苦的病人想服用聖約翰草的萃取物應該要尋求專業健康照護人員的協助。使用聖約翰草的萃取物是合理的,但有一些重要議題要列入考慮:市場中的聖約翰草萃取物產品差異很大。此篇回顧的結果只能運用在有納入試驗的聖約翰草,包括其他有相近特徵的聖約翰草。聖約翰草的副作用很輕微,不常見。但其他藥物的效果可能會顯著受損

Plain language summary

St. John's wort for treating depression.

Depression is characterised by depressed mood and/or loss of interest or pleasure in nearly all activities and a variety of other symptoms for periods longer than two weeks. Extracts of St. John's wort (botanical name Hypericum perforatum L.) are prescribed widely for the treatment of depression.

We have reviewed 29 studies in 5489 patients with depression that compared treatment with extracts of St. John's wort for 4 to 12 weeks with placebo treatment or standard antidepressants. The studies came from a variety of countries, tested several different St. John's wort extracts, and mostly included patients suffering from mild to moderately severe symptoms. Overall, the St. John's wort extracts tested in the trials were superior to placebo, similarly effective as standard antidepressants, and had fewer side effects than standard antidepressants. However, findings were more favourable to St. John's wort extracts in studies form German-speaking countries where these products have a long tradition and are often prescribed by physicians, while in studies from other countries St. John's wort extracts seemed less effective. This differences could be due to the inclusion of patients with slightly different types of depression, but it cannot be ruled out that some smaller studies from German-speaking countries were flawed and reported overoptimistic results.

Patients suffering from depressive symptoms who wish to use a St. John's wort product should consult a health professional. Using a St. John's wort extract might be justified, but important issues should be taken into account: St. John's wort products available on the market vary to a great extent. The results of this review apply only to the preparations tested in the studies included, and possibly to extracts with similar characteristics. Side effects of St. John's wort extracts are usually minor and uncommon. However, the effects of other drugs might be significantly compromised.

Laički sažetak

Kantarion (Gospina trava) za liječenje depresije

Depresija je obilježena depresivnim raspoloženjem i/ili gubitkom interesa ili mogućnosti uživanja u gotovo svim aktivnostima, kao i niz drugih simptoma koji traju dulje od dva tjedna. Ekstrakt kantariona, biljke koja se još naziva i Gospina trava (botaničko ime Hypericum perforatum L., engleski naziv: St. John's wort) naveliko se propisuje za liječenje depresije.

Autori Cochrane sustavnog pregleda analizirali su 29 studija s ukupno 5489 sudionika s depresijom, u kojima je uspoređeno liječenje ekstraktima kantariona u trajanju od 4-12 tjedana s placebo liječenjem ili standardnim antidepresivima. Studije su provedene u različitim zemljama, istražile su različite vrste ekstrakata kantariona i uglavnom su uključile bolesnike koji pate od depresije blage ili umjerene težine. Zbirni rezultati analiziranih studija pokazuju da su istraženi ekstrakti kantariona bili bolji od placeba, slične učinkovitosti kao stanardni antidepresivi i imali su manje nuspojava nego standardni antidepresivi. Međutim, rezultati koji idu u prilog ekstraktima kantariona bili su povoljniji u studijama provedenima u zemljama njemačkog govornog područja, gdje ti proizvodi imaju dulju tradiciju te ih često propisuju liječnicima, dok su u studijama iz drugih zemalja ekstrakti kantariona bili manje učinkoviti. Te razlike možda se mogu objasniti uključivanjem pacijenata s različitim tipovima depresije, ali se ne može isključiti ni mogućnost da su manje studije s njemačkog govornog područja bile pogrešno osmišljenje i da su opisale pretjerano optimistične rezultate.

Osobe koje pate od depresivnih simptoma i koje žele koristiti proizvode kantariona trebale bi se posavjetovati sa zdravstvenim radnicima. Korištenje ekstrakta kantariona može biti opravdano, ali pritom treba imati na umu niz činjenica: primjerice, proizvodi od kantariona koji se mogu naći na tržištu veoma se razlikuju. Rezultati ovog sustavnog pregleda odnose se isključivo na proizvode kantariona koji su testirani u uključenim studijama, i možda na druge ekstrakte koji imaju slična svojstva. Nuspojave ekstrakata kantariona obično su manje i rijetke. Međutim, uzimanje ekstrakata kantariona može značajno negativno utjecati na učinak drugih lijekova koji se uzimaju u isto vrijeme.

Bilješke prijevoda

Hrvatski Cochrane
Prevela: Livia Puljak
Ovaj sažetak preveden je u okviru volonterskog projekta prevođenja Cochrane sažetaka. Uključite se u projekt i pomozite nam u prevođenju brojnih preostalih Cochrane sažetaka koji su još uvijek dostupni samo na engleskom jeziku. Kontakt: cochrane_croatia@mefst.hr

Резюме на простом языке

Зверобой для лечения депрессии

Депрессия характеризуется депрессивным настроением и/или потерей интереса или удовольствия от практически всех видов деятельности и разнообразием других симптомов на периоды более чем две недели. Экстракты зверобоя (ботаническое название Hypericum perforatum L.) широко назначается для лечения депрессии.

Мы рассмотрели 29 исследований с участием 5489 пациентов с депрессией, которые сравнивали лечение экстрактом зверобоя в течение от 4 до 12 недель с лечением плацебо или стандартными антидепрессантами. Исследования происходили из различных стран, проверяли несколько разных экстрактов зверобоя и в большинстве случаев включали пациентов, страдающих симптомами от легких до умеренно тяжелых. В целом, экстракты зверобоя, проверяемые в испытаниях, превосходили плацебо, были так же эффективны как и стандартные антидепрессанты, и имели меньше побочных эффектов, чем стандартные антидепрессанты. Однако, результаты были более благоприятными для экстрактов зверобоя в исследованиях из немецко-говорящих стран, где эти продукты имеют давние традиции и часто прописываются врачами, в то время как в исследованиях из других стран, экстракты зверобоя кажутся менее эффективными. Эти различия могут быть обусловлены включением пациентов с несколько различающимися видами депрессии, но нельзя исключить, что некоторые небольшие исследования из немецко-говорящих стран были ошибочными и опубликовали излишне оптимистичные результаты.

Пациенты, страдающие от симптомов депрессии, которые хотят использовать продукты зверобоя, должны проконсультироваться у медицинского работника. Использование экстракта зверобоя может быть оправданным, но необходимо учитывать важный вопрос: продукты зверобоя, доступные на рынке, в значительной степени различаются. Результаты этого обзора применимы только к препаратам, проверенным во включенных исследованиях и, возможно, к экстрактам с похожими характеристиками. Побочные эффекты экстрактов зверобоя обычно незначительны и редки. Однако, эффекты других лекарств могут быть значительно снижены.

Заметки по переводу

Перевод: Нурхаметова Диляра Фархадовна. Редактирование: Зиганшина Лилия Евгеньевна. Координация проекта по переводу на русский язык: Cochrane Russia - Кокрейн Россия (филиал Северного Кокрейновского Центра на базе Казанского федерального университета). По вопросам, связанным с этим переводом, пожалуйста, обращайтесь к нам по адресу: cochrane.russia.kpfu@gmail.com; cochranerussia@kpfu.ru

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