BMJ Press Releases, Saturday 3 August 1996
Volume 313 No 7052

EMBARGOED 00.01 HRS 2 AUGUST 1996

PLANT IS PROMISING TREATMENT FOR DEPRESSION SAYS RESEARCH

[St John's wort for depression - an overview and meta-analysis of randomised clinical trials]

The herb St John's wort (Hypericum perforatum), which has long been used in folk medicine, can be effective for treating depression, according to a paper in this week's BMJ.

Extracts of the plant are often used for the treatment of depression, anxiety and sleep disorders in German speaking countries but it is virtually unknown in the English speaking world. For instance in Germany in 1993 2.7 million prescriptions were issued for the seven most popular preparations.

Researchers from Germany and the USA, report on the efficacy of extracts of hypericum in an overview of clinical trials involving 1,757 outpatients with mild to moderately severe depressive disorders. In 15 trials they found that hypericum was superior to placebo in treatment and that it was also effective as a standard antidepressant.

They conclude that hypericum is a promising treatment for mild to moderately severe depressive disorders. But point out that further research is needed to determine whether St John's wort is safer than other antidepressants for patients with particular types of depressive disorders, whether it has fewer side effects and to evaluate the relative efficacy of different preparations and doses. Contact:

Contact: Dr Klaus Linde
Scientific assistant
Projekt "Munchener Modell"
Ludwig-Maximilians Universitat
Kaiserstrasse 9
Munich,
Germany

Tel:00 49 89 33041048
Fax: 00 49 89 39 34 84
E-mail: Muenchener.Modell@sunmail.lrz-muenchen.de

EDITORIAL

[Is St John's wort an antidepressant in the strict sense?]

An accompanying editorial points out one of the big differences between British and German medicine is the extensive use of herbal medicines in Germany. One of the reasons why German physicians may prescribe so much herbal medicine is because they are easily available. The authors say as promising as the research is there is no evidence to suggest that it should be used to treat severe depression. But they note for mild depressive disorders it can have an advantage in terms of relative safety and tolerableness which may encourage patients to take it. So far, its extensive use in Germany has not resulted in published case reports about serious drug interactions or toxicity after overdose. The most commonly, though fairly infrequent, reported side effects were gastrointestinal symptoms, allergic reactions and fatigue.

Contact: Peter Agm De Smet
Clinical pharmacologist
Psychiatrist
Royal Dutch Association for the Advancement of Pharmacy
2514 JL The Hague
Netherlands

Tel: 00 31 70 36 24 111
Fax: 00 31 70 31 06 530

or

Willem Nolen
H C Rumke Group
Academic Hospital
Utrecht,
Netherlands

Tel: 00 31 30 23 088 88

CLEARER GUIDANCE NEEDED ON CLINICAL CRITERIA FOR PRESCRIBING METHADONE TO HEROIN ADDICTS

[Prescribing injectable and oral methadone to opiate addicts: results from the 1995 national postal survey of community pharmacies in England and Wales]

Three papers in this week's BMJ look at the prescription of methadone - the heroin substitute - and its availability to opiate addicts in treatment.

The first calls for clearer guidance on the clinical criteria for prescribing substitute drugs especially injectable methadone. The authors find that nearly all prescriptions to heroin addicts are for methadone and that tablets and ampoules make up one fifth of all methadone prescriptions. Arrangements already exist for daily dispensing of methadone to patients but many prescribers, particularly GPs and private doctors, prescribe large amounts with long intervals between pick-ups. They also say that daily dispensing arrangements are insufficiently used and guidelines for prescribers on dispensing arrangements need to be reviewed.

Contact: Professor John Strang
(available until 2 August only)
Professor of Addictions
National Addiction Centre
Institute of Psychiatry and Maudsley Hospital
London SE5 8AF

Tel: 0171 919 3438
Fax: 0171 701 8454

PHARMACIST HAS VITAL ROLE TO PLAY IN HIV PREVENTION

[Role of community pharmacies in relation to HIV prevention and drug misuse: findings from the 1995 national survey in England and Wales]

In this paper researchers conclude that pharmacists represent a "huge reservoir of untapped potential" with often hard to reach drug misusers, particularly in the prevention of HIV. The Government's Health of the Nation strategy identified needle sharing as one of its targets and pharmacists have a role in providing HIV prevention services for injecting drug users, such as dispensing controlled drugs on prescription, selling injecting equipment and operating needle exchange schemes. Researchers found since 1988 the proportion of pharmacists dispensing prescribed controlled drugs (mostly methadone) has doubled in England and Wales and the proportion of pharmacists taking part in needle exchange schemes has increased sixfold. Contact:

EXTRA RESOURCES NEEDED FOR SAFER PRESCRIPTION OF METHADONE

[Characteristics of fatal methadone overdose in Manchester, 1985-94]

More resources should be made available to allow methadone to be prescribed more safely, say researchers. Methadone is an important part of the treatment of heroin misuse and its prescription has increased in the hope that it will reduce risk taking behaviour such as needle sharing which can spread HIV (the virus that leads to AIDS) and viral hepatitis. In this paper researchers report that deaths associated with methadone, including non-prescribed, have been reported from several countries. They examined all drug and alcohol-related deaths investigated by the coroner for Manchester in England and found the number of deaths related to methadone rose rapidly after 1989, although the overall number of drug related deaths remained static. The number of deaths from non-prescribed methadone was high. Contact:

Emyr Benbow
Senior Lecturer in Pathology
Dept of Pathological Sciences
Stopford Building
University of Manchester
Manchester
M13 9PT

Tel: 0161 275 5285/5300
Fax: 0161 275 5289
E-mail: uk-ac-man-scg-fs2\ebenbow

DEBATE ON INSURANCE COMPANIES AND PATIENTS' MEDICAL RECORDS

[Controversies in Management. Should insurance companies have access to patients' medical records?]

The case for and against insurance companies having access to medical records is debated in this week's BMJ.

A GP argues that access should be denied because she believes when a patient's doctor reveals information to insurance companies, the trust that has to exist between a doctor and patient which is essential for good medical care, is destroyed. She suggests that insurance companies should deal directly with the patient by getting them to fill in questionnaires, follow these up with medical tests, if necessary, but with the proviso that companies can ask the patient for their consent for access to their medical records, or apply through the courts, if they suspected the patient of lying. Contact:

However, the Association of British Insurers says that denying access to medical records would do more harm than good because the current system allows fairer evaluations. Insurers must do their utmost to convince the medical profession that the information passed to them is handled sensitively, intelligently and with complete confidentiality. Insurance companies can demonstrate a good record and a move away from the current system would impose extra costs with few additional benefits, they say. Contact:

Dr Hilary Lavender
Falmouth Road Group Practice
London SE1 4JW

Tel: 0171 407 0945
0171 407 4101
Fax: 0171 357 6170
Mobile: 0973 668 914

Paul Smee
Head of Life Insurance
Association of British Insurers
London EC2V 7HQ

Tel: 0171 216 7680
Fax: 0171 696 8998

EMBARGO: 00.01 HRS FRIDAY 2 AUGUST 1996 Issued by: Public Affairs Division, British Medical Association, BMA House, Tavistock Square, London, WC1H 9JP Telephone: 0171 383 6254, (between 08.30 - 18.00), (After 6pm & at weekends): 01895 23 96 87, 01491 65 14 05, 01483 42 77 93

PLEASE STATE THE BMJ AS THE SOURCE OF ALL ARTICLES USED

Access jobs at BMJ Careers
Whats new online at Student BMJ