![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 101. This is the beginning of the thread.
Posted by colin wallace on March 16, 2002, at 11:42:10
Prozac trial: I take one 20mg capsule, and within hours feel uplifted, a slightly dizzying or tipsy feeling, and music enters my mind so that I feel like whistling!Hmmmm. A (slightly)giddying state in which to go about one's ordinary life, but great for a Saturday night.Much preferable to feeling like crap-but needs some tuning down I think.
Next day: 200mg Sam-e.Terrific- achieved just the right 'pitch', and life's back in focus.
Next day: 20mg prozac- Yeuch...not fun at all! WAY overstimulated....don't raise your voice at me or I'll ******* pulverize you!!Snarl!Hmmmm.
Must tone this down!Where's my genial good nature gone?? And the whistling...?
Next day: 200mg sam-e- still far too strung out, but human and sociable again by the evening.
Okay, try again.... two days washout.
next day.20mg prozac- whistlin' dixie.
next three days in a row-200mg Sam-e...nothing else.
Fifth day: cautious 20mg prozac...wait for it...aah, a telltale foot tapping to the radio, a breezy 'hello' on the telephone.... a brief whistle and a tentative early morning stiffie, perhaps heralding....anyway, you get the picture here.
Question: Can the therapeutic window of Prozac, or indeed any SSRI be THAT narrow? Can I really benefit from less than 5mg a day?Am I med. hypersensitive? This perhaps seems a plausible explanation.This may well explain my wholesale rejection of all things SSRI in the past.No wonder I turned into Hannibal Lecter on 150mg effexor.Pause for thought.Like the feel of prozac (at infant-like doses),seems to complement sam-e very well.But have to put up with feeling 'overly upbeat and stupefied' every fifth day, till things settle down.
So, I wondered if anyone else has had a similar reaction/overreaction to Prozac , or another ssri.Anyone tried liquid prozac?? (didn't particularly like celexa either..)
Just coming back down to earth..........(whistlin') Col.
Posted by Ron Hill on March 16, 2002, at 22:23:01
In reply to Anyone respond to subtherapeutic med doses only ?, posted by colin wallace on March 16, 2002, at 11:42:10
> Prozac trial: I take one 20mg capsule, and within hours feel uplifted, a slightly dizzying or tipsy feeling, and music enters my mind so that I feel like whistling!Hmmmm. A (slightly)giddying state in which to go about one's ordinary life, but great for a Saturday night.Much preferable to feeling like crap-but needs some tuning down I think.
> Next day: 200mg Sam-e.Terrific- achieved just the right 'pitch', and life's back in focus.
> Next day: 20mg prozac- Yeuch...not fun at all! WAY overstimulated....don't raise your voice at me or I'll ******* pulverize you!!Snarl!Hmmmm.
> Must tone this down!Where's my genial good nature gone?? And the whistling...?
> Next day: 200mg sam-e- still far too strung out, but human and sociable again by the evening.
> Okay, try again.... two days washout.
> next day.20mg prozac- whistlin' dixie.
> next three days in a row-200mg Sam-e...nothing else.
> Fifth day: cautious 20mg prozac...wait for it...aah, a telltale foot tapping to the radio, a breezy 'hello' on the telephone.... a brief whistle and a tentative early morning stiffie, perhaps heralding....anyway, you get the picture here.
> Question: Can the therapeutic window of Prozac, or indeed any SSRI be THAT narrow? Can I really benefit from less than 5mg a day?Am I med. hypersensitive? This perhaps seems a plausible explanation.This may well explain my wholesale rejection of all things SSRI in the past.No wonder I turned into Hannibal Lecter on 150mg effexor.Pause for thought.Like the feel of prozac (at infant-like doses),seems to complement sam-e very well.But have to put up with feeling 'overly upbeat and stupefied' every fifth day, till things settle down.
> So, I wondered if anyone else has had a similar reaction/overreaction to Prozac , or another ssri.Anyone tried liquid prozac?? (didn't particularly like celexa either..)
> Just coming back down to earth..........
>
> (whistlin') Col.
---------------------------------------------Dear Mr. Whistlin:
I like your humor. Colin, you and I have touched base recently, so you know that I react in a simillar fashion as you to SSRI's and SAM-e. Since my last pdoc visit four months ago, my med cocktail has been 600 mg/d Lithobid, 12.5 mg/d Zoloft, and 200 mg/d SAM-e.
Like you, I feel the uplifting effect of an SSRI almost as soon as I swallow it and I usually become slightly hypomanic for a day. But within a few days the beneficial effects are overtaken by unwanted side effects. My side effect symptoms are different than yours. Instead of getting irritable on an SSRI, I get anergic (low energy, low motivation, blunted emotions, etc). As a side note, I usually get highly irritable (GRRRRRRRRRRR!) when coming off of an SSRI, even a micro-dose like you and I take. As you recall from prior posts, the 200 mg/d SAM-e add-on to the low dose SSRI effectly eliminated the anergic side effects for four months.
However, here's the latest. Yesterday, I once again began to feel the anergic side effects caused by the SSRI (Zoloft). It figures that no sooner than I begin to post the success of SAM-e, something would go wrong! In an attempt to solve this problem, I have stopped taking the low-dose Zoloft and increased the SAM-e dose to 400 mg/d. I feel pretty good today. Time will tell if SAM-e can provide enough of an antidepressant effect without the help of a low dose SSRI.
