This week our Journal Club discussed a Cochrane review article on St.  Johns Wort (SJW) and its use in patients with mild to moderate Major Depression managed most commonly on an out patient basis.  Please listen to the podcast which provides and excellent summary of the review, in brief this is what the article says:

• SJW is more more effective than placebo, but “size of effect” was relatively small, and the result is comparable to antidepressants vs placebo
• SJW compared to antidepressants had similar effect with lesser side effects (note the amount of antidepressants used in study were below standard management doses utilized in US psychiatric clinical practice)
• SJW MOA is unknown, it interacts with other medication, thus a pt should consult a physician/integrative medicine MD for appropriate monitoring and determination if its right for them
  
• Results in Germany were more favorable than from other countries, reasons unknown but were results from Primary care offices
• Depression can be dangerous (high suicide rate), and thus should be monitored by a mental health care provider
• The high quality of SJW used in the trials were of greater concentration comparable to whats commonly available to the public

Side anectote: During third year of medical school, I met a woman admitted to our psychiatric unit with MDD who attempted suicide and was treating her MDD with SJW. She tried to jump out the window, luckly someone managed to stop her.

The discussion in journal club involved residents, psychology interns and our stellar medical students.  Everyone chimed into the discussion with out fearless unit chief leading the discussion.

A wide range of opinions were shared, which included a discussion on why Medicine is conservative about embracing CAM therapies and how that culturally varies by country, and region within the US.  Overall, a few people were open to considering integrating its use in their practice when appropriate and others who recognised the relevance of simply knowing about the results from the study due to the popularity of the herb.

It was a great talk, I was thrilled my colleague picked this article!