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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by bulldog2 on September 17, 2008, at 17:08:52
Mass General Hospital Depression Study Offers Hope For Millions Of Americans For Whom Antidepressants Do Not Work
Release date: 5/5/2004
NEW YORK--More than 18 million Americans a year are diagnosed with major depression. Five out of 10 of those people will not respond or will only partially respond to standard antidepressant treatment, or they will discontinue use because of side effects. The Boston-based Massachusetts General Hospital (MGH) study findings presented today at the American Psychiatric Association Annual meeting indicate that the addition of dietary supplement S-adenosylmethionine, better known as SAM-e (pronounced sammy), to a patients current selective serotonin SSRI (most widely used antidepressants such as Zoloft, Paxil, Prozac) regimen, improves patient response.The SAM-e/antidepressant combination was comparable to that of two antidepressants, with faster onset of action and fewer side effects such as weight gain and sexual dysfunction, says Jonathan Alpert, M.D., Ph.D., associate director of the depression clinical and research program at Massachusetts General Hospital and lead investigator of the trial.
It is common practice for physicians to add a second agent with established or putative antidepressant properties when one alone does not help a patient, adds Alpert. Recently, interest has increased in adding dietary supplements and other complementary therapies to current treatment options.
SAM-e is known for having few side effects and being well tolerated, says Maurizio Fava, M.D., associate chief of psychiatry for clinical research and the director of the Mass General Hospital Depression Clinical and Research Program. Based on the trial results, we feel it may be a more acceptable solution for patients who require combination therapy.
Study Details
The open trial was designed to evaluate the safety, tolerability and efficacy of oral SAM-e tosylate as an antidepressant adjunct. The trial included thirty patients with current Major Depressive Disorder (MDD) despite an adequate dose of a single Selective Serotonin Reuptake Inhibitor (SSRI), the most common class of antidepressants or venlafaxine (Effexor XR). The patients were given 800 to 1,600 mg of SAM-e over six weeks. The mean patient age was 48.4 ± 13.0 years.
The primary outcome test was the number of responders and remitters. A responder was defined as someone with a 50 percent reduction in HAM-D-17 score from baseline to endpoint. A remitter was defined as someone who had a final HAM-D-17 score greater than or equal to seven. Secondary efficacy measures included the Montgomery Asberg Depression Rating Scale (MADRAS), the Clinical Global Impressions Severity (CGI-S), Improvement (CGI-I) scales and the 90 item Kellner Symptom Questionnaire (SQ).
When used in combination with prescription antidepressants, SAM-e was associated with a 50 percent intent-to-treat response rate, acceptable tolerability, no weight gain, and statistically significant reductions in reported sexual dysfunction, anxiety symptoms and serum homocysteine levels.
No patient experienced a serious adverse event. Moderate side effects reported in the trial include constipation, GI upset and headaches.
Pharmavite LLC funded the trial and provided the active ingredient. The promising results of this preliminary study provide the basis for a larger, controlled follow-up study that is being funded by the National Institutes of Health.
About SAM-e
S-adenosylmethionine (SAM-e) is a naturally occurring methyl donor in mammals and has been available in the United States in recent years as an over the counter dietary supplement under the Food and Drug Administrations (FDAs) Dietary supplement Health and Education Act (DSHEA).
SAM-e is involved in more than 35 biochemical processes in the human body. SAM-es broad metabolic role in all tissues, including the brain, suggests that its antidepressant mechanisms may include increasing the availability of neurotransmitters, such as serotonin and dopamine, as well as increasing the number of neurotransmitter receptors.
In December 2002, the Agency for Healthcare Research and Quality (AHRQ) reviewed 39 placebo or active-controlled clinical trials, involving 2,485 patients, on the role SAM-e has in treating depression, and concluded that SAM-e is more effective than placebo; and is as effective as standard prescription medication for treating patients with major depression. Report abstract is available at www.ahrq.gov/clinic/epcsums/samesum.htm.
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Posted by desolationrower on September 17, 2008, at 19:06:56
In reply to Sam-e Ad Combination For Incomplete Responders, posted by bulldog2 on September 17, 2008, at 17:08:52
The interesting thing was not serotonin syndrome. That was my concern with usuing it to augment. Otherwise, lack of placebo/control= >:(
Posted by Sigismund on September 18, 2008, at 2:25:07
In reply to Re: Sam-e Ad Combination For Incomplete Responders, posted by desolationrower on September 17, 2008, at 19:06:56
SAMe + Tianeptine was quite OK.
SAMe + Parnate was not OK.
Posted by SLS on September 18, 2008, at 6:03:47
In reply to Re: Sam-e Ad Combination For Incomplete Responders, posted by Sigismund on September 18, 2008, at 2:25:07
Hi.
