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Record W90690077 · doi:10.1136/bmj.322.7284.493

Comparison of St John's wort and imipramine

2001· letter· en· W90690077 on OpenAlexaff
Peter L. Cornwall

Bibliographic record

VenueBMJ · 2001
Typeletter
Languageen
FieldAgricultural and Biological Sciences
TopicNatural Compound Pharmacology Studies
Canadian institutionsSunnybrook HospitalUniversity of Toronto
Fundersnot available
KeywordsDepression (economics)ImipramineMedicinePlaceboAdverse effectInternal medicineComplete remissionPsychiatryAtypical depressionRandomized controlled trialClinical trialMoodAlternative medicineChemotherapy

Abstract

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# Remission is important outcome {#article-title-2} EDITOR—The authors of either of the two large trials of St John's wort for treating depression published in the BMJ have reported the proportion of patients entering full remission of symptoms after acute treatment. 1 2 This is unfortunate as remission of symptoms rather than response to treatment should be the key outcome objective. Partial remission is a common adverse outcome of depression after short term treatment and carries with it a high risk of relapse and continuing disability.3 There is now emerging evidence that although all antidepressants seem to be similarly efficacious in producing a short term response, there are differences in remission rates, particularly in severely ill patients.4 This shows the importance of reporting categorical as well as continuous outcomes in clinical trials of treatment with antidepressants. 1. 1.↵1. Woelk H, for the Remotiv/Imipramine Study Group .Comparison of St John's wort and imipramine for treating depression: randomized controlled trial.BMJ2000; 321:536–539. (2 September.) [OpenUrl][1][Abstract/FREE Full Text][2] 2. 2.↵1. Philipp M, 2. Kohnen R, 3. Hiller KO .Hypericum extract versus imipramine or placebo in patients with moderate depression: randomised multi-centre study of treatment for eight weeks.BMJ1999; 319:1534–1538. [OpenUrl][3][Abstract/FREE Full Text][4] 3. 3.↵1. Cornwall PL, 2. Scott J .Partial remission in depressive disorders.Acta Psychiatr Scand1997; 95:265–271. [OpenUrl][5][PubMed][6][Web of Science][7] 4. 4.↵1. Kent JM .SNaRIs, NaSSAs, and NaRIs: new agents for the treatment of depression.Lancet2000; 355:911–918. [OpenUrl][8][CrossRef][9][PubMed][10][Web of Science][11] # Study design casts doubt on value of St John's wort in treating depression {#article-title-7} EDITOR—Although it is impressive to see a study in which hypericum is equivalent to an antidepressant, suggesting efficacy, the design of this study by Woelk et al makes it difficult for us to know the value of St John's wort for the treatment of depression.1 Firstly, imipramine is an outdated antidepressant. The current batch of selective serotonin reuptake inhibitors and atypical antidepressants have far fewer side effects and can be tailored to the specific needs and responses of the patient. Will hypericum be coupled with activating herbs (such as Gingko biloba or Siberian ginseng) or sedating ones (such as kava or valerian root) to achieve the same effect? This study strikes me as an example of statistical interest (yes, hypericum may be at least as effective as imipramine), but it has minimal practical clinical relevance. Secondly, the study ran for only six weeks. Most studies exploring the efficacy of an antidepressant run for a … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft.stitle%253DBMJ%26rft.issn%253D0007-1447%26rft.aulast%253DWoelk%26rft.auinit1%253DH.%26rft.volume%253D321%26rft.issue%253D7260%26rft.spage%253D536%26rft.epage%253D539%26rft.atitle%253DComparison%2Bof%2BSt%2BJohn%2527s%2Bwort%2Band%2Bimipramine%2Bfor%2Btreating%2Bdepression%253A%2Brandomised%2Bcontrolled%2Btrial%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fbmj.321.7260.536%26rft_id%253Dinfo%253Apmid%252F10968813%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=bmj&resid=321/7260/536&atom=%2Fbmj%2F322%2F7284%2F493.atom [3]: {openurl}?query=rft.jtitle%253DBMJ%26rft.stitle%253DBMJ%26rft.issn%253D0007-1447%26rft.aulast%253DPhilipp%26rft.auinit1%253DM.%26rft.volume%253D319%26rft.issue%253D7224%26rft.spage%253D1534%26rft.epage%253D1539%26rft.atitle%253DHypericum%2Bextract%2Bversus%2Bimipramine%2Bor%2Bplacebo%2Bin%2Bpatients%2Bwith%2Bmoderate%2Bdepression%253A%2Brandomised%2Bmulticentre%2Bstudy%2Bof%2Btreatment%2Bfor%2Beight%2Bweeks%2B%2595%2BCommentary%253A%2BHas%2Bhypericum%2Bfound%2Bits%2Bplace%2Bin%2Bantidepressant%2Btreatment%253F%26rft_id%253Dinfo%253Apmid%252F10591711%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [4]: /lookup/ijlink?linkType=ABST&journalCode=bmj&resid=319/7224/1534&atom=%2Fbmj%2F322%2F7284%2F493.atom [5]: {openurl}?query=rft.jtitle%253DActa%2Bpsychiatrica%2BScandinavica%26rft.stitle%253DActa%2BPsychiatr%2BScand%26rft.aulast%253DCornwall%26rft.auinit1%253DP.%2BL.%26rft.volume%253D95%26rft.issue%253D4%26rft.spage%253D265%26rft.epage%253D271%26rft.atitle%253DPartial%2Bremission%2Bin%2Bdepressive%2Bdisorders.%26rft_id%253Dinfo%253Apmid%252F9150818%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [6]: /lookup/external-ref?access_num=9150818&link_type=MED&atom=%2Fbmj%2F322%2F7284%2F493.atom [7]: /lookup/external-ref?access_num=A1997WX14700001&link_type=ISI [8]: {openurl}?query=rft.jtitle%253DLancet%26rft.stitle%253DLancet%26rft.aulast%253DKent%26rft.auinit1%253DJ.%2BM.%26rft.volume%253D355%26rft.issue%253D9207%26rft.spage%253D911%26rft.epage%253D918%26rft.atitle%253DSNaRIs%252C%2BNaSSAs%252C%2Band%2BNaRIs%253A%2Bnew%2Bagents%2Bfor%2Bthe%2Btreatment%2Bof%2Bdepression.%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0140-6736%252899%252911381-3%26rft_id%253Dinfo%253Apmid%252F10752718%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [9]: /lookup/external-ref?access_num=10.1016/S0140-6736(99)11381-3&link_type=DOI [10]: /lookup/external-ref?access_num=10752718&link_type=MED&atom=%2Fbmj%2F322%2F7284%2F493.atom [11]: /lookup/external-ref?access_num=000085896000041&link_type=ISI