Ok, enough about me, let's focus on you. I realize that Prozac has a long half life but none-the-less wouldn't it make more sense to take a very small dose every day as opposed to a "normal" dose every third or forth day? I wonder if the daily low-dose might be less of a shock to your system than the big hit periodically. You can open the 20 mg Prozac capsule and divide it into, say, four equal portions. I buy empty capsules at the health food store so I can make my own low dose capsule. At one point I looked into buying a liquid SSRI (Zoloft in my case), but I felt that the added convenience was small in comparison to the higher cost. I am self insured.
I forget if you are bipolar. I am bipolar and I believe that's why I have problems with AD's in general. Please refresh my memory by telling me your dx and a list of the meds you currently take.
A little bit of SSRI and its "Whistle While You Work",
But too much Prozac and its "Colin The Irritable Jerk".Been there, done that.
-- Ron
Posted by colin wallace on March 17, 2002, at 6:28:13
In reply to Re: Anyone respond to subtherapeutic med doses only ? » colin wallace, posted by Ron Hill on March 16, 2002, at 22:23:01
Hi there Ron,
Thanks for the reply.
Yeah, you and I seem to be in uncannily similar situations as far as the meds go.I doubt if either of us would even be able to grasp the concept of 'whistlin'' if it weren't for Sam-e.
Sorry to hear that those pain in the ass side- effects are cropping up again with the Zoloft.
Hopefully the Sam-e will produce the desired effect by itself.Actually, Sam-e did work marvellously for me for a while, but unfortunately the shitty weather we have in the UK sends my mood plummeting beyond belief- three weeks of stormy overcast gloom, and I can literally (physically) feel the left side of my brain begin to 'implode'.Like a football slowly deflating.I end up feeling suicidal,although without Sam-e things would be much worse I'm sure.(Plan to emigrate eventually!- anyone want to get married?!(not Ron!)
Also, I get quite severe mood swings, but only in the downward direction- there are no corresponding highs, so I doubt I'm bipolar , although I have only limited knowledge of BP. disorder.
Your pill splitting idea makes good sense to me; I wasn't aware that you could buy empty capsules, so I may try and get hold of some.I was also considering a brief trial of zoloft- does it come in very small doses/pill form?Isn't it slightly less activating than Prozac?
Regardless, Sam-e is going to be my staple, because nothing comes close to achieving that 'balanced' uplift it provides.
I also wondered whether you'd noticed any difference in the sam-e brands and forms (tosylate etc.)I've tried the Nutralife ('original') and the Nature Made Actimet(supposedly more stable) forms, and can't say one is noticably better than the other.One oddity I have noticed however, is the super-fast boost I get if I take a split pill, even though all the literature suggests that Sam-e is destroyed in the stomach!It's actually more uplifting than taking the whole pill!!Must be just me.
Anyway, best of luck with the 400 mg trial- you may well get away with taking nothing else in the way of meds.That's my eventual aim too.Whistlin'/maniacal Col.
Posted by Ron Hill on March 17, 2002, at 18:52:30
In reply to Re: Anyone respond to subtherapeutic med .Ron H., posted by colin wallace on March 17, 2002, at 6:28:13
Colin,
Please take the online test at the following link:
http://www.mentalhealth.com/fr71.htmlIt used to be free of charge but now it costs ten US dollars (or equivalent number of Britsh Pounds in your case). Spend the money. The test is pretty good. Have you ever seen a pdoc? Do you have a formal dx? If so, was it a GP or pdoc that determined the dx?
Do you only take 20 mg Prozac every four days and 200 mg/d of SAM-e? Anything else?
Tablet forms of Zoloft are available in 25 mg, 50mg, and 100 mg. Zoloft is also available in a liquid form. The 100 mg tablet is by far the most economical. Therefore, in the past I have bought the larger tablet, ground it up and measured out my low doses. I think Prozac and Zoloft are simillar with regard to activation. For me they were anyway.
So far I have only used one brand of SAM-e (Nature Made) so I have nothing to compare it to.
Although I have never split a SAM-e tablet, I suspect it would affect me in a simillar fashion as you. I say this because when I swallow a whole coated tablet, I get an immediate positive effect. This does not make sense to me, but that's what happens.
-- Ron
----------------------------------------> Hi there Ron,
>
> Thanks for the reply.
> Yeah, you and I seem to be in uncannily similar situations as far as the meds go.I doubt if either of us would even be able to grasp the concept of 'whistlin'' if it weren't for Sam-e.
> Sorry to hear that those pain in the ass side- effects are cropping up again with the Zoloft.
> Hopefully the Sam-e will produce the desired effect by itself.Actually, Sam-e did work marvellously for me for a while, but unfortunately the shitty weather we have in the UK sends my mood plummeting beyond belief- three weeks of stormy overcast gloom, and I can literally (physically) feel the left side of my brain begin to 'implode'.Like a football slowly deflating.I end up feeling suicidal,although without Sam-e things would be much worse I'm sure.(Plan to emigrate eventually!- anyone want to get married?!(not Ron!)
> Also, I get quite severe mood swings, but only in the downward direction- there are no corresponding highs, so I doubt I'm bipolar , although I have only limited knowledge of BP. disorder.
> Your pill splitting idea makes good sense to me; I wasn't aware that you could buy empty capsules, so I may try and get hold of some.I was also considering a brief trial of zoloft- does it come in very small doses/pill form?Isn't it slightly less activating than Prozac?
