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Understanding Depression Slideshow

What other names is SAMe known by?

Ademetionine, Adenosylmethionine, Adénosylméthionine, S-Adenosyl Methionine, S-Adénosyl Méthionine, S-Adenosyl-L-Methionine, S-Adénosyl-L-Méthionine, S-Adenosylmethionine, S-Adénosylméthionine, S-Adenosylmethionine Butanedisulfonate, S-Adenosylmethionine Tosylate, S-Adenosylmethionine Tosylate Disulfate, SAM, SAM-e, Sammy.

What is SAMe?

SAMe is a molecule that is formed naturally in the body. It can also be made in the laboratory. SAMe is involved in the formation, activation, or breakdown of other chemicals in the body, including hormones, proteins, phospholipids, and certain drugs.

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 in Germany since 1989.

SAMe is used by mouth for depression, anxiety, heart disease, fibromyalgia, abdominal pain, osteoarthritis, bursitis, tendonitis, chronic lower back pain, dementia, Alzheimer's disease, slowing the aging process, chronic fatigue syndrome (CFS), improving mental performance, liver disease, and Parkinson's disease. It is also used for attention deficit-hyperactivity disorder (ADHD), multiple sclerosis, spinal cord injury, seizures, migraine headache, lead poisoning, to break down a chemical in the body called bilirubin, or to help with disorders related to the buildup of a chemical called porphyrin or its precursors.

Some women take SAMe by mouth for premenstrual syndrome (PMS) and a more severe form of PMS called premenstrual dysphoric disorder (PMDD).

SAMe is used intravenously (by IV) for depression, osteoarthritis, AIDS-related nervous system disorders, fibromyalgia, liver disease, cirrhosis, and for a liver disorder that occurs in pregnant women called intrahepatic cholestasis.

SAMe is injected as a shot for fibromyalgia, depression, and Alzheimer's disease.

Is SAMe effective?

SAMe can relieve pain and some of the other symptoms of osteoarthritis about as well as aspirin and similar drugs, but it may take twice as long to work. Most people with arthritis need to take SAMe for about a month before they feel better.

There is also scientific evidence that SAMe can relieve depression and some fibromyalgia symptoms.

SAMe also seems to help protect the liver. People with liver disease in the early stages sometimes do better when they take SAMe and might even be able to delay the need for a liver transplant. But people with advanced liver disease are not as likely to be helped by taking SAMe.

There isn't enough information to know if SAMe is effective for the other conditions that people use it for, including: heart disease, bursitis, tendonitis, chronic low back pain, improving intelligence, staying young, multiple sclerosis, spinal cord injury, seizures, migraine headache, and others.

Likely Effective for...

  • Depression. Taking SAMe by mouth, as an injection, or as a shot seems to reduce symptoms of major depression. Several studies have shown that taking SAMe by mouth can be beneficial and might be as effective as some prescription medications used for depression (tricyclic antidepressants). Some research also shows that taking SAMe by mouth might be helpful for people who do not have a good response to a prescription antidepressant. Giving SAMe as an injection or as a shot also seems to improve depression as effectively as some prescription medications used for depression. But lower doses of SAMe (100-200 mg) might not improve depression scores in people with mild to moderate depression when given as an injection or a shot. SAMe should not be taken in combination with a prescription antidepressant without the monitoring of a health professional.
  • Osteoarthritis. Taking SAMe by mouth seems to work about as well as aspirin and similar medications for reducing symptoms of osteoarthritis. But it can take twice as long to start working. Most people with arthritis need to take SAMe for about a month before they feel better.

Possibly Effective for...

  • Symptoms of AIDS-related nerve problems. Taking SAMe intravenously (by IV) seems to improve some symptoms caused by AIDS related to nerve problems.
  • Cirrhosis. Most early research suggests that taking SAMe by mouth or intravenously (by IV) improves liver function in people with chronic liver disease or cirrhosis. But some research suggests that giving SAMe by IV after surgery does not reduce the risk of mild liver dysfunction in patients with cirrhosis who undergo liver resection.
  • Fibromyalgia. Some research suggests that taking SAMe by mouth improves symptoms of fibromyalgia. However, evidence on the use of SAMe intravenously for fibromyalgia is inconsistent. Some research suggests it may reduce symptoms such as pain and number of tender points, while other research shows that it does not.
  • Condition in which the flow of bile from the liver is slow or blocked (Intrahepatic cholestasis). Taking SAMe by mouth or intravenously (by IV) short-term seems to help reduce symptoms of intrahepatic cholestasis. This condition can be caused by acute or chronic liver diseases, as well as pregnancy. SAMe seems to reduce symptoms such as itching, tiredness, and markers of liver damage. In women with intrahepatic cholestasis of pregnancy, SAMe also seems to reduce preterm births better than prescription medications called beta-mimetics, which are given to suppress preterm labor. But SAMe does not seem reduce symptoms of intrahepatic cholestasis better than a prescription medication called ursodeoxycholic acid.
  • Sexual dysfunction. Research suggests that taking SAMe by mouth in addition to antidepressants improves sexual dysfunction in men with depression.

