Conclusions : International differences in prescriber behaviour may influence , and in turn be influenced by , the conduct of clinical trials .
Objective : International differences are thought to exist in dosages used by clinicians treating mood disorders .
This study examined international dosage differences in antidepressant clinical trials , using a data base formed and maintained as a component of a Cochrane review of comparative clinical trials of fluoxetine .
Hypericum perforatum versus fluoxetine in the treatment of mild to moderate depression
In a r and omized , controlled , double-blind trial , 70 patients ( mean age , 49.7 years ) suffering from mild to moderate depression received one tablet of either  St. John ’s Wort ( Hypericum perforatum ) extract ( Calmigen ® ) or fluoxetine hydrochloride ( Prozac ® ) twice a day for 6 weeks . Efficacy was determined according to the 17-item Hamilton Rating Scale for Depression ( HAMD ) , the von Zerssen depression scale ( DS ) , Clinical Global Impression ( CGI ) , and patients ’ overall evaluation . Significant decreases ( P<.001 ) of 50 % in theHypericum group and 58 % in the fluoxetine group in the HAMD score and of 42 % and 52 % on the DS spoke to the efficacy of both medications . TheHypericum extract achieved 83 % of the efficacy of fluoxetine on the HAMD and 78 % on the DS . Assessment s by physicians ( CGI ) and patients indicated considerable improvement with no between-treatment differences . Of the 9 dropouts ( 13 % ) , 2 in theHypericum group and 2 in the fluoxetine group were due to adverse reactions . Safety evaluations demonstrated only minor changes . TheHypericum preparation tested in this study is therapeutically equivalent to fluoxetine and is therefore a rational alternative to synthetic antidepressants
Conclusions : International differences in prescriber behaviour may influence , and in turn be influenced by , the conduct of clinical trials .
Objective : International differences are thought to exist in dosages used by clinicians treating mood disorders .
This study examined international dosage differences in antidepressant clinical trials , using a data base formed and maintained as a component of a Cochrane review of comparative clinical trials of fluoxetine .