Major depressive disorder (MDD) is among the
most frequently diagnosed psychiatric illnesses,
with a lifetime prevalence approaching 20 percent.12
It is well-established that if left untreated
MDD is associated with substantial morbidity and
mortality,13,14 including an increased risk for
suicide.8,9 !e widely-communicated potential link
between antidepressant use and suicidality,
together with the recognition that the greatest risk
for depression-related morbidity and mortality lies
with no treatment, may prompt greater numbers of
prescribers and patients to turn to alternative
treatment options. Pharmacotherapies perceived
to be devoid of the suicidality risk are likely to
attract the most interest. Candidate therapies
include “natural” mood-enhancing dietary supplements,
which include herbal as well as non-herbal
products/nutraceuticals. !ese are available
“over-the-counter” (OTC) in the United States.
Although many dietary supplements are purported
to have mood-enhancing properties, the two most
widely-used are the herbal product St. John’s wort
(SJW) and the nutraceutical s-adenosyl methionine
(SAM-e).