From Dr. Weil.com
Today's Question
Is 'Sammy' the Solution for Depression?
What do you know about S-adenosylmethionine (SAMe), the new over-the-counter supplement for mood enhancement? Can it be combined with St. John's Wort?
-- Kate
Today's Answer
(Published 09/16/1999)
S-adenosylmethionine, a dietary supplement better known as SAMe (pronounced Sammy), is generating extraordinary media attention as a new treatment option for depression, arthritis, and perhaps, some liver disorders. SAMe contains a compound that all living cells produce. The compound -- an important player in a molecular process called methylation -- helps neighboring organs and tissues by transfering one molecule, which contains a package of four atoms, to an adjacent molecule. This transfer changes the shape of both molecules and affects several physical processes, including the regulation of some hormones and the neurotransmitters serotonin, melatonin, dopamine and adrenaline (important regulators of mood). It probably won't hurt to try SAMe for mild or moderate depression -- and I know of no reason why you shouldn't combine it with St. Johns Wort. (It should not be combined with monoamine oxidase inhibitors, or MAO inhibitors.) However, the best treatment I know for depression is aerobic exercise, 30 minutes, five days a week.
In Europe, where it is a prescription drug, SAMe is widely used to treat depression. Of the 40 or so scientific studies looking at SAM-e's effect on depression, most suggest it works as well as pharmaceutical antidepressants -- and without the side effects. Another advantage: compared to antidepressant drugs, SAMe works quickly, and patients often feel the effects within a week (antidepressants usually take at least four weeks to kick in). However, while study results are impressive, most of the trials thus far have been small, involving fewer participants than depression drug studies. Bear in mind that, like antidepressant drugs, SAMe doesn't work for everyone. A study from the University of California at Irvine followed 17 severely depressed patients and found the response rate to SAMe was 62 percent compared to 50 percent for the antidepressant desipramine (Norpramin).
One great disadvantage of SAMe is its price -- between $2.50 to $4.50 per 400 mg pill. Look for tablets with enteric coatings which improve absorption, and also go for the new butanedisulfonate form. Be aware, however, that some experts feel none of the brands of SAMe on the market provide enough of the compound in usable form. (And go for the best price -- there's no advantage to buying more expensive products.)
SAMe is also being promoted as an arthritis remedy. A number of studies suggest that it works as well as drugs for pain and inflammation without the serious gastrointestinal side effects (including ulcers and potentially fatal gastrointestinal bleeding) that can occur with drug treatment. There is also scientific data suggesting that SAMe can help normalize liver function in patients with such serious disorders as cirrhosis and hepatitis.
One 400 mg pill per day is considered a sufficient dose for arthritis, but to get an anti-depressant effect you may have to take up to 1,600 mg per day. Take SAMe on an empty stomach.
Dr. Andrew Weil
