It has been estimated that FDA learns of fewer than one percent of adverse events involving these products.
Contributing factors to such under-reporting include physicians often being unaware that their patients are using dietary supplements and that general practitioners are not familiar with the risk profiles of CAM therapies
While SJW and SAM-e products appear to be safe and at least as well-tolerated as conventional antidepressants such as the SSRIs, it has become increasingly clear that herbal or “natural” does not
always mean safer
Questionable adherence to good manufacturing processes and quality control measures in the supplement industry has led to undisclosed product adulterations and to preparations that can vary substantially in content from batch to batch, potentially putting consumers at risk.