Scant clinical data exist for either SJW or SAM-e
in children and adolescents. Placebo-controlled
studies utilizing either product in depressed
pediatric patients appear to be nonexistent. For
SJW, open-label data131,132 and “post-marketing”
surveillance data133 in depressed pediatric patients
exist. For SAM-e, only a case series summarizing
experience in three depressed pediatric patients
was identified.134 Despite the paucity of data
supporting their use in children and adolescents,
both products are widely utilized in these populations,
particularly SJW. In Germany, SJW is labeled
for adolescent use and is the most commonly used
antidepressant in that population.135 Advocates for
the pediatric use of these products point to their
long-standing use in folk remedies as evidence of
their overall safety and tolerability. In their view,
natural antidepressants should be preferred to
synthetic antidepressants in pediatric patients due
to a gentler side effect profile.25,136 !e open-label
study of SJW in juvenile depression reported by
Findling found that approximately 75 percent of
participants responded favorably.131 A similar
response rate was seen in the open-label SJW study
in adolescent depression reported by Simeon.132
While these preliminary findings suggest that SJW
may be an appropriate treatment for depressed
pediatric patients, more rigorously conducted
research, including placebo-controlled studies,
clearly are needed before SJW can be routinely
recommended for this population.
!e literature contains numerous double-blind
studies comparing SJW to a conventional antidepressant,
but without utilizing a placebo control.
!e majority of these studies concluded that SJW
was as at least as effective as the conventional
product, following short-term (e.g., Szegedi137) or