> Regardless, Sam-e is going to be my staple, because nothing comes close to achieving that 'balanced' uplift it provides.
> I also wondered whether you'd noticed any difference in the sam-e brands and forms (tosylate etc.)I've tried the Nutralife ('original') and the Nature Made Actimet(supposedly more stable) forms, and can't say one is noticably better than the other.One oddity I have noticed however, is the super-fast boost I get if I take a split pill, even though all the literature suggests that Sam-e is destroyed in the stomach!It's actually more uplifting than taking the whole pill!!Must be just me.
> Anyway, best of luck with the 400 mg trial- you may well get away with taking nothing else in the way of meds.That's my eventual aim too.
>
> Whistlin'/maniacal Col.
Posted by Ritch on March 17, 2002, at 21:41:12
In reply to Re: Anyone respond to subtherapeutic med » colin wallace, posted by Ron Hill on March 17, 2002, at 18:52:30
> So far I have only used one brand of SAM-e (Nature Made) so I have nothing to compare it to.
>
> Although I have never split a SAM-e tablet, I suspect it would affect me in a simillar fashion as you. I say this because when I swallow a whole coated tablet, I get an immediate positive effect. This does not make sense to me, but that's what happens.
>
> -- Ron
Hey Ron,You wanted to know how my SAM-e trial would go. Well, I bought some yesterday after checking out several stores. I just got the cheapest stuff-hey it's a trial. Well, I must say that I got very *tired* and *sleepy* after I ate lunch and took all my vitamins and the SAM-e (just one 200mg tablet). I got so drowsy I started to nap (that was around 5-6pm-about three hours later). I slept plenty the nite before-so I think it could be attributable to the SAM-e. It was a pleasant kind of nap-like thing. I didn't get any nausea or anything. I took a 2nd dose of it today at the same time and re-experienced a pleasant *grogginess* at about the same time of day. I must say that whatever it does-mustn't be too bad. I feel calm enough to restart dexedrine again.
Mitch
Posted by colin wallace on March 18, 2002, at 12:08:28
In reply to Re: Anyone respond to subtherapeutic med .Ron H., posted by colin wallace on March 17, 2002, at 6:28:13
Ron,
Thanks for the link- I plan to take the online diagnosis, not least because I couldn't fare any worse than I did when I visited a psych.,(over two years ago!)The encounter was an unmitigated disaster, and left me reluctant ever to submit to a 'shrink'again.
I had suffered a breakdown as a result of long term , untreated depression, and was diagnosed with 'major depressive disorder', which in turn led to severe anxiety.I was however, more than hopeful that this 100 pound an hour medieval alchemist could sort me out.If he'd ground up stinging nettles with a pestle and mortar, I would have swallowed it.Unfortunately though, things took a downward spiral when his second question was 'do you masturbate?', and I replied , 'do you think it will help?'
He accused me of being flippant, I, in my paranoia convinced myself that he was a rampant homosexual,and any rapport went up in smoke.
When I told him that 20mg (generic) fluoxetine was driving me toward rage/suicide, he suggested that I was an inherant worrier, and promptly doubled the dose, along with 4mg xanax! very nearly did commit suicide- it was a long and painful rite of passage before I worked out that very small doses suit me best.
I'm now settling in to a one day 20mg prozac, two day sam-e routine, and am beginning to tolerate it better.Time will tell.Col.
Posted by Ron Hill on March 18, 2002, at 16:16:00
In reply to Re: Anyone respond to subtherapeutic med » Ron Hill, posted by Ritch on March 17, 2002, at 21:41:12
Mitch,
Thanks for the progress report. Give the SAM-e trial at least a week or two before drawing any firm conclusions.
I'm surprised by your sleepiness side effect. Most people find it to be slightly stimulating (increase in dopamine) in a smooth calm kind of way. My pdoc warned me against taking it to close to bedtime since it can make it hard to sleep. In fact, I did this once and sure enough I had a very poor nights sleep. As I have mentioned before in my prior posts, SAM-e is an important methylating agent essential for our bodies to manufacture neurotransmitters (serotonin and dopamine, in particular). SAM-e is also involved in the production of melatonin which, as you know, is a neurotransmitter that regulates the sleep/wake cycle. Just a guess, but maybe your daytime sleepiness is somehow connected to melatonin production. And further, this may be a short term effect provided you implement good sleep hygiene protocol ASAP.
Mitch, you know more about this brain chemistry stuff than I do. I'm just offering my opinion in hopes of helping you. Good sleep hygiene includes (among other things) staying awake during the day. I encourage you to use whatever tricks needed to stay awake during the daytime. Drink coffee; go for brisk walks, etc. And I don't need to tell you how important it is for us bipolars to get good regular sleep. SAM-e has improved my sleep, but no daytime sleeping is allowed.
Here is the SAM-e dosing schedule that seems to work best for me:
1. Get up in the morning and eat a good healthy breakfast within thirty minutes of rising.
2. Immediately after breakfast, take oral (down-the-hatch) vitamins followed by sublingual (under the tongue) B-12.
3. Wait for at least 30 minutes or an hour, and then take a 200 mg tablet of SAM-e. This wait time is important because SAM-e is adsorbed in the small intestines more effectively if there is not food present to compete for absorption. IMHO, I think it is important to have the B vitamins in the body ready and waiting for the SAM-e dose. I also think it is VERY IMPORTANT to take the B-12 in a bioactive sublingual form.
