The Hamilton anxiety subscale was improved in the hypericum group relative to imipramine. Authors state that hypericum may be better than imipramine in relieving anxiety associated with depression. This hypericum perforatum extract is therapeutically equivalent to imipramine in treating mild to moderate depression, but patients tolerate hypericum better. Commentary Tricyclic antidepressants are believed to cause long-term changes in the way nerve endings function. It takes two-four weeks for their effects to come into play.
Many patients stop taking tricyclics due to adverse effects.
Shelton's criticized Phillip's trial for use of a low dose of imipramine. This was only 2 points on the scale lower than that in Shelton et al. This trial was randomized, double-blind in parallel groups. 126 participants took one 250 mg. The HAM-D and other standard scales were used to assess results, in addition to laboratory tests.