America has not been kind to St. John’s Wort. In Europe, this flowering bush that blooms around June 24 (St. John’s Day), has been all the rage for about 2000 years. It was first mentioned by the Roman Pliny the Elder in the first century, and over the past two millennia it has been used for a variety of ills, including diarrhea, urinary problems, demonic exorcism, and more recently, for melancholia.

… psychiatric research standards, the numbers were huge: 851 patients in the Effexor XR group, 748 in the SSRI group (Prozac, Paxil, and Luvox), and 446 in the placebo group. The doses of comparator SSRIs were robust enough to mirror what we actually use in clinical practice, and treatment duration...

Celexa (Citalopram) has been used in Europe since the late 1980s, and since its introduction in the U.S. market in 1998 it has made steady inroads into the SSRI market, largely because it has the reputation of being unusually well tolerated.

The latest member of the “controlled-release club” is GlaxoSmithKline, with its Paxil CR. While cynics may believe that CR launches are simply efforts to prolong patent-lives and therefore profits, the reality is that CR formulations are generally better tolerated and easier to dose.

Dr. O’Reardon, I’d like to pick your mind about your approach to treatment resistant depression. First of all, how do you define it?

Dr. Richard Naimark, a psychiatrist in private practice at Chestnut Hill Counseling in Dover, New Hampshire, relates a tidbit that tempers TCR’s fairly lukewarm review of Paxil CR.