SAM-e News

SAM-e: The antidepressant celebrity

October 14, 1999 - By Ronald Pies, M.D.

(WebMD) -- The world of depression treatment is beginning to look a little like Hollywood these days. First Prozac was the star, splashing across the headlines as the miracle cure everyone was waiting for. Then St. John's Wort stole center stage, touted as a natural cure.

Now that the limitations of St. John's Wort are becoming better known, the public seems to have settled on SAM-e as the new star of the moment.

Derived from a substance naturally occurring in the human body, SAM-e scored some impressive successes against depression in several tests while causing few side effects. That may be why the drug has gained popularity since drug stores started selling it earlier this year.

But while SAM-e has its place in the toolbox of depression treatments, it's no more a miracle cure than its predecessors; like all medicines it has drawbacks. And a lot of important questions remain unanswered.

Not a drug

Part of SAM-e's mystique comes from its unusual origins. Short for S-adenosyl-l-methionine, the U.S. Food and Drug Administration classifies it as a dietary supplement rather than a drug. But that doesn't necessarily mean it's safe to use without a doctor's supervision.

In the body, SAM-e functions as a methyl donor -- a kind of spark-plug for more than 30 chemical reactions. Among these may be the production of certain brain chemicals, such as serotonin, critical in maintaining normal mood. If this turns out to be true, SAM-e has something in common with antidepressant drugs such as Prozac (fluoxetine) and Zoloft (sertraline).

SAM-e for depression

After years of investigating SAM-e, Dr. Richard Brown and colleagues at Columbia University have concluded that SAM-e is safe, virtually free of side effects and at least as effective as some older prescription antidepressants. Many studies suggest that SAM-e works faster than conventional antidepressants, which take at least two or three weeks to boost mood in most patients.

In a 1988 study, for example, Dr. Kate Bell and colleagues at the University of California, Irvine, compared SAM-e to a standard prescribed antidepressant, imipramine. By the end of the second week, 66 percent of the nine patients given SAM-e had improved vs. only 22 percent of the nine imipramine-treated patients.

In many of the studies cited in support of SAM-e's benefits, patients took the medication as intravenous infusions or injections, not the tablets now sold over-the-counter. But the few small-scale studies comparing SAM-e tablets to older (tricyclic) antidepressants have also been favorable for SAM-e.

One of the unanswered questions is how well SAM-e works compared to newer and safer antidepressants, such as fluoxetine, sertraline and venlafaxine (which is marketed as Effexor).

The risks of SAM-e

SAM-e appears to cause fewer short-term side effects than the older antidepressants. Some people have developed headaches when they began taking SAM-e, but these generally disappeared within two weeks. High doses of SAM-e (which are not recommended) sometimes cause diarrhea.

Among the other questions left to answer:

# How might SAM-e affect a developing fetus? A pregnant woman is best off not using SAM-e until more is known.

# How does SAM-e interact with standard, prescribed antidepressants? Some doctors are already prescribing SAM-e in combination with these drugs, but no one has conducted a controlled study to find out if this is safe or effective. SAM-e should not be used with the MAOI class of antidepressants because of a potentially harmful reaction between the two chemicals.

# What effect does SAM-e have on people with bipolar disorder (manic depression) or psychosis? A few doctors have already reported problems.

Should I use SAM-e on my own?

Depression is a complex and potentially life-threatening illness. Before treating yourself with SAM-e, talk to your doctor. Make sure you have ruled out other illnesses that can mimic depression. See a psychiatrist for more severe cases of depression or manic-depressive illness, particularly when psychosis or addiction is involved.

These experts can help you sort out the real benefits of SAM-e from the Hollywood hype.

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