Insufficient Evidence to Rate Effectiveness for...

  • Alcohol-related liver disease. Evidence on the effect of SAMe in alcohol-related liver disease is inconsistent. Some early research shows that taking SAMe by mouth or intravenously (by IV) reduces some symptoms associated with liver disease, such as jaundice and ankle swelling. However, it does not affect some liver function tests or reduce death or complications in people with alcohol-related liver disease.
  • Attention deficit-hyperactivity disorder (ADHD). Research on the effects of SAMe in people with ADHD is not clear. Early research suggests that SAMe might reduce ADHD symptoms in adults. However, other research suggests it does not improve symptoms.
  • Abdominal pain for which there is no obvious cause (Functional abdominal pain). Early research suggests that taking a daily multivitamin and SAMe by mouth might reduce stomach pain in children with functional abdominal pain. But it does not appear to completely eliminate pain.
  • Gilbert syndrome. People with Gilbert syndrome have a lower amount of the protein that normally helps break down a chemical called bilirubin. As a result, too much bilirubin to build up in the body. This can lead to jaundice or other symptoms. Early research suggests that taking SAMe by mouth or intravenously (by IV) might help break down bilirubin in people with Gilbert syndrome.
  • Hepatitis. Early research suggests that taking SAMe by mouth or intravenously improves liver function in people with hepatitis. But most of these studies were small and of low quality.
  • Schizophrenia. Early research suggests that SAMe might reduce aggressive behavior in people with schizophrenia.
  • Blood infection (Sepsis). Early research shows that taking SAMe along with the drug sulodexide reduces the amount of time needed to recover from a septic infection.
  • Quitting smoking. Early research suggests that taking SAMe (Nature Made, Pharmavite LLC, Gnosis, Italy) by mouth does not help people quit smoking.
  • Heart disease.
  • Anxiety.
  • Bursitis.
  • Tendonitis.
  • Chronic low back pain.
  • Improving intelligence.
  • Premenstrual syndrome (PMS).
  • Premenstrual dysphoric disorder (PMDD).
  • Chronic fatigue syndrome (CFS).
  • Multiple sclerosis.
  • Spinal cord injury.
  • Seizures.
  • Migraine headache.
  • Poisoning.
  • Other conditions.
More evidence is needed to rate SAMe for these uses.

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, and Insufficient Evidence to Rate (detailed description of each of the ratings).

Quick GuidePhysical Symptoms of Depression in Pictures

Physical Symptoms of Depression in Pictures

How does SAMe work?

The body uses SAMe to make certain chemicals in the body that play a role in pain, depression, liver disease, and other conditions. People who don't make enough SAMe naturally may be helped by taking SAMe as a supplement.

Are there safety concerns?

SAMe is LIKELY SAFE when taken by mouth, given intravenously (by IV), or when injected as a shot, appropriately. It can sometimes cause gas, vomiting, diarrhea, constipation, dry mouth, headache, mild insomnia, anorexia, sweating, dizziness, and nervousness, especially at higher doses. It can also make some people with depression feel anxious.

Special Precautions & Warnings:

Pregnancy: SAMe is POSSIBLY SAFE when given intravenously (by IV) in the short-term during the third trimester of pregnancy. An 800 mg dose of SAMe has been used intravenously for 14-20 days without any adverse effects. There is not enough reliable information about the safety of taking higher doses of SAMe for longer periods of time or during the earlier trimesters of pregnancy. Stay on the safe side and avoid use.

Breast-feeding: There is not enough reliable information about the safety of taking SAMe if you are pregnant or breast feeding. Stay on the safe side and avoid use.

Children: SAMe is POSSIBLY SAFE when taken by mouth or used intravenously (by IV) in children in the short-term.

Bipolar disorder: Use of SAMe can cause people with bipolar disorder to convert from depression to mania.

Inherited disorder called Lesch-Nyhan syndrome: SAMe might make symptoms of Lesch-Nyhan syndrome worse.

Parkinson's disease: SAMe might make Parkinson's symptoms worse.

Surgery: SAMe might affect the central nervous system. This could interfere with surgery. Stop taking SAMe at least 2 weeks before a scheduled surgery.

Are there any interactions with medications?



Dextromethorphan (Robitussin DM, and others)
Interaction Rating: Major Do not take this combination.

