![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Geno on April 27, 2002, at 16:52:48
Hello, Im Thinking about switching to sam-e. I cannot take the sexual dysph and side effects from ssris. Has anyone taken same for mood or depression? I may add 800-1200mg of same along with my remeron and klopin mix.
Same is suppose to increase seratonin and dopamine?
geno
Posted by 3 Beer Effect on April 28, 2002, at 11:01:06
In reply to SAME VS SSRI, posted by Geno on April 27, 2002, at 16:52:48
I searched Pubmed, & found no reputable scientific double-blind studies that have compare ORAL SamE to SSRIs like Zoloft or Prozac, which kind of makes you wonder if SAMe is really as effective as the media makes it out to be. Most of the studies compared IV Sam E with Old Tricyclic Antidepressants. (Almost any drug is much more powerful & effective when given intraveneously, so that kind of skews the results).
You have to watch out when buying supplements like SAMe/Herbs/weight lifting supplements because most of the sites/information about them on the internet are created and/or funded by the companies that sell those supplements or herbs.
There is a good book you should read that they have in most Barnes & Nobel bookstores in the Medical Reference section called the PDR guide to nutritional Supplements, which doesn't sugarcoat anything or misrepresent facts or make dramatic unproven statements- it just gives you the real information. But it is about $60, so you might just want to sit in one of those chairs they have their in the bookstore & read it for a few hours and then leave- then you get all the info you want for free.
Here's the info I found from what appears to a reputable source on herbs & supplements called supplementalmed.com(although the dose given seems kind of high- most people start off with 200mg/day and titrate to 400 mg or more depending on response)-
http://www.supplementalmed.com/supplementalmed_023.htm"SAMe (S-Adenosyl-Methionine) General: S-Adenosyl-Mehtionine is a naturally occurring physiological substance present throughout the body, including the central nervous system, whose primary role appears to be that of a methyl donor (Janicak, 1989). It contributes to the activation, production, and metabolism of enzymes, hormones, neurotransmitters, nucleic acids, proteins, phospholipids and certain drugs (Frezza, 1993).
Reported Effects: It has been used in Europe since the 1970's for the treatment of depression and arthritis. It may also play a therapeutic role in liver disorders.
Dose: 1200-1400 mg
Half Life: unspecified in the studies reviewed.
Depression: A review of 20 studies using intravenous SAMe for the treatment of depression showed a statistically significant improvement in mood symptoms (Janek, 1989). This review included 6 open label studies without a placebo, and 14 randomized controlled studies comparing SAMe to either placebo or to a tricyclic antidepressant. Sixty-one percent of the 100 patients in open labeled trials responded to the supplement. Three of the controlled studies reported a 74% response rate (29 of 37 SAMe patients and 1 of 25 placebo patients). The 8 studies comparing SAMe to tricyclic antidepressants (TCAs) revealed a 77% response rate for SAMe (109 of 142 patients) and 65% for TCAs (80 of 124 patients). This 12% difference was statistically significant (p<.01). Response to IV SAMe is reported to be quite rapid (within a few days). and to have few side effects.
Two small studies showed similar responses to oral SAMe (Rosenbaum, 1990)(Salmaggi, 1993), though definitive placebo controled trials have yet to be done.
Adverse Effects: Reported side effects inclued mania or hypomania (a few reports with IV preparations), thirst, salivation, nausea, urinary frequency, diarrhea, and headache. All occur in low incidence in available studies.
Pharmacology and possible mechanisms: SAMe appears to increase serotonin turnover, inhibit the reuptake of Norepinephrine in a temperature-dependent fashion, and to augment dopaminergic activity. SAMe also increases folate levels and donates a methyl group to catecholeamines (Baldessarini, 1987).
Discussion: There is reasonable preliminary evidence to support to benefit of SAM-e for patients with Depression. Many of the above studies were conducted with intravenous SAM-e rather than oral SAM-e which makes generalizing the findings difficult. There is data to suggest that is may be helpful with arthritis, and certain forms of liver disease, though data is scant. Nevertheless, SAM-e is a vital, naturally occuring substance which may prove to be useful in multiple medical conditions and warrants further study. The broad statements made in some recent magazine articles are a bit dramatic and not yet justified. Interactions with other drugs have not been studied so people should use this substance with caution and in coordination with their health care provider".
Posted by 3 Beer Effect on April 28, 2002, at 17:16:01
In reply to No studies been done comparing oral SAMe to SSRIs, posted by 3 Beer Effect on April 28, 2002, at 11:01:06
I just bought the Nature Made 200 mg SAMe 80 pack for $36 from Costco. I take a Centrum Multivitamin that has the 100% RDA of everything every day- is it necessary to take additional vitamins in order for SAMe to work properly?
The instructions say to take 400 mg/day, but i've also heard that many people only take 200 mg/day- I figured i'd just do what the Nature Made instructions say, especially since in many SAMe studies the subjects were usually taking large doses, something like 800-1200 mg intravenously. Do you get more side effects by starting out at 400 mg?- I have to go to work tommorrow, I can't be in the bathroom the whole time!
About how long does it take to respond to SAMe usually?I'm not getting any anti-depressant response so far from Lamictal 175mg, which I am titrating to 200 mg on Friday. Nothing else seems to work & these psychiatric drugs (Lamictal, Dexedrine, Klonopin, Sonata) are probably doing a number on my liver so I figured I might as well give SAMe a shot. I think SAMe & Milk Thistle are the only liver repairer supplements available.