> SAMe + Parnate was not OK.
In what ways was this combination not ok?
I tried just a few doses of S-AMe while taking Parnate. It made me dysphoric and irritable.
- Scott
Posted by bulldog2 on September 18, 2008, at 9:50:09
In reply to Re: Sam-e Ad Combination For Incomplete Responders » Sigismund, posted by SLS on September 18, 2008, at 6:03:47
> Hi.
>
> > SAMe + Parnate was not OK.
>
> In what ways was this combination not ok?
>
> I tried just a few doses of S-AMe while taking Parnate. It made me dysphoric and irritable.
>
>
> - ScottI'm curious if you would have the same response if you combined sam-e with nardil. While both are maois Nardil seems more dominant with serotonin while Parnate is more Dopamine oriented.
Posted by Sigismund on September 18, 2008, at 15:27:16
In reply to Re: Sam-e Ad Combination For Incomplete Responders » Sigismund, posted by SLS on September 18, 2008, at 6:03:47
Hi Scott
Maybe it was agitation?
I just didn't feel right, was very uncomfortable, had trouble walking past people, like I needed a very good pair of sunglasses and a strategy (keep to the far left, for example) in order to do it.
Posted by raisinb on September 20, 2008, at 10:43:09
In reply to Sam-e Ad Combination For Incomplete Responders, posted by bulldog2 on September 17, 2008, at 17:08:52
I'd be very cautious trying sam-e with an AD. I tried it by itself before going on ADs and it made me quite hypomanic (maybe even manic). I was convinced I could rule the world, start my own business, make millions--all in about a week.
Posted by bulldog2 on September 20, 2008, at 10:57:24
In reply to Re: Sam-e Ad Combination For Incomplete Responders, posted by raisinb on September 20, 2008, at 10:43:09
> I'd be very cautious trying sam-e with an AD. I tried it by itself before going on ADs and it made me quite hypomanic (maybe even manic). I was convinced I could rule the world, start my own business, make millions--all in about a week.
But that is essentially the mechanism of Deplin augmentation. It boosts the body's production of sam-e.
Posted by Jimmyboy on September 20, 2008, at 15:11:22
In reply to Re: Sam-e Ad Combination For Incomplete Responders, posted by bulldog2 on September 20, 2008, at 10:57:24
I also had a hypomanic episode after I started taking SAM-e, as well as major anxiety. It can be helpful for some, but be mindful of the possible side effects.
Posted by Sigismund on September 20, 2008, at 17:23:36
In reply to Re: Sam-e Ad Combination For Incomplete Responders, posted by raisinb on September 20, 2008, at 10:43:09
>I tried it by itself before going on ADs and it made me quite hypomanic (maybe even manic). I was convinced I could rule the world, start my own business, make millions--all in about a week.
Goodness! It certainly didn't do that to me.
I guess combinations of ADs with SAMe are as hard to get right as combinations of ADs.
Posted by Sigismund on September 20, 2008, at 17:27:13
In reply to Re: Sam-e Ad Combination For Incomplete Responders, posted by bulldog2 on September 18, 2008, at 9:50:09
>I'm curious if you would have the same response if you combined sam-e with nardil. While both are maois Nardil seems more dominant with serotonin while Parnate is more Dopamine oriented.
Well, FWIW (not much) my 2 bob's worth was that Parnate + SAMe caused some serotonin related agitation. If this is right, Nardil would be even worse in combination with it.
Posted by raisinb on September 22, 2008, at 9:32:35
In reply to Re: Sam-e Ad Combination For Incomplete Responders, posted by Sigismund on September 20, 2008, at 17:23:36
I'm sure it can be helpful, but it's very powerful stuff. I had more mania on that then when I began Wellbutrin.
Honestly, I believe that OTC or herbal remedies ought to be more stringently regulated--or at least, the public should be more educated on their effects and not taught to believe that herbal remedies are so often "kinder, gentler" ways for them to find relief.
Posted by desolationrower on September 22, 2008, at 10:02:57
In reply to Re: Sam-e Ad Combination For Incomplete Responders » Sigismund, posted by raisinb on September 22, 2008, at 9:32:35
I would hate that. You need an excuse - a diagnosis - for a doc to give you a script. Creatine can cause mania, i should have to have a diagnosible problem to get it?
-D/R
Posted by raisinb on September 22, 2008, at 10:59:38
In reply to Re: Sam-e Ad Combination For Incomplete Responders, posted by desolationrower on September 22, 2008, at 10:02:57
Not necessarily. But there's too much of the assumption that if one goes "natural," things will be fine and dandy. Not true. Some herbs can cause liver damage; many are dangerous for pregnant women. St. John's Wort can contribute to seratonin syndrome, since it's an MAOI (rare, of course, but does happen). Sam-E can cause mania.
