With respect to efficacy, this review examined
whether SJW and SAM-e provide clinically relevant
benefit when utilized as antidepressant monotherapy.
Whether either product is potentially
useful in an augmentation or combination
approach along with a conventional antidepressant
was not addressed. Sarris et al, in their review,
report that either product, when used in combination
with conventional antidepressants, has the
potential to enhance response or limit side effects
(by allowing lower doses of the conventional
antidepressant to be prescribed).140 Results from a
recent randomized, placebo-controlled study
support the notion that SAM-e can be an effective,
well-tolerated adjunctive treatment in depressed
patients who have not responded to SSRI or
serotonin-norepinephrine reuptake inhibitor
(SNRI) therapy.141 In that study, non-responding
depressed patients taking an SSRI or SNRI who
were treated with adjunctive SAM-e achieved
two- to three-fold greater response and remission
rates than nonresponding depressed patients
taking an SSRI or SNRI who were treated with
adjunctive placebo. While this finding needs to be
replicated, it suggests the greatest promise for a
product like SAM-e may lie with adjunctive use
rather than as monotherapy treatment. !e
adjunctive treatment approach using SJW is
potentially problematic given its propensity for
causing pharmacokinetic drug interactions.