Conclusions
Based on the evidence examined in this review,
both SJW and SAM-e appear to be potentially
useful for the short-term treatment of mild-tomoderate
depressive symptoms. When considering
these data one should keep in mind that the
majority of studies examined were not of the
quality typically used to establish the efficacy of
conventional antidepressants from a regulatory
standpoint. !e evidence for SJW appears to be the
more reliable of the two, given the methodological
weaknesses characteristic of most of the SAM-e
studies. It is the opinion of this author, after
reviewing the data, that neither product can be
recommended in place of conventional antidepressants
for patients with moderate-to-severe
depression, in patients less than age 18 years, or
for long-term monotherapy treatment of depression
of any severity level, without physician
supervision.
Both products appear to be generally well-tolerated
from a behavioral AE standpoint. No publication
examined in this review revealed evidence of
treatment-emergent suicidality for either product.
However, these studies were not prospectively
designed to assess the suicidality issue specifically.
Consequently, whether these products have the
potential to increase the risk of suicidality in
adolescents or young adults (like conventional
antidepressants) remains an unanswered question.
Until more data are available, it would be prudent
to apply the recommendations of the antidepressant
boxed warning to all individuals being treated
pharmacologically for depressive illness, irrespective
of treatment modality (i.e., conventional or
alternative).
Despite the lack of rigorous regulatory oversight
of the manufacture, testing, and marketing of
dietary supplements, the use of alternative
products should not be categorically discouraged.
Some products, including SJW, represent potentially
legitimate treatment options. It is important
that clinicians and other healthcare practitioners
recommend natural/herbal antidepressant products,
including SJW and SAM-e, judiciously and
with a sound understanding of the data that exists
to support such a recommendation.
ConclusionsBased on the evidence examined in this review,both SJW and SAM-e appear to be potentiallyuseful for the short-term treatment of mild-tomoderatedepressive symptoms. When consideringthese data one should keep in mind that themajority of studies examined were not of thequality typically used to establish the efficacy ofconventional antidepressants from a regulatorystandpoint. !e evidence for SJW appears to be themore reliable of the two, given the methodologicalweaknesses characteristic of most of the SAM-estudies. It is the opinion of this author, afterreviewing the data, that neither product can berecommended in place of conventional antidepressantsfor patients with moderate-to-severedepression, in patients less than age 18 years, orfor long-term monotherapy treatment of depressionof any severity level, without physiciansupervision.Both products appear to be generally well-toleratedfrom a behavioral AE standpoint. No publicationexamined in this review revealed evidence oftreatment-emergent suicidality for either product.However, these studies were not prospectivelydesigned to assess the suicidality issue specifically.Consequently, whether these products have thepotential to increase the risk of suicidality inadolescents or young adults (like conventionalantidepressants) remains an unanswered question.Until more data are available, it would be prudentto apply the recommendations of the antidepressantboxed warning to all individuals being treatedpharmacologically for depressive illness, irrespectiveof treatment modality (i.e., conventional oralternative).Despite the lack of rigorous regulatory oversightof the manufacture, testing, and marketing ofdietary supplements, the use of alternativeproducts should not be categorically discouraged.Some products, including SJW, represent potentiallylegitimate treatment options. It is importantthat clinicians and other healthcare practitionersrecommend natural/herbal antidepressant products,including SJW and SAM-e, judiciously andwith a sound understanding of the data that existsto support such a recommendation.
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