this review only examined studies in which SJW and SAM-e were utilized as antidepressant monotherapy
As mentioned, preliminary results (from one randomized, well-controlled trial) suggest the greatest potential benefit (at least for SAM-e) may lie with adjunctive use rather than as monotherapy
Regarding examination of the publications for evidence of possible treatment-emergent suicidality, none of the studies examined were prospectively designed to look at this issue
therefore, they may have been unable to reliably detect such events.
Similarly, the limited attention paid to addressing safety and tolerability in the studies did not allow for a thorough assessment of the incidence of the potential suicidal precursor behavioral AEs of interest.
Many studies reported extremely low AE incidence rates, or reported that no AEs occurred at all, which leads one to question the rigor with which those safety data were collected