Not to go off on a tangent or anything, but I also think the often-used distinction between "natural" remedies and "pharmaceuticals" isn't justifiable. *All* chemical compounds come from the earth (originally at least). All have effects on your body which may or may not be beneficial. Herbs sold OTC can be full of fillers, colorings, and other processed material, just like any drug. And they're not necessarily less powerful, in some cases.
Sorry, one of my pet peeves is people who go around saying "no drugs for me, I'm going *natural*" when they know little about side effects, etc.
This is obviously different from a well-informed person who weighs his/her options and decides that the herbal or OTC remedy for his/her condition is probably safer or better than the one proffered by the pdoc.
Posted by desolationrower on September 22, 2008, at 11:51:50
In reply to Re: Sam-e Ad Combination For Incomplete Responders » desolationrower, posted by raisinb on September 22, 2008, at 10:59:38
I agree that is a bad perspective. But many people see it the opposite way, and will take a seroquel from a doctor and think it is safer than melatonin. I don't like making things illegal 'to send a message.' like that natural things are just drugs too.
-D/R
Posted by Tony P on September 27, 2008, at 21:23:33
In reply to Re: Sam-e Ad Combination For Incomplete Responders, posted by desolationrower on September 22, 2008, at 11:51:50
I've been experimenting a little with SAMe & various other Rx & OTC A/D's, because I had to cut back my Cymbalta for a while. I'm taking a very mixed cocktail, including Remeron, which I won't take the space to list completely right now, but I found:
SAMe (moderate dosage, .4 - .8 gm/day) and low dose Selegeline (10 mg oral) were OK for me (CAUTION: Selegeline is an MAOI and you may react differently and dangerously, especially if you are on other A/Ds -- experiment _very_ carefully if at all & use a reliable home BP monitor).
SAMe & St. John's Wort actually seemed to help each other -- the St.J.W. had a calming effect as against SAMe's edginess. Didn't try this for long, but it may be worth following up. BTW, there is some controversy as to whether St.J.W. _is_ an MAOI -- I'm not up-to-date, but the last paper I read said it _wasn't_ after all. I'm open to correction.
SAMe + Reboxetine -- a little too stimulating, especially with Modafinil &/or Adrafinil, which I take prn when I'm getting into hypersomnia.
I just wish SAMe wasn't so darned expensive. How much do people take who are on it long-term? One brand I bought said on the label (for depression) to start at .4-1.6 g. per day but cut back to .2-.4 g/day for maintenance. BTW, this is the tosylate form, which seems to be the only one readily available; there's an old thread here that says another formulation (sulfonate???) is much more bioavailable -- don't know why it's not sold (here in Canada anyway).
Well, overall I'm a bit hypomanic on all these experimental combinations, but it's a lot more fun than the opposite!
Tony P
Posted by bulldog2 on September 28, 2008, at 8:41:14
In reply to Re: Sam-e Ad Combination For Incomplete Responders, posted by Tony P on September 27, 2008, at 21:23:33
> I've been experimenting a little with SAMe & various other Rx & OTC A/D's, because I had to cut back my Cymbalta for a while. I'm taking a very mixed cocktail, including Remeron, which I won't take the space to list completely right now, but I found:
>
> SAMe (moderate dosage, .4 - .8 gm/day) and low dose Selegeline (10 mg oral) were OK for me (CAUTION: Selegeline is an MAOI and you may react differently and dangerously, especially if you are on other A/Ds -- experiment _very_ carefully if at all & use a reliable home BP monitor).
>
> SAMe & St. John's Wort actually seemed to help each other -- the St.J.W. had a calming effect as against SAMe's edginess. Didn't try this for long, but it may be worth following up. BTW, there is some controversy as to whether St.J.W. _is_ an MAOI -- I'm not up-to-date, but the last paper I read said it _wasn't_ after all. I'm open to correction.
>
> SAMe + Reboxetine -- a little too stimulating, especially with Modafinil &/or Adrafinil, which I take prn when I'm getting into hypersomnia.
>
> I just wish SAMe wasn't so darned expensive. How much do people take who are on it long-term? One brand I bought said on the label (for depression) to start at .4-1.6 g. per day but cut back to .2-.4 g/day for maintenance. BTW, this is the tosylate form, which seems to be the only one readily available; there's an old thread here that says another formulation (sulfonate???) is much more bioavailable -- don't know why it's not sold (here in Canada anyway).
>
> Well, overall I'm a bit hypomanic on all these experimental combinations, but it's a lot more fun than the opposite!
>
> Tony PVitacost has some pharm grade sam-e at a reasonable price.
This is the end of the thread.
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