4. About mid-afternoon, at least an hour after lunch and at least an hour before dinner, I take my second 200 mg tablet of SAM-e
As side notes, I also take a 500 mg gel cap of a phosphatidylserine complex containing 100 mg of phosphatidylserine (PS). This helps my brain with a mood stabilizer kind of effect, whereas, SAM-e helps my brain in an AD kind of way. Although it is like comparing apples and oranges (MS vs. AD), the benefits I experience from SAM-e are much more profound than that of PS. IMHO, PS helps because it improves brain cell plasticity. Unfortunately, PS is expensive (about $1 per gel cap). Also included on my list of helpful "medications" are exercise and omega-3 fatty acids.
Mitch, as you read in my previous post above, I discontinued my low-dose (12.5 mg/d) of Zoloft a couple of days ago due to breakthrough anergic side effects. Therefore, SAM-e is my sole "AD" at this point. So far I'm doing extremely well! It's been many years and many med trials looking for the right med combo. I truly think I've finally found an "AD" that will work long term for me, a bipolar. A little Lithobid (600 mg/d) and a little SAM-e (400 mg/d) and I'm good to go. I expect this good result to last, but only time will tell for sure.
>I just got the cheapest stuff-hey it's a trial.
Cheap in the short run is not necessarily cost effective in the long run. The problem with SAM-e is that it is expensive to manufacture in a biochemically stable form. Also, care must be taken in packaging and shipping to retain product integrity and freshness and, thereby, to maintain true stated SAM-e content quantity. What brand did you buy? What formulation (e.g. tosylate)?
>I must say that whatever it does-mustn't be too bad. I feel calm enough to restart dexedrine again.
I will not presume to tell you what to do, but if it were me, I'd limit it to one trial at a time. Give the SAM-e at least a week or two. Please refresh my memory by listing all of your current meds. Also, your formal dx is BP II with comorbid ADHD, right? Will you also tell me the active ingredient in your sublingual B-12. Is it the bioactive form, methylcobalamin? It is sublingual, correct?
-- Ron
----------------------------------------------
> Hey Ron,
>
> You wanted to know how my SAM-e trial would go. Well, I bought some yesterday after checking out several stores. I just got the cheapest stuff-hey it's a trial. Well, I must say that I got very *tired* and *sleepy* after I ate lunch and took all my vitamins and the SAM-e (just one 200mg tablet). I got so drowsy I started to nap (that was around 5-6pm-about three hours later). I slept plenty the nite before-so I think it could be attributable to the SAM-e. It was a pleasant kind of nap-like thing. I didn't get any nausea or anything. I took a 2nd dose of it today at the same time and re-experienced a pleasant *grogginess* at about the same time of day. I must say that whatever it does-mustn't be too bad. I feel calm enough to restart dexedrine again.
>
> Mitch
Posted by Ron Hill on March 18, 2002, at 16:22:43
In reply to Re: Anyone respond to subtherapeutic med .Ron H., posted by colin wallace on March 18, 2002, at 12:08:28
Colin,
No, if that helped I'd been cured long long ago!
-- Ron
-----------------------------------------------
> Ron,
>
> Thanks for the link- I plan to take the online diagnosis, not least because I couldn't fare any worse than I did when I visited a psych.,(over two years ago!)The encounter was an unmitigated disaster, and left me reluctant ever to submit to a 'shrink'again.
> I had suffered a breakdown as a result of long term , untreated depression, and was diagnosed with 'major depressive disorder', which in turn led to severe anxiety.I was however, more than hopeful that this 100 pound an hour medieval alchemist could sort me out.If he'd ground up stinging nettles with a pestle and mortar, I would have swallowed it.Unfortunately though, things took a downward spiral when his second question was 'do you masturbate?', and I replied , 'do you think it will help?'
> He accused me of being flippant, I, in my paranoia convinced myself that he was a rampant homosexual,and any rapport went up in smoke.
> When I told him that 20mg (generic) fluoxetine was driving me toward rage/suicide, he suggested that I was an inherant worrier, and promptly doubled the dose, along with 4mg xanax! very nearly did commit suicide- it was a long and painful rite of passage before I worked out that very small doses suit me best.
> I'm now settling in to a one day 20mg prozac, two day sam-e routine, and am beginning to tolerate it better.Time will tell.
>
> Col.
Posted by Ritch on March 19, 2002, at 0:18:46
In reply to Re: SAM-e Trial » Ritch, posted by Ron Hill on March 18, 2002, at 16:16:00
> Mitch,
>
> Thanks for the progress report. Give the SAM-e trial at least a week or two before drawing any firm conclusions.
I always will take something at least two weeks to see how it will fare unless it has clearly unbearable startup side effects that I feel intuitively aren't going to improve with time.>
> I'm surprised by your sleepiness side effect. Most people find it to be slightly stimulating (increase in dopamine) in a smooth calm kind of way. My pdoc warned me against taking it to close to bedtime since it can make it hard to sleep. In fact, I did this once and sure enough I had a very poor nights sleep. As I have mentioned before in my prior posts, SAM-e is an important methylating agent essential for our bodies to manufacture neurotransmitters (serotonin and dopamine, in particular). SAM-e is also involved in the production of melatonin which, as you know, is a neurotransmitter that regulates the sleep/wake cycle. Just a guess, but maybe your daytime sleepiness is somehow connected to melatonin production. And further, this may be a short term effect provided you implement good sleep hygiene protocol ASAP.Actually, I was going to mention something else, but forgot to. It really seemed like taking a small dose of Mirapex without the nausea. BTW, DA agonists never goofed with my sleep.
