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Do early changes in the HAM-D-17 anxiety/somatization factor items affect the treatment outcome among depressed outpatients? Comparison of two controlled trials of St John's wort (Hypericum perforatum) versus a SSRI

Bitran, Stella; Farabaugh, Amy H.; Ameral, Victoria E.; LaRocca, Rachel A.; Clain, Alisabet J.; Fava, Maurizio; Mischoulon, David

International Clinical Psychopharmacology: July 2011 - Volume 26 - Issue 4 - p 206–212
doi: 10.1097/YIC.0b013e328343ba08
Original Articles

To assess whether early changes in Hamilton Depression Rating Scale-17 anxiety/somatization items predict remission in two controlled studies of Hypericum perforatum (St John's wort) versus selective serotonin reuptake inhibitors for major depressive disorder. The Hypericum Depression Trial Study Group (National Institute of Mental Health) randomized 340 patients to Hypericum, sertraline, or placebo for 8 weeks, whereas the Massachusetts General Hospital study randomized 135 patients to Hypericum, fluoxetine, or placebo for 12 weeks. The investigators examined whether remission was associated with early changes in anxiety/somatization symptoms. In the National Institute of Mental Health study, significant associations were observed between remission and early improvement in the anxiety (psychic) item (sertraline arm), somatic (gastrointestinal item; Hypericum arm), and somatic (general) symptoms (placebo arm). None of the three treatment arms of the Massachusetts General Hospital study showed significant associations between anxiety/somatization symptoms and remission. When both study samples were pooled, we found associations for anxiety (psychic; selective serotonin reuptake inhibitors arm), somatic (gastrointestinal), and hypochondriasis (Hypericum arm), and anxiety (psychic) and somatic (general) symptoms (placebo arm). In the entire sample, remission was associated with the improvement in the anxiety (psychic), somatic (gastrointestinal), and somatic (general) items. The number and the type of anxiety/somatization items associated with remission varied depending on the intervention. Early scrutiny of the Hamilton Depression Rating Scale-17 anxiety/somatization items may help to predict remission of major depressive disorder.

Department of Psychiatry, Depression Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA

Correspondence to David Mischoulon, MD, PhD, 1 Bowdoin Square, 6th Floor, Massachusetts General Hospital, Boston, MA 02114, USA Tel: +1 617 724 5198; fax: +1 617 724 3028; e-mail:

Received August 7, 2010

Accepted December 14, 2010

© 2011 Lippincott Williams & Wilkins, Inc.