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Feb. 8th, 2013 11:10 pmPeople Use This For:
Orally, SAMe is used for depression, anxiety, heart disease, fibromyalgia, osteoarthritis, bursitis, tendonitis, chronic lower back pain, dementia, Alzheimer's disease, slowing the aging process, chronic fatigue syndrome (CFS), improving intellectual performance, liver disease, and Parkinson's disease. Other uses include premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), attention deficit-hyperactivity disorder (ADHD), multiple sclerosis, spinal cord injury, seizures, migraine headache, chronic lead poisoning, disorders of porphyrin, and bilirubin metabolism.
Intravenously, SAMe is used for treating depression, osteoarthritis, AIDS-related myelopathy, fibromyalgia, liver disease, cirrhosis, and intrahepatic cholestasis.
Intramuscularly, SAMe is injected for fibromyalgia, depression, and Alzheimer's disease.
Safety:
LIKELY SAFE ...when used orally, intravenously, or intramuscularly and appropriately. Serious toxicity has not been reported in multiple clinical studies involving more than 22,000 patients and lasting from a few days to 2 years.
LIKELY EFFECTIVE
Depression. Taking SAMe orally significantly improves symptoms of major depression. Several clinical studies show that taking SAMe is more effective than placebo and appears to be as effective as tricyclic antidepressants in trials lasting up to 42 days. However, some of these studies are limited by small numbers of patients, inconsistent diagnostic criteria, short treatment periods, and potentially flawed study designs.
In patients who don't respond to conventional antidepressants, adding a specific SAMe supplement (SAMe Complete 400 mg, Nature Made) 400 mg to 800 mg twice daily to conventional treatment significantly increases remission rates by about 14% after 6 weeks. About 7 patients need to be treated with SAMe for 6 weeks for one additional non-responding patient to have remission.
Administering SAMe intravenously or intramuscularly, short-term, also significantly improves symptoms of major depression. Several small-scale clinical trials have shown that parenterally administered SAMe is superior to placebo and possibly as effective as intravenous or oral tricyclic antidepressants in studies lasting up to 30 days. In some trials, the antidepressant effect occurred rapidly, within 1-2 weeks of initiation of treatment. This benefit is likely the result of the parenteral route of administration. Parenteral SAMe has been used successfully in combination with an oral tricyclic antidepressant to speed the onset of antidepressant action.
Practice guidelines from the American Psychiatric Association suggest SAMe as a potential alternative to conventional antidepressants (e.g., paroxetine, venlafaxine, etc) for patients with major depression who are interested in using alternative therapies. The Canadian Network for Mood and Anxiety Treatments (CANMAT) also recommends SAMe as an effective option for second line treatment of mild to moderate depression.
Adverse Reactions:
Orally, SAMe is generally well tolerated. Side effects are more common with higher doses and include flatulence, nausea, vomiting, diarrhea, constipation, dry mouth, headache, mild insomnia, anorexia, sweating, dizziness, and nervousness. Anxiety and tiredness have occurred in people with depression, and hypomania in people with bipolar disorder. A case of mania with suicidal ideation has also been reported in an otherwise healthy patient.
There has been some concern that taking SAMe might increase homocysteine levels. SAMe is metabolized to s-adenosylhomocysteine, which can be metabolized to homocysteine. Elevated levels of homocysteine have been linked to cardiovascular and renal disease. However, in a study lasting 4 weeks, administration of SAMe orally in doses titrated up to 1600 mg/day, there was no significant increase in homocysteine levels. In another study, there also was no difference in cardiovascular mortality in people with cirrhosis taking SAMe 1200 mg daily for two years.
When used as an injection, SAMe has caused mania in people with bipolar disorder.
Interactions with Herbs & Supplements:
HERBS AND SUPPLEMENTS WITH SEROTONERGIC PROPERTIES: Theoretically, SAMe might increase the effects and adverse effects of products that increase serotonin levels, including 5-hydroxytryptophan (5-HTP), Hawaiian baby woodrose, L-tryptophan, and St. John's wort.
Interactions with Diseases or Conditions:
BIPOLAR DISORDER: Use of SAMe can cause patients to convert from a depressed state to a hypomanic or manic state.
PARKINSON'S DISEASE: SAMe methylates levodopa, which could theoretically worsen Parkinsonian symptoms. However, this has not been reported in humans.
SURGERY: SAMe might affect serotonin levels. Theoretically, SAMe might interfere with surgical procedures due to serotonergic central nervous system effects or serotonergic effects on the vascular system. Tell patients to discontinue SAMe at least 2 weeks before elective surgical procedures.
Dosage/Administration:
ORAL: For depression, an oral dose of 400-1600 mg per day has been used. Doses of 1600 mg per day are the most commonly used in clinical trials. In patients with treatment-resistant depression, 400 mg to 800 mg twice daily in combination with conventional treatment has been used.
SAMe has been available as a dietary supplement in the US since 1999, but it has been used as a prescription drug in Italy since 1979, in Spain since 1985, and Germany since 1989. The potential usefulness of SAMe for treating osteoarthritis was discovered when patients in clinical trials of SAMe for depression noted improvement in their osteoarthritis symptoms.
© Copyright 1995-2013 Therapeutic Research Faculty, publishers of Natural Medicines Comprehensive Database, Prescriber's Letter, and Pharmacist's Letter. All rights reserved.