> Mitch, as you read in my previous post above, I discontinued my low-dose (12.5 mg/d) of Zoloft a couple of days ago due to breakthrough anergic side effects. Therefore, SAM-e is my sole "AD" at this point. So far I'm doing extremely well! It's been many years and many med trials looking for the right med combo. I truly think I've finally found an "AD" that will work long term for me, a bipolar. A little Lithobid (600 mg/d) and a little SAM-e (400 mg/d) and I'm good to go. I expect this good result to last, but only time will tell for sure.Lithium was the only thing that I could take as a sole RX med that could keep me above water. It didn't do as well as Neurontin for bipolar depression, didn't do as well as Depakote for hypomania, but it is a quite decent and cheap multipurpose drug. I just had big tolerability issues with Li due to GI distress (similar to SSRi's).
>
> >I just got the cheapest stuff-hey it's a trial.
>
> Cheap in the short run is not necessarily cost effective in the long run. The problem with SAM-e is that it is expensive to manufacture in a biochemically stable form. Also, care must be taken in packaging and shipping to retain product integrity and freshness and, thereby, to maintain true stated SAM-e content quantity. What brand did you buy? What formulation (e.g. tosylate)?It's a blue bottle I got at Walgreen's. Something good is happening with it. Sorry, but I am not going to pay more than $20 a month that likely will not work as well. Hey, I could add another digital cable option!
> >I must say that whatever it does-mustn't be too bad. I feel calm enough to restart dexedrine again.
> I will not presume to tell you what to do, but if it were me, I'd limit it to one trial at a time. Give the SAM-e at least a week or two. Please refresh my memory by listing all of your current meds. Also, your formal dx is BP II with comorbid ADHD, right? Will you also tell me the active ingredient in your sublingual B-12. Is it the bioactive form, methylcobalamin? It is sublingual, correct?
>
> -- RonWell, it is sublingual (primitive?):-). Yes, on the dx. Nope, cyanocobalimin. Yes, restarted Dexedrine, but a daily microdose of 5mg.
So....
Depakote 125-250mg hs (no tremor with Flax oil and the SAM-e!)
Klonopin .5mg hs
Neurontin 100mg tid
Dexedrine 5mg/day
Celexa 2.5mg every other dayMitch
Posted by Ron Hill on March 19, 2002, at 1:21:25
In reply to Re: SAM-e Trial » Ron Hill, posted by Ritch on March 19, 2002, at 0:18:46
> It's a blue bottle I got at Walgreen's. Something good is happening with it. Sorry, but I am not going to pay more than $20 a month that likely will not work as well. Hey, I could add another digital cable option!
-------------------------------------Mitch,
I hear ya. A guy has to have his priorites! So far I've been buying Mature Made brand at Costco ($48 for a box of eighty 200 mg tablets). So I guess I pay $36 per month if I take 400 mg/day. I plan to buy my next "refill" on-line because I can get good quality product at a slightly better price than at Costco.
Here is a paragraph that addresses the product quality issue. I read another article that dealt with this issue in more detail, but I can't find it at the moment. Please click on the link below and read this entire article if you have not read it before.
The first challenge is to buy full-strength SAMe. "Some companies are very reliable manufacturers," says Dr. Paul Packman of Washington University in St. Louis. "But some aren't. You can't always tell from the label on the bottle how much active ingredient is actually in it." Pharmaceutical-grade SAMe comes in two forms, one called tosylate and a newer, more stable form called butanedisulfonate. Only Nature Made and GNC sell the new butanedisulfonate version, but several U.S. retailers import reliable tosylate products. And because SAMe is absorbed mainly through the intestine, it's best taken in "enteric coated" tablets that pass through the stomach intact. None of the products comes cheap. The price of a 400-mg dose ranges from $2.50 (Nature Made) up to $18.56 for an uncoated Natrol product called SAM sulfate.
http://www.biopsychiatry.com/sameart.html
Glad to hear it is helping you. Please stay in touch.
-- Ron
Posted by davex on March 19, 2002, at 10:10:30
In reply to Re: SAM-e Trial » Ritch, posted by Ron Hill on March 19, 2002, at 1:21:25
"Better, faster and safer", they sayd about Sam-e, and i could think it was almost true.
I'm on Sam-e since last week for a dystimic disorder caused (i think) by a low level of dopamine.
We know that Sam-e increase the permeability of dopamine through the cellular skin and so increase its disponibility in the brain.
We, also, know that Amisulpride increase the dopamine release in the intercellular space, making so dopamine more available for the cellular usage.
They seem to work for the same result, using differnet ways.
My experience during this week using 400+400 mg/d Sam-e and 75 mg/d Amisulpride, support B group vitamine, is:
More active, alert and interessed in daily things;
Little more energetic, mood a little higher, more "ready to go";
A "wiew of the life" little bright, little more interested in "new projects".
The vision seems to be more clear and i feel easyer in doing more complex thought.
As side-effects i report:
A little difficulty to fall asleep, this cause i feel more energic and active and i feel more difficulty to stay without doing nothing and a little difficulty in relax.
I'll go on this trial and keep you posted about my experience.
