SAM-e, like all antidepressants, should be used with some caution in patients with a history of cardiac arrhythmia. He stressed that there have been surprisingly little data on the use of SAM-e in pregnancy and that the patient should "make a decision about SAM-e and pregnancy and lactation after discussing the pros and cons [with her doctor].
SAM-e has been used to treat cholestasis of pregnancy in numerous studies with no adverse effects on mothers or children, Brown said. However, there are no definitive prospective long-term studies to exclude the possibility of teratogenic or neurodevelopmental effects Brown et al. He added that since high levels of SAM-e are normal for infants, it is unlikely they would be harmed by the amount of SAM-e received through breast-feeding. In several depression studies, SAM-e induced mania in a significant proportion of patients who had a prior history of bipolar disorder De Vanna and Rigamonti, ; Kagan et al.
Treatment for severe depression, Brown said, generally requires higher doses. Side effects occurring at the higher doses include mild jitteriness, loose bowels and headaches. To date, SAM-e has not been systematically studied in well-defined samples of psychotic or bipolar depressed patients-Ed. Brown noted that SAM-e is generally available in two forms: a butanedisulfonate form and a tosylate form.
That is a relatively low rate compared to placebo discontinuation rates. In study after study, the investigators said there was no difference from placebo in the side effect rate. The biggest study of SAM-e, Brown said, was a two-year postmarketing study of 20, patients conducted in Germany after SAM-e was approved for treatment of osteoarthritis Berger and Nowak, At higher doses, there are some "mild, temporary side effects.
Reports of drug interactions have been nearly nonexistent, according to Brown. He mentioned a case report of an elderly woman who was given clomipramine together with SAM-e. The patient exhibited symptoms of what the clinicians diagnosed as serotonin syndrome Iruela et al. The investigators attributed it to a "toxic interaction produced by S-adenosylmethionine and clomipramine association. Brown had some misgivings about the case report, however, explaining, "If you look at the world's literature of serotonin syndrome, the preponderance of cases are from clomipramine.
There have been no reports of SAM-e effects on cytochrome P metabolism or on the binding of prescription drugs to serum proteins Brown et al. Research studies Bell et al. Brown described one of his patients who had been tried on all available antidepressants, including tricyclics TCAs , serotonin reuptake inhibitors SRIs , selective serotonin reuptake inhibitors SSRIs , monoamine oxidase MAO inhibitors, combinations of antidepressants and agents used to augment antidepressants, with little or no response.
On this combination, the patient recovered He also cited a randomized double-blind study Berlanga et al. Brown said he has also found SAM-e effective for fibromyalgia Jacobsen et al. It also seems to reverse some effects of alcoholic hepatitis and cirrhosis Mato et al. Brown said accumulated evidence indicates that SAM-e in higher doses is perhaps as effective for major depression as TCAs. Studies show very few side effects, and SAM-e does not cause the sexual dysfunction or weight gain associated with other medications," he said.
Side effects of SAMe are uncommon, and when they do occur they are usually minor problems such as nausea or digestive upsets. More To Consider. Consult your health care provider about using SAMe supplements. Take charge of your health—talk with your health care providers about any complementary health approaches you use. Together you can make shared, well-informed decisions. For More Information. Toll-free in the U. MedlinePlus To provide resources that help answer health questions, MedlinePlus a service of the National Library of Medicine brings together authoritative information from the National Institutes of Health as well as other Government agencies and health-related organizations.
Key References. Carpenter DJ. Alternative Medicine Review. Evidence for the efficacy of complementary and alternative medicines in the management of osteoarthritis: a systematic review. Interventions for treating cholestasis in pregnancy. Cochrane Database of Systematic Reviews. Accessed at www. S-Adenosylmethionine in liver health, injury, and cancer.
Physiological Reviews. SAMe helps produce and regulate hormones and maintain cell membranes. A synthetic version of SAMe is available as a dietary supplement in the U. In some countries in Europe, SAMe is a prescription drug. SAMe can be taken orally, through a muscular injection or by IV.
People generally use SAMe to treat depression, osteoarthritis and liver disease. However, SAMe can also interact with antidepressant medications. SAMe appears to be safe and might be effective in treating depression and osteoarthritis. However, SAMe might interact with antidepressants.
Don't use SAMe and prescription antidepressants together. If you have bipolar disorder, don't take SAMe without talking to your doctor first. The supplement might increase anxiety and mania. If you have a compromised immune system, talk to your doctor before taking SAMe. Still, Cooper, of Louisville, Kentucky, knew she needed to do something to counter the weepiness, irritability, fatigue, and feelings of hopelessness that had begun to overtake her.
She felt encouraged when an online search led to her discovery of SAMe, a natural supplement. And she was even more excited when, after buying a box over the counter at Target, she started feeling better in a couple of weeks. She stayed on the supplement for months, until she felt well enough to work on staying healthy via lifestyle changes, something she was familiar with as a blogger helping women maintain balance in their lives.
Its effectiveness for depression stems from its key part in the physiological process known as methylation, which turns our biological switches on and off. According to a review of the research on SAMe published in the Journal of Clinical Psychiatry , methylation has been documented to be a factor in depression.
Still, researchers are in the early stages of fully understanding exactly how SAMe and other methyl-group chemicals work. What they do know is that preliminary studies of SAMe for depression have been encouraging. The experts we spoke to for this story are especially high on this remedy now that a high-quality version has returned to the US market after a long lull.
As with the better-known herb St.
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