Open-label pilot study of St. John's Wort in adolescent depression

Aim: Clinical experience suggests the use of alternative remedies, such as St. John's Wort (SJW), in adolescents with affective disorders is increasing. In view of the paucity of documented, well-established, and safe antidepressant medications for children and adolescents, it was important to investigate the potential usefulness of SJW in adolescents with major depressive disorders (MDD). Methods and Results: An 8-week, open-label study evaluated the potential efficacy and safety of SJW (300 mg TID) in adolescents with MDD. Twenty-six patients, 12-17 years of age (mean age, 14.8 years) were enrolled in the study. Of the 11 patients who completed the study, 9 patients (82%) showed significant clinical improvement based on Clinical Global Improvement (CGD change scores (treatment response was indicated by a clinical improvement rating of either very much improved or much improved at the final visit). Of the 15 patients (58%) who did not complete the study, 8 patients were noncompliant and 7 patients were discontinued because of persisting or worsening depression. Of the 8 noncompliant patients, at week 8, 2 patients (25%) remained unchanged, 1 patient (12.5%) was minimally improved, 4 patients (75%) were much improved, and 1 patient (12.5%) was very much improved, based on the CGI change score. Conclusion: Preliminary findings suggest that SJW is well tolerated and may be clinically effective in the treatment of some adolescents with mild depression. Controlled trials of SJW in adolescents with MDD are suggested.