Orally, SAMe is used for depression, anxiety, heart disease, fibromyalgia, osteoarthritis, bursitis, tendonitis, chronic lower back pain, dementia, Alzheimer's disease, slowing the aging process, chronic fatigue syndrome (CFS), improving intellectual performance, liver disease, and Parkinson's disease. Other uses include premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), attention deficit-hyperactivity disorder (ADHD), multiple sclerosis, spinal cord injury, seizures, migraine headache, chronic lead poisoning, disorders of porphyrin, and bilirubin metabolism.
Intravenously, SAMe is used for treating depression, osteoarthritis, AIDS-related myelopathy, fibromyalgia, liver disease, cirrhosis, and intrahepatic cholestasis.
Intramuscularly, SAMe is injected for fibromyalgia, depression, and Alzheimer's disease.
Safety:
LIKELY SAFE ...when used orally, intravenously, or intramuscularly and appropriately. Serious toxicity has not been reported in multiple clinical studies involving more than 22,000 patients and lasting from a few days to 2 years.
LIKELY EFFECTIVE
Depression. Taking SAMe orally significantly improves symptoms of major depression. Several clinical studies show that taking SAMe is more effective than placebo and appears to be as effective as tricyclic antidepressants in trials lasting up to 42 days. However, some of these studies are limited by small numbers of patients, inconsistent diagnostic criteria, short treatment periods, and potentially flawed study designs.
In patients who don't respond to conventional antidepressants, adding a specific SAMe supplement (SAMe Complete 400 mg, Nature Made) 400 mg to 800 mg twice daily to conventional treatment significantly increases remission rates by about 14% after 6 weeks. About 7 patients need to be treated with SAMe for 6 weeks for one additional non-responding patient to have remission.
Administering SAMe intravenously or intramuscularly, short-term, also significantly improves symptoms of major depression. Several small-scale clinical trials have shown that parenterally administered SAMe is superior to placebo and possibly as effective as intravenous or oral tricyclic antidepressants in studies lasting up to 30 days. In some trials, the antidepressant effect occurred rapidly, within 1-2 weeks of initiation of treatment. This benefit is likely the result of the parenteral route of administration. Parenteral SAMe has been used successfully in combination with an oral tricyclic antidepressant to speed the onset of antidepressant action.
Practice guidelines from the American Psychiatric Association suggest SAMe as a potential alternative to conventional antidepressants (e.g., paroxetine, venlafaxine, etc) for patients with major depression who are interested in using alternative therapies. The Canadian Network for Mood and Anxiety Treatments (CANMAT) also recommends SAMe as an effective option for second line treatment of mild to moderate depression.
Adverse Reactions:
Orally, SAMe is generally well tolerated. Side effects are more common with higher doses and include flatulence, nausea, vomiting, diarrhea, constipation, dry mouth, headache, mild insomnia, anorexia, sweating, dizziness, and nervousness. Anxiety and tiredness have occurred in people with depression, and hypomania in people with bipolar disorder. A case of mania with suicidal ideation has also been reported in an otherwise healthy patient.
There has been some concern that taking SAMe might increase homocysteine levels. SAMe is metabolized to s-adenosylhomocysteine, which can be metabolized to homocysteine. Elevated levels of homocysteine have been linked to cardiovascular and renal disease. However, in a study lasting 4 weeks, administration of SAMe orally in doses titrated up to 1600 mg/day, there was no significant increase in homocysteine levels. In another study, there also was no difference in cardiovascular mortality in people with cirrhosis taking SAMe 1200 mg daily for two years.
When used as an injection, SAMe has caused mania in people with bipolar disorder.
Interactions with Herbs & Supplements:
HERBS AND SUPPLEMENTS WITH SEROTONERGIC PROPERTIES: Theoretically, SAMe might increase the effects and adverse effects of products that increase serotonin levels, including 5-hydroxytryptophan (5-HTP), Hawaiian baby woodrose, L-tryptophan, and St. John's wort.
Interactions with Diseases or Conditions:
BIPOLAR DISORDER: Use of SAMe can cause patients to convert from a depressed state to a hypomanic or manic state.
PARKINSON'S DISEASE: SAMe methylates levodopa, which could theoretically worsen Parkinsonian symptoms. However, this has not been reported in humans.
SURGERY: SAMe might affect serotonin levels. Theoretically, SAMe might interfere with surgical procedures due to serotonergic central nervous system effects or serotonergic effects on the vascular system. Tell patients to discontinue SAMe at least 2 weeks before elective surgical procedures.
Dosage/Administration:
ORAL: For depression, an oral dose of 400-1600 mg per day has been used. Doses of 1600 mg per day are the most commonly used in clinical trials. In patients with treatment-resistant depression, 400 mg to 800 mg twice daily in combination with conventional treatment has been used.
SAMe has been available as a dietary supplement in the US since 1999, but it has been used as a prescription drug in Italy since 1979, in Spain since 1985, and Germany since 1989. The potential usefulness of SAMe for treating osteoarthritis was discovered when patients in clinical trials of SAMe for depression noted improvement in their osteoarthritis symptoms.
© Copyright 1995-2013 Therapeutic Research Faculty, publishers of Natural Medicines Comprehensive Database, Prescriber's Letter, and Pharmacist's Letter. All rights reserved.