Thanks for every share and counsel.
Posted by Ritch on March 19, 2002, at 10:33:07
In reply to Re: SAM-e Trial » Ritch, posted by Ron Hill on March 19, 2002, at 1:21:25
Posted by Ron Hill on March 19, 2002, at 10:42:05
In reply to SAM-e + AMISULPRIDE: week #1 trial experience., posted by davex on March 19, 2002, at 10:10:30
Dave,
Thanks for posting regarding your experience with SAM-e. Please continue to do so.
-- Ron
----------------------> "Better, faster and safer", they sayd about Sam-e, and i could think it was almost true.
> I'm on Sam-e since last week for a dystimic disorder caused (i think) by a low level of dopamine.
> We know that Sam-e increase the permeability of dopamine through the cellular skin and so increase its disponibility in the brain.
> We, also, know that Amisulpride increase the dopamine release in the intercellular space, making so dopamine more available for the cellular usage.
> They seem to work for the same result, using differnet ways.
> My experience during this week using 400+400 mg/d Sam-e and 75 mg/d Amisulpride, support B group vitamine, is:
> More active, alert and interessed in daily things;
> Little more energetic, mood a little higher, more "ready to go";
> A "wiew of the life" little bright, little more interested in "new projects".
> The vision seems to be more clear and i feel easyer in doing more complex thought.
> As side-effects i report:
> A little difficulty to fall asleep, this cause i feel more energic and active and i feel more difficulty to stay without doing nothing and a little difficulty in relax.
> I'll go on this trial and keep you posted about my experience.
> Thanks for every share and counsel.
Posted by IsoM on March 19, 2002, at 13:19:48
In reply to Re: SAM-e + AMISULPRIDE: week #1 trial experience. » davex, posted by Ron Hill on March 19, 2002, at 10:42:05
Because SAMe is not a patented medication & any company can make it, is there any reasoning behind its exorbitantly high prices? Like lithium carbonate is simply a salt & couldn't be patented, so the profits to drug companies wasn't high. What is it with SAMe that it's so costly? I can't believe that it's manufacture is that guarded & difficult? ANy ideas???
Posted by Ron Hill on March 19, 2002, at 15:38:47
In reply to Re: SAM-e and the price, posted by IsoM on March 19, 2002, at 13:19:48
IsoM,
As I understand it, the following contribute to the high cost of SAM-e.
1. SAM-e degrades quickly if exposed to air. Further, the SAM-e tablets need to be enteric coated so that the SAM-e can be dissolved in the small intestines where it can be effectively absorbed. These constraints raise manufacturing costs, packaging costs, and shipping costs. Innovation in SAM-e manufacturing processes will eventually bring the price down.
2. Almost all of the commercially available SAM-e is currently manufactured by one company in Italy. As demand goes up (and it will!), competition will come in and the price will come down.
I pay a buck twenty a day ($1.20) for my 400 mg/day of SAM-e. To me, this is DIRT CHEAP compared to the very high price I paid over the years of lost opportunity due to repeated failures of prescription AD trials. Plus, since I'm self-insured, SAM-e is less expensive for me to purchase than rx AD's.
Here is a good article I just came across:
http://www.iherb.com/same2.html-- Ron
--------------------------------------------------
> Because SAMe is not a patented medication & any company can make it, is there any reasoning behind its exorbitantly high prices? Like lithium carbonate is simply a salt & couldn't be patented, so the profits to drug companies wasn't high. What is it with SAMe that it's so costly? I can't believe that it's manufacture is that guarded & difficult? ANy ideas???
Posted by IsoM on March 19, 2002, at 18:34:14
In reply to Re: SAM-e and the price » IsoM, posted by Ron Hill on March 19, 2002, at 15:38:47
I suppose that the Italian company has a monopoly or patent on the method of synthesising it then. The enteric-coating, easy oxidation problems to overcome, etc does not bring costs up much at all. I'm going to dig out my old pharmaceutical/chemical supplies catalogue I've stashed somewhere & see if it's listed. Think I'll check with my old chem prof too.
Posted by davex on March 19, 2002, at 19:14:08
In reply to Re: SAM-e and the price » Ron Hill, posted by IsoM on March 19, 2002, at 18:34:14
Hi, I live in Italy.
Here we have about five different brands of SAM-e.
The difference of price between them is significative. One of them is the cheaper (Samyr), were the cost for a 20 pill at 400 mg is about 20 euros (less than 1$ for pill).
The injectable preparation is more expensive (3-4 euros for flx at 500 mg) but this preparation seems to be more effective than oral pills.
However, it is a great cost therapy!
The cost seem to depend by the particular preparation system that is very observing for do not damage the preparate that is very instable and delicate.
Posted by IsoM on March 19, 2002, at 19:29:58
In reply to Re: SAM-e and the price, posted by davex on March 19, 2002, at 19:14:08
So Dave, do you take it yourself & did you find a difference in how each works?
Posted by colin wallace on March 20, 2002, at 3:57:35
In reply to Re: SAM-e and the price » davex, posted by IsoM on March 19, 2002, at 19:29:58
I've been scouring the net in a quest to find an online Italian manufacturer to buy direct from Italy- cut out the middle man.So far, no luck.
If I come across one, I'll post it.
Posted by davex on March 20, 2002, at 6:51:57
In reply to Re: SAM-e and the price » davex, posted by IsoM on March 19, 2002, at 19:29:58
Sorry, no i was only on one brand and in the oral pill form (never tray injectable form).