SAMe can affect a brain chemical called serotonin. Dextromethorphan (Robitussin DM, others) can also affect serotonin. Taking SAMe along with dextromethorphan (Robitussin DM, others) might cause too much serotonin in the brain and serious side effects including heart problems, shivering, and anxiety. Do not take SAMe if you are taking dextromethorphan (Robitussin DM, and others).



Medications for depression (Antidepressant drugs)
Interaction Rating: Major Do not take this combination.

SAMe increases a brain chemical called serotonin. Some medications for depression also increase the brain chemical serotonin. Taking SAMe along with these medications for depression might increase serotonin too much and cause serious side effects including heart problems, shivering, and anxiety. Do not take SAMe if you are taking medications for depression.

Some of these medications for depression include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), amitriptyline (Elavil), clomipramine (Anafranil), imipramine (Tofranil), and others.



Medications for depression (MAOIs)
Interaction Rating: Major Do not take this combination.

SAMe increases a chemical in the brain called serotonin. Some medications used for depression also increase serotonin. Taking SAMe along with these medications used for depression might cause too much serotonin in the body, and serious side effects including heart problems, shivering, and anxiety.

Some of these medications used for depression include phenelzine (Nardil), tranylcypromine (Parnate), and others.



Levodopa
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Levodopa is used for Parkinson's disease. SAMe can chemically change levodopa in the body and decrease the effectiveness of levodopa. Taking SAMe along with levodopa might make Parkinson's disease symptoms worse. Do not take SAMe if you are taking levodopa.



Meperidine (Demerol)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

SAMe increases a chemical in the brain called serotonin. Meperidine (Demerol) can also increase serotonin in the brain. Taking SAMe along with meperidine (Demerol) might cause too much serotonin in the brain and serious side effects including heart problems, shivering, and anxiety.



Pentazocine (Talwin)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

SAMe increases a brain chemical called serotonin. Pentazocine (Talwin) also increases serotonin. Taking SAMe along with pentazocine (Talwin) might cause serious side effects including heart problems, shivering, and anxiety. Do not take SAMe if you are taking pentazocine (Talwin).



Tramadol (Ultram)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Tramadol (Ultram) can affect a chemical in the brain called serotonin. SAMe can also affect serotonin. Taking SAMe along with tramadol (Ultram) might cause too much serotonin in the brain and side effects including confusion, shivering, stiff muscles, and other side effects.

Dosing considerations for SAMe.

The following doses have been studied in scientific research:

BY MOUTH:
  • For depression: Up to 1600 mg of SAMe daily in two divided doses for up to 8 weeks has been used alone or together with antidepressant medications. A combination product (DDM Metile, Omeopiacenza, Piacenza, Italy) containing 250 mg of SAMe taken twice daily for 12 months has been used.
  • For osteoarthritis: 600-1200 mg of SAMe daily in up to three divided doses for up to 84 days has been used.
  • For cirrhosis: 600 mg of SAMe daily for one month has been used. A combination 30 mg of SAMe plus 100 mcg of vitamin B12 six times daily for 30 days has been used.
  • For fibromyalgia: 800 mg per of SAMe daily in two divided doses for 6 weeks has been used.
  • For conditions in which bile flow from the liver is slow or blocked (Intrahepatic cholestasis): 500 mg of SAMe taken twice daily until delivery or 1600 mg taken daily in two divided doses for 2 weeks has been used.
  • For sexual dysfunction: 400 mg of SAMe taken twice daily for 2 weeks, then increased to 800 mg twice daily for another 6 weeks, has been used.
BY INJECTION:
  • For depression: 400-800 mg of SAMe has been used intravenously (by IV) for 2-4 weeks. 45-400 mg of SAMe has been injected as a shot daily for 1-4 weeks, with or without antidepressant drugs. 200 mg of SAMe has been injected as a shot daily along with 400 mg taken by mouth in two divided doses for 6 weeks.
  • For osteoarthritis: 400 mg of SAMe has been given by IV daily for 5 days, followed by 600 mg of SAMe taken by mouth in three divided doses for 23 days. 60 mg of SAMe injected as a shot for 7 days has also been used.
  • For cirrhosis: 800 mg of SAMe has been used by IV once daily for 2 weeks, or 250 mg twice daily for 30 days. 1000 mg of a specific product (Transmetil, Abbott SPA) given by IV has been used daily for 7 days. 100 mg of SAMe given as a shot once daily for 30 days has also been used.
  • For fibromyalgia: 400 mg of SAMe given by IV daily for 15 days has been used. 200 mg of SAMe given as a shot daily for 21 days has also been used.
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Reviewed on 3/29/2011 12:35:40 PM

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