Discussion
Given current concerns surrounding conventional
antidepressant therapy and suicidality,
which led to the boxed warning in labeling, it is
conceivable that use of “natural” antidepressant
therapies will rise. Recently available data suggesting
that some antidepressants may be associated
with teratogenicity may also increase the use of
CAM treatments for treating perinatal depression,
despite the fact that no systematic information
exists regarding the safety of Hypericum or SAM-e
use during pregnancy.124-126 !
systematic review was to determine whether the
scientific evidence regarding antidepressant
efficacy actually justifies wider use.
Numerous clinical studies, reviews, and metaanalyses
have examined the antidepressant efficacy
of SJW and SAM-e. Most authors have concluded
that both products appear to be superior to placebo,
generally as effective as conventional antidepressants,
and better tolerated than their conventional
counterparts, leading many to conclude that both
products are viable alternative options for the
treatment of depressive patients.48,49,53,63,127-130 For
many clinicians, however, the jury is still out
regarding the effectiveness of these two therapies,
particularly for moderate-to-severe depressive
illness. Meta-analyses can be subject to over-interpretation
and, therefore, should not necessarily be
considered definitive, given the varying designs,
sample sizes, power, entrance/diagnostic criteria,
and depression assessment approaches utilized in