I know that pdoc strongly counsel injectable form cause it seems to be stronger and faster than oral form: in oral form the most part of Metionine is destroied by the liver and only about 20% of active drug pass to the brain cells.
However, i've read that a dosage near to 1600 mg/d in oral form is quite similar to injectable form.
I will probably increase soon dosage to 400 mg for 3 times a day.
I'll post any impressions reported on it.
Posted by Lia Mason on March 20, 2002, at 10:01:16
In reply to Re: SAM-e and the price » IsoM, posted by davex on March 20, 2002, at 6:51:57
I've posted this before...
CVS puts nature made on sale 50% off regularly. I stock up this way and save money. Watch CVS circulars!
Posted by Ron Hill on March 20, 2002, at 11:39:46
In reply to Re: SAM-e and the price » IsoM, posted by davex on March 20, 2002, at 6:51:57
> I know that pdoc strongly counsel injectable form cause it seems to be stronger and faster than oral form: in oral form the most part of Metionine is destroied by the liver and only about 20% of active drug pass to the brain cells. However, i've read that a dosage near to 1600 mg/d in oral form is quite similar to injectable form.
------------------------------------Dave et al,
The following article is a worthwhile read and the issue of oral verses injectable effectiveness is addressed in the tenth paragraph.
http://www.iherb.com/same2.htmlThe contents of the following article are excerpted from "Encyclopedia of Nutritional Supplements", chapter 45, by Michael M. Murray, Copyright © 1996 by Prima Publishing.
S-Adenosylmethionine (SAM) is an important physiological agent formed in the body by combining the essential amino acid methionine with adenosyl-triphosphate (ATP). SAM was discovered in Italy in 1952-- not surprisingly, most of the research on SAM has been conducted in the country of its discovery.
Food Sources
Because SAM is manufactured from methionine, you might think that dietary sources of methionine provide the same benefits as SAM. However, high doses of methionine do not increase levels of SAM, nor do they provide the same pharmacological activity as SAM. On the contrary, high dosages of methionine are associated with some degree of toxicity.Deficiency Signs and Symptoms
Normally the body manufactures all the SAM it needs from the amino acid methionine. However, a deficiency of methionine, vitamin B12, or folic acid can result in decreased SAM synthesis. In addition, tissue levels of SAM are typically low in the elderly and in patients suffering from osteoarthritis, depression, and various liver disorders.Beneficial Effects
SAM is involved in over 40 biochemical reactions in the body. It functions closely with folic acid and vitamin B12 in "methylation" reactions--the process of adding a single carbon unit (a metyl group) to another molecule. SAM is many times more effective in transferring methyl groups than other methyl donors. Methylation reactions are critical in the manufacture of many body components--- especially brain chemical --and in detoxification reactions.SAM is also required in the manufacture of all sulfur-containing compounds in the human body, including glutathione and various sulfur-containing cartilage components. The beneficial effects of SAM supplementation are far-reaching because of its central role in so many metabolic processes.
Available Forms
SAM has been available commercially in Europe since 1975. Unfortunately, as of April 1996, it was still not available in the United States. I discuss it here because I believe it will be into U.S. health-food stores as a nutritional supplement in the very near future. The commercial form of SAM is a stabilized salt produced under U.S. patent numbers 3,954,726 (1976) and 4,057,686 (1977).Principal Uses
There are five principal conditions where SAM is used: depression, osteoarthritis, fibromyalgia, liver disorders, and migraine headaches.Depression
SAM is necessary in the manufacture of important brain compounds such as neurotransmitters and phospholipids like phosphatidylcholine and phosphatidylserine. Supplementing the diet with SAM in depressed patients results in increased levels of serotonin, dopamine, and phosphatidylserine. It improves binding of neurotransmitters to receptor sites, which causes increased serotonin and dopamine activity and improved brain cell membrane fluidity, all resulting in significant clinical improvement.The antidepressive effects of folic acid (Vitamin B6) are mild compared to the effects noted in clinical trials using SAM. Based on results from a number of clinical studies, it appears that SAM is perhaps the most effective natural antidepressant (although a strong argument could be made for the extract of St. John's Wort standardized to contain 0.3 percent hypericin) Tables 45.1 and 45.2 [ following tables ] summarize double-blind studies comparing SAM to either a placebo or an antidepressant drug.
Most of the studies cited in Table 45.1 and 45.2 used injectable SAM. However, more recent studies using a new oral preparation at a dosage of 400 milligrams four times daily (1600 mg total) demonstrate that SAM is just as effective orally as it is intravenously. SAM is better tolerated and has a quicker onset of antidepressant action than tricyclic antidepressants.
The most recent study compared SAM to the tricyclic desipramine. In addition to clinical response, the blood level of SAM was determined in both groups. At the end of the 4-week trial, 62 percent of the patients treated with SAM and 50 percent of the patients treated with desipramine had significantly improved. Regardless of the type of treatment, patients with a 50 percent decrease in their Hamilton Depression Scale (HAM-D) score showed a significant increase in plasma SAM concentration. These results suggests that one of the ways tricyclic drugs exert antidepressive effects is by raising SAM levels.
