Please remember to credit the BMJ as source when publicising
an
article and to tell your readers that they can read its full text on
the
journal's web site (http://bmj.com).
If your story is posted on a website please include a link back to
the source BMJ article (URL's are given under titles).
(2) HEART
TRANSPLANTS BENEFIT ONLY THE
SICKEST PATIENTS
(1) ST JOHN'S
WORT AS EFFECTIVE AS STANDARD
ANTIDEPRESSANT THERAPY
(Comparison of St John's wort and
imipramine for treating
depression: randomised controlled
trial)
http://bmj.com/cgi/content/full/321/7260/536
St John's wort is as effective as imipramine
- one of the most
commonly used antidepressants - and should
be considered
as a first line treatment in patients
with mild to moderate
depression, according to the largest ever
study of St John's
wort published this week in the BMJ.
Over 300 patients in Germany with mild
to moderate
depression were randomly treated with
either St John's wort
extract or imipramine for six weeks. Throughout
the treatment
period, progress was measured using a
series of standard
rating scales, along with patients' self
assessments. The
results show that the two treatments were
"therapeutically
equivalent" with regard to overall effect
on depression.
However, patients seemed to tolerate St
John's wort better
than imipramine, with side effects such
as dry mouth,
sweating and dizziness, reported in 39%
of patients taking St
John's wort compared to 63% taking imipramine.
As a
result, only 3% of patients taking St
John's wort stopped
treatment compared to 16% of patients
on imipramine.
These results, along with other recently
published trials,
provide compelling evidence that St John's
wort extract is as
effective as standard antidepressants,
says the author. In view
of its superior safety record, St John's
wort should be
considered for first line treatment in
mild to moderate
depression, especially in general practice
where the milder
forms of depression are most commonly
seen, he concludes.
Contact:
Helmut Woelk, Medical Director, Akademisches
Lehrkrankenhaus der Universitat Giessen,
Germany
(2) HEART TRANSPLANTS
BENEFIT ONLY THE
SICKEST PATIENTS
(Paper: Effect of receiving a heart
transplant: analysis of a
national cohort entered on to a
waiting list, stratified by heart
failure severity)
http://bmj.com/cgi/content/full/321/7260/540
(Commentary: Time for a controlled
trial?)
http://bmj.com/cgi/content/full/321/7260/540#resp1
(Editorial: A fair way of donating
hearts for transplantation)
http://bmj.com/cgi/content/full/321/7260/526
Heart transplantation improves survival
only in patients with
the worst heart failure and therefore
at the highest risk of
death while on the waiting list, according
to a study in this
week's BMJ. This questions the current
view in the medical
community that transplantation improves
the chances of
survival for all patients who reach an
advanced stage of heart
failure.
Deng and colleagues identified all 889
adult patients listed for
a first heart transplant in Germany in
1997. Patients were
grouped according to disease severity
"low, medium and
high risk of dying on the waiting list"
and a heart failure
survival score was calculated for each
patient. The authors
found that only patients in the high-risk
group had a
temporary survival benefit from transplantation,
whereas the
medium and low risk groups showed no such
benefit.
These findings challenge the current role
of transplantation in
heart failure management, say the authors.
They suggest that
transplantation should be limited to the
sickest patients and
that low or medium risk patients should
instead be managed
with organ saving treatments.
Sharon Hunt, Professor of Cardiovascular
Medicine at
Stanford University in California, reiterates
these views in an
accompanying editorial. She believes that
this study will help
to drive forward organ allocation schemes
that give donor
hearts to those most likely to benefit
most from them. It may
also intensify the pursuit of alternatives
to transplantation, she
adds.
Contacts:
[Paper] Mario Deng, Associate Professor
of Medicine and
Cardiology, Heart Failure Center, Columbia
University
College of Physicians and Surgeons, New
York, USA
Email: md785@columbia.edu
[Editorial] Sharon Hunt, Professor of Cardiovascular
Medicine, Department of Cardiovascular
Medicine, Stanford
University, Stanford, CA, USA
FOR ACCREDITED JOURNALISTS
Embargoed press releases and articles are available from:
Public Affairs Division
BMA House
Tavistock Square
London WC1H 9JR
(contact: pressoffice@bma.org.uk)
and from:
the EurekAlert website, run by the American Association for the
Advancement of Science
(http://www.eurekalert.org)