3 Beers...................
Posted by Ron Hill on April 28, 2002, at 22:09:22
In reply to SAMe- Are additional vitamins needed for it?, posted by 3 Beer Effect on April 28, 2002, at 17:16:01
3BE,
> I just bought the Nature Made 200 mg SAMe 80 pack for $36 from Costco. I take a Centrum Multivitamin that has the 100% RDA of everything every day- is it necessary to take additional vitamins in order for SAMe to work properly?
As you know, SAM-e is a methylating agent. Once it has donated its methyl group, it becomes homocysteine. In order to avoid elevated levels of homocysteine, it is important to take plenty of B-6, B-12, and folate. Also bear in mind that some (most?) humans do not absorb B-12 efficiently when taken orally. Therefore, it is very important to take a sublingual (under tongue) tablet (or get B-12 injections). Further, buy the bioactive form of B-12 (Methylcobalamin). I take one B-100 complex tablet and a 1000 mcg sublingual tablet of bioactive B-12(methylcobalamin) each day after breakfast. As an aside, I believe several of the B's are instrumental in maintaining good mental health, but that's a subject for another thread. Here is an article that discusses the SAM-e, homocysteine, B vitamin connection:
Supercharged SAM-e: B Vitamins, Folate Increase the Supplement’s Effectiveness
by ImmuneSupport.com Staff12-01-1999 - Homocysteine is a sulfur-containing amino acid involved in several important methyl and sulfur transfer reactions, and is actually beneficial in small amounts. When homocysteine levels begin to rise in the body, excessive accumulation of homocysteine in the body fluid compartments is normally prevented by degradation through two enzymatic reactions called transsulfuration and remethylation. These two processes have to be functioning for homocysteine to be kept in control and for SAM-e to function in the body. Importantly, these same enzyme reactions cannot occur without proper levels of folate, vitamin B 6 (pyridoxal 5- phosphate), and vitamin B12 (cobalamin). If you take SAM-e to promote better health (lighter mood, comfortable joints and a detoxed liver), you also need adequate levels of B vitamins and folic acid to help the SAM-e do its job.
When the body has proper levels of folic acid, Vitamins B6 and B12, the enzymatic break-down of homocysteine occurs either through remethylation, which converts it into methionine, the SAM-e building block; or through transsulfuration, which turns it into glutathione, a powerful antioxidant.
But when those processes become sluggish, the homocysteine levels in the body begin to rise. Large homocysteine levels left unchecked in the body, become an invitation to disease, including heart attack, stroke, cancer, birth defects, depression and perhaps CFS and FM.
A published Swedish study showed results of which demonstrate consistently high homocysteine levels and low concentrations of vitamin B12 in the cerebrospinal fluid (CSF) of patients meeting established clinical criteria for Chronic Fatigue Syndrome and Fibromyalgia.
Those taking SAM-e should be aware that the healthy benefits they experience are not due to SAM-e alone. SAM-e may be the “team leader” however, folic acid, vitamin B6 and vitamin B12 are crucial members of the team that contribute to its success. It is only by incorporating the entire team that one can achieve the victory of better health and well-being.
Source:
Evarts, Jeremy Lucius. “New Study Links Fibromyalgia and Chronic Fatigue Syndrome to Low Vitamin B12 and High Homocysteine in Cerebrospinal Fluid.” Healthwatch, August 1998.
Cowley, Geoffrey and Underwood, Anne. "What is SAMe?" Newsweek, July 5, 1999.
Brown, Richard, M.D., Bottigileri, Teodoro, Ph.D., Colman, Carol. Stop Depression Now. New York, 1999.> The instructions say to take 400 mg/day, but i've also heard that many people only take 200 mg/day- I figured i'd just do what the Nature Made instructions say, especially since in many SAMe studies the subjects were usually taking large doses, something like 800-1200 mg intravenously. Do you get more side effects by starting out at 400 mg?- I have to go to work tommorrow, I can't be in the bathroom the whole time!
Starting at 400 mg sounds like a wise choice. I currently take 200 mg/day, and I am considering a trial at 100 mg/day. It is my observation that med hypersensitive patients are served well by these low doses of SAM-e. However, if my memory serves me correctly 3BE, you are not particularly med hypersensitive and, therefore, 400 mg/day is a good place to start the trial. You may have to increase from there, but if I were you, I'd give it at least a week or so at the 400 mg/day level before increasing. Initially, I could only take one 200 mg tablet of SAM-e every other day. If I took more, I would experience side effects (flush, nausea, confused thinking, general ill feeling, "skin crawling"). It felt like an overstimulation kinda thing.
> About how long does it take to respond to SAMe usually?
I felt it the first day and the full beneficial effect occurred within about a week. But remember, I'm med hypersensitive.
> I'm not getting any anti-depressant response so far from Lamictal 175mg, which I am titrating to 200 mg on Friday.Would it be best to make one change at a time so that you know without a doubt if it's the increase in Lamictal or the add-on of SAM-e that provides benefit, if any?
Best wishes in your SAM-e trial. As you know, SAM-e increases the amount of serotonin and dopamine in the patient’s brain. SAM-e saved my life, and I hope it does well for you also. Please post your results.
-- Ron
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.