In addition to generalized depression, there are two conditions associated with depression where SAM produces significant effects: the postpartum (after pregnancy) period and drug rehabilitation. SAM's benefits in these conditions probably stem from a combination of its effects on brain chemistry and liver function. In the study in postpartum depression (after-pregnancy "blues"), the administration of SAM (1,600 milligrams per day) produced significantly better mood scores than a placebo group. As for the use of SAM in drug detoxification, SAM (1,200 milligrams daily) significantly reduced psychological distress (chiefly anxiety and depression) in the detoxification and rehabilitation of opiate abusers.
Fibromyalgia
Fibromyalgia is a recently recognized disorder which is regarded as a common cause of chronic musculoskeletal pain and fatigue. Fibromyalgia shares many common features with another recently termed syndrome, the chronic fatigue syndrome (CFS).
The only difference in diagnostic criteria for fibromyalgia and CFS is the requirement of musculoskeletal pain in fibromyalgia and fatigue in CFS. The likelihood of being diagnosed as having fibromyalgia or CFS depends on the type of physician consulted. Specifically, if the patient consults a rheumatologist or orthopedic specialist, he or she is much more likely to be diagnosed with fibromyalgia than CFSs. Depression is often an underlying finding in both fibromyalgia and CFS.Diagnosis requires fulfillment of all the following major criteria and four or more minor criteria. The major criteria are:
Generalized aches or stiffness of at least three anatomic sites for at least three months
Six or more typical, reproducible tender points
Exclusion of other disorders that can cause similar symptoms
The minor criteria are:
Generalized fatigue
Chronic headache
Sleep disturbance
Neurological and psychological complaints
Joint swelling
numbing or tingling sensations
Irritable bowel syndrome
Variation of symptoms in relation to activity, stress, and weather changes
Three clinical studies show SAM produces excellent benefits in patients suffering from fibromyalgia. The first study was a double-blind, crossover study of 17 patients with fibromyalgia. During treatment with SAM (200 milligrams daily by injection for 21 days), subjects demonstrated significant reduction in the number of trigger points and painful areas and improvements in mood.
In another double-blind study, orally administered SAM (800 milligrams daily) was compared to a placebo for 6 weeks in 44 patients with fibromyalgia. Researchers evaluated tender point score, muscle strength, disease activity, subjective symptoms, mood parameters, and side effects. Patients given SAM demonstrated improvements in clinical disease activity, pain experienced during the last week, fatigue, morning stiffness, and mood; however, the tender point score and muscle strength did not differ in the two treatment groups. SAM was without side effects.
The most recent study compared SAM to transutaneous electrical nerve stimulation (TENS)-- a popular treatment for fibromyalgia-- in 30 patients with fibromyalgia. Patients receiving SAM (200 milligrams by injection and 400 milligrams orally daily) demonstrated significantly greater clinical benefits---decreased number of tender points, subjective feelings of pain and fatigue, and improved mood. TENS offered little benefit on most symptoms while SAM was deemed "effective in relieving the signs and symptoms of primary fibromyalgia."
Migraine
SAM is beneficial in the treatment of migraine headaches. The benefits manifest gradually and require long-term treatment for therapeutic effectiveness.Dosage Ranges
In general, the longer SAM is used, the more beneficial the results. It is perfectly suited for long-term use because of its excellent safety profile. Here are the dosage ranges for the various clinical indications.Depression Four hundred milligrams three to four times daily. Because SAM can cause nausea and gastrointestinal disturbances in some people, it should be started at a dosage of 200 milligrams twice daily for the first day, increased to 400 milligrams twice daily on day three, 400 milligrams three times daily on day ten, and finally to the full dosage of 400 milligrams four times daily after 20 days if needed.
Fibromyalgia Two hundred milligrams to 400 milligrams two times daily.
Safety Issues
No significant side effects have been reported with oral SAM other than the occasional nausea and gastrointestinal disturbances. However, individuals with bipolar (manic) depression should not take SAM unless under strict medical supervision. SAM's antidepressant activity may lead to the manic phase in these individuals. This effect is exclusive to some individuals with bipolar depression.Interactions
SAM functions very closely with vitamin B12, folic acid, vitamin B6, and choline in methylation reactions. Because of SAM's effects on the liver, it may enhance the elimination of various drugs from the body. The clinical significance of this particular effect has not been fully determined.-- Ron
Posted by colin wallace on March 20, 2002, at 14:32:55
In reply to Re: SAM-e and the price, posted by davex on March 19, 2002, at 19:14:08
This is about the cheapest Nature Made Sam-e I've stumbled across:
Posted by Ron Hill on March 20, 2002, at 14:57:35
In reply to Sam-E offer (link) , posted by colin wallace on March 20, 2002, at 14:32:55
> This is about the cheapest Nature Made Sam-e I've stumbled across:
>
> http://col.branddiscountvitamins.com/sam-e.htm
--------------------------------------------Colin,
I get the same brand for a little less money at Costco.
Website: 50 tablets (200 mg) for $34.63 = 69.3 cents/tablet
Costco: 80 tablets (200 mg) for $46.99 = 58.7 cents/tablet
-- Ron
Posted by colin wallace on March 20, 2002, at 15:30:47
In reply to Re: Sam-E offer (link) » colin wallace, posted by Ron Hill on March 20, 2002, at 14:57:35
Oh yeah, I forgot about costco...trouble is, they won't ship to the UK- I contacted them recently, and they say they hope to get this up and running in the near future.
BTW, up to 400mg now, and feeling good.
Couldn't let you outdo me could I.?!!!Stay well'
Col.
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