Posted by JohnX2 on April 6, 2002, at 15:23:05
In reply to Re: SAM-e Trial » JohnX2, posted by Ron Hill on March 23, 2002, at 15:11:39
> John,
>
> I was hoping you would weigh in on this topic. As you can see by some of the posts in this thread, several people are reporting favorable results with SAM-e. It is, of course, not the answer to every psychiatric disorder under the sun, but it sure gave me my life back!
>
> My observation (not a scientific study) is that SAM-e seems to be of particular value to depressive (especially bipolar depressive) patients that are initially hypersensitive to AD's (favorable response in a matter of days to very low dosage), but soon thereafter, suffer anergy (low drive, low energy, etc.) and anhedonia (inability to fully experience pleasure, blunted emotions, etc.). It is my layman's opinion that AD's (SSRI's in particular) lower dopamine levels and or impede DA transmission in some (most?) patients and this, in turn, causes the aforementioned symptoms. I think SAM-e is particularly useful in treating anergy and anhedonia, and that it does so by increasing the amount of DA produced by the body. Further, I (layman) hypothesize that one reason SAM-e works so well is that it increases both serotonin and dopamine in a very balanced synergistic kind of way. Okay, enough rambling, let me respond to the issues you raise.
>
> > Maybe if I try this again I need to address the dosing scheme much more carefully. I did try SAM-E nature made brand a long way back with a placebo effect, even at a high dose. I've also gotton a placebo effect on Depakote.
>
> By "placebo effect" I am assuming you mean that you experienced some initial sense of benefit by taking SAM-e, but the improvement was due to psychological reasons instead of physiological improvement and, therefore, the benefits did not last. Do I understand you correctly? Did you take B-6, folic acid, and SUBLINGUAL bioactive B-12 (methylcobalamin)? If you've read my posts, you know how important I think B vitamins (especially sublingual bioactive B-12) are. Were you able to take the SAM-e on a relatively empty stomach? Each morning, I eat a good breakfast, take my vitamins, wait an hour or so, and take my SAM-e dose. In your prior trial, what meds were you on? How much SAM-e did you take and for how long? Nature Made is a good enough brand, so I doubt that it was a bad product issue.
>Ron, by placebo, I'm thinking more like "sugar pill". But at the time that I was trying SAM-E I was experimenting with so many other supplements and medicines it wasn't really a controlled trial. I just know that the SAM-E that I was taking (Nature Made) at a max dose of I think 800 mg, was not giving me a substantial AD boost. I don't remember if I was taking vitamins at the time. I did go on a vitamin binge, but I don't remember when. Also, I would like to note that I tend to get AD responses in the typical therapeutic range, not at the lower sub-therapeutic doses. Dr. Kramer mentioned that his SAM-E patients generally responded in the 1200-1600 mg range? I had seen those figures before.
> >So I wonder if these enteric coated tablets aren't getting absorbed well into my body. However, other enteric coated tablets do okay (like wellbutrin). What do you think?
>
> I doubt that this is the problem.
>
> > Are there good brands that maybe use different fillers/binders in the pill? Does it need to get absorbed through the intestines?
>
> Yes, as I understand it, the supplemental SAM-e must be able to find its way to the small intestines intact in order for the body to absorb it efficiently. But again, I doubt that this is a problem for you. I go back to my usual mantra; were you taking sublingual bioactive B-12 at the time of the trial?No I wasn't taking sublingual B-12's. I have tried them though, and I haven't noticed that they made much difference in mean (you mentioned that they gave you a "calming effect?).
>
> John, I read a high percentage of your posts so, to some degree, I stay aware of your current meds and your conditions. With the exception of your recent bout with hypomania, it seems like your current med combo is working fairly well. If I remember correctly you're taking Lamictal, Serzone, and I think a benzo or something {I would stop and look it up in one of your previous posts, but too many times I've lost partially completed posts in the dialogue box by surfing other pbabble links before completing and sending off the post. Have you ever done that? Make ya mad? Does me!}.
>Yep!
> Since your meds are working, what is prompting you to ponder SAM-e? Due to the fact that AD's were so fickle (work one day, poop-out the next) in their effectiveness for me, I would attempt to replace Serzone with SAM-e if I were in your shoes. SAM-e is smooth, even, and highly repeatable every day. That was definitely not the case with AD's, but this is just my bias.
>I always thought SAM-E was a good concept. I believed it could work. The only thing I don't like about it is the price.
> John, given the fact that merely missing two days of Serzone induced some hypomania, I am concerned that SAM-e might cause some hypomania for you as well. SAM-e induces hypomania in me if I take more than 200 mg/day. Does increasing your Lamictal dosage improve your stability against hypomania? Have you made any decision regarding the lithium add-on to the Lamictal for more anti-mania stability?
I have a weird problem with Lamictal and some other meds, if I raise the dose above a certain level, they induce myofacial pain and sometimes they blunt out my emotions. Zoloft was really bad. Lamictal does this at doses above 150 mg. Serzone fixes this problem. It seems to be related to a gating of serotonin/dopamine interactions (Serzone blocking offensive serotonin receptors). Specifically blockade of 5-ht2 receptors increases dopamine in the (pre)frontal cortex where there are dopamine neurons that inhibit facial muscle contractions, also hypodopaminergic states in the frontal cortex lead to "blunted emotions" such as symtoms similarly described like a "negative psychosis" in schizophrenia. That's why the atypical neuroleptics block the serotonin 5-ht2a receptors (as does serzone and remeron). (Maybe some swagging on behalf here...)
Regards,
John>
> -- Ron
poster:JohnX2
thread:98301
URL: http://www.dr-bob.org/babble/20020402/msgs/102156.html