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.

How this classification was reachedexpand

Full frame machine prediction

Teacher imitation

Not calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.

metaresearch head score (Codex)0.009
metaresearch head score (Gemma)0.018
Version: metacan-v3-hybrid-931329e0061cValidation status: machine_predicted_unvalidated
Candidate categoriesnone
Consensus categoriesnone
DomainCandidate signal: none · Consensus signal: none
Study designCandidate signal: Not applicable · Consensus signal: none
GenreCandidate signal: Commentary · Consensus signal: none
Teacher disagreement score0.010
Threshold uncertainty score0.045

Distilled classifier scores by category (both heads)

CategoryCodexGemma
Metaresearch0.0090.018
Meta-epidemiology (narrow)0.0010.000
Meta-epidemiology (broad)0.0070.005
Bibliometrics0.0010.001
Science and technology studies0.0000.001
Scholarly communication0.0020.001
Open science0.0010.001
Research integrity0.0030.004
Insufficient payload (model declined to judge)0.0100.001

Machine scores (provisional)

The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.

Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.

Opus teacher head0.069
GPT teacher head0.350
Teacher spread0.281 · how far apart the two teachers sit on this one work
Validation statusscore_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it

Classification

machine, unvalidated

Machine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.

The models applied no category: nothing in the taxonomy fit this work.
Study designNot applicable
Domainnot available
GenreCommentary

How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".

Quick stats

Citations7
Published2001
Admission routes1
Has abstractyes

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