• Ademetionine, S-Adenosylmethionine, SAM
S-adenosylmethionine is quite a mouthful; the abbreviation SAMe (pronounced samm-ee ) is easier to say. Its chemical structure and name are derived from two materials you may have heard about already: methionine, a sulfur-containing amino acid; and adenosine triphosphate (ATP), the body's main energy molecule.
SAMe was discovered in Italy in 1952. It was first investigated as a treatment for depression, but along the way it was accidentally noted to improve arthritis symptoms—a kind of positive side effect.
Unfortunately, SAMe is an extraordinarily expensive supplement at present. Full dosages can easily cost more than $200 per month.
The body makes all the SAMe it needs, so there is no dietary requirement. However, deficiencies in methionine
It's been suggested that the supplement
A typical full dosage of SAMe is 400 mg taken 3 to 4 times per day. If this dosage works for you, take it for a few weeks and then try reducing the dosage. As little as 200 mg twice daily may suffice to keep you feeling better once the full dosage has "broken through" the symptoms.
However, some people develop mild stomach distress if they start full dosages of SAMe at once. To get around this, you may need to start low and work up to the full dosage gradually.
Recently, SAMe has come on the US market at a recommended dosage of 200 mg twice daily. This dosage labeling makes SAMe appear more affordable (if you're only taking 400 mg per day, you'll spend only about a third or a fourth of what you'd pay for the proper dosage), but it is unlikely that SAMe will actually work when taken at such a low dosage.
Weak and inconsistent evidence hints that SAMe might be helpful for a variety of
SAMe has undergone some investigation as a possible supportive treatment for
Highly preliminary evidence suggests that SAMe can protect the stomach against damage caused by alcohol.
What Is the Scientific Evidence for S-Adenosylmethionine?
A substantial body of scientific evidence supports the use of SAMe to treat
For example, a
A more recent double-blind study compared SAMe to celecoxib (Celebrex), a member of the newest class of non-steroidal anti-inflammatory drugs.
Another double-blind study compared SAMe with the anti-inflammatory drug piroxicam.
Similarly long-lasting results have been seen with glucosamine and chondroitin. This pattern of response suggests that these treatments are somehow making a deeper impact on osteoarthritis than simply relieving symptoms. However, while we have some direct evidence that glucosamine and chondroitin can slow the progression of osteoarthritis, the evidence regarding SAMe is more hypothetical.
In other double-blind studies, oral SAMe has shown equivalent benefits to various doses of indomethacin, ibuprofen, and naproxen.
The evidence for SAMe for the treatment of
Several double-blind, placebo-controlled studies have found SAMe effective in relieving depression, but most were small and poorly reported, and many used an injected form of the supplement.
Other trials compared SAMe to standard antidepressants rather than to placebo. The best of these was a 6-week, double-blind trial of 281 people with mild depression that compared oral SAMe to imipramine.
Other studies have also compared the benefits of oral or intravenous SAMe to those of tricyclic antidepressants and have also found generally equivalent results; however, again, poor reporting and inadequacies of study design (such as too limited a treatment interval) mar the meaningfulness of the reported outcomes.
Four double-blind trials have studied the use of SAMe for
Nonetheless, the one double-blind study that used only oral SAMe did find positive results.
It isn't clear whether SAMe is helping fibromyalgia through its antidepressant effects, or by some other mechanism.
Evidence suggests that levodopa (the drug used to treat
SAMe appears to be quite safe, according to both human and animal studies. 52-56
Safety in young children, pregnant or nursing women, or those with severe liver or kidney disease has not been established.
SAMe might interfere with the action of the Parkinson's drug levodopa.
Interactions You Should Know About
If you are taking:
- Standard antidepressants, including MAO inhibitors
5. Frezza M, Surrenti C, Manzillo G, et al. Oral S-adenosylmethionine in the symptomatic treatment of intrahepatic cholestasis. A double-blind, placebo-controlled study. Gastroenterology. 1990;99:211-215.
10. Nicastri P, Diaferia A, Tartagni M, et al. A randomised placebo-controlled trial of ursodeoxycholic acid and S-adenosylmethionine in the treatment of intrahepatic cholestasis of pregnancy. Br J Obstet Gynaecol. 1998;105:1205-1207.
12. Volkmann H, Norregaard J, Jacobsen S, et al. Double-blind, placebo-controlled cross-over study of intravenous S-adenosyl-L-methionine in patients with fibromyalgia. Scand J Rheumatol. 1997;26:206-211.
13. Carrieri PB, Indaco A, Gentile S, et al. S-adenosylmethionine treatment of depression in patients with Parkinson's disease. A double-blind, crossover study versus placebo. Curr Ther Res. 1990;48:154-160.
27. Delle Chiaie R, Pancheri P. Combined analysis of two controlled, multicentric, double blind studies to assess efficacy and safety of sulfo-adenosyl-methionine (SAMe) vs. placebo (MC1) and SAMe vs. clomipramine (MC2) in the treatment of major depression [in Italian; English abstract]. G Ital Psicopatol. 1999;5:1-16.
28. Delle Chiaie R, Pancheri P, Scapicchio P. MC3: multicentre, controlled efficacy and safety trial of oral S-adenosyl-methionine (SAMe) vs. oral imipramine in the treatment of depression [abstract]. Int J Neuropsychopharmcol. 2000;3(suppl 1):S230.
34. Delle Chiaie R, Pancheri P, Scapicchio P. MC4: multicentre, controlled efficacy and safety trial of intramuscular S-adenosyl-methionine (SAMe) vs. oral imipramine I the treatment of depression [abstract]. Int J Neuropsychopharmcol. 2000;3(suppl 1):S230.
35. Mato JM, Camara J, Fernandez de Paz J, et al. S-adenosylmethionine in alcoholic cirrhosis: a randomized, placebo-controlled, double-blind, multicenter clinical trial. J Hepatol. 1999;30:1081-1089.
37. Frezza M, Surrenti C, Manzillo G, et al. Oral S-adenosylmethionine in the symptomatic treatment of intrahepatic cholestasis. A double-blind, placebo-controlled study. Gastroenterology. 1990;99:211-215.
40. Nicastri P, Diaferia A, Tartagni M, et al. A randomised placebo-controlled trial of ursodeoxycholic acid and S-adenosylmethionine in the treatment of intrahepatic cholestasis of pregnancy. Br J Obstet Gynaecol. 1998;105:1205-1207.
46. Volkmann H, Norregaard J, Jacobsen S, et al. Double-blind, placebo-controlled cross-over study of intravenous S-adenosyl-L-methionine in patients with fibromyalgia. Scand J Rheumatol. 1997;26:206-211.
50. Charlton CG, Crowell B Jr. Striatal dopamine depletion, tremors, and hypokinesia following the intracranial injection of S-adenosylmethionine: a possible role of hypermethylation in parkinsonism. Mol Chem Neuropathol. 1995;26:269-284.
51. Carrieri PB, Indaco A, Gentile S, et al. S-adenosylmethionine treatment of depression in patients with Parkinson's disease: a double-blind, crossover study versus placebo. Curr Ther Res. 1990;48:154-160.
63. Pancheri P, Scapicchio P, Chiaie RD. A double-blind, randomized parallel-group, efficacy and safety study of intramuscular S-adenosyl-L-methionine 1,4-butanedisulphonate (SAMe) versus imipramine in patients with major depressive disorder. Int J Neuropsychopharmacol. 2002;5:287-294.
64. Najm WI, Reinsch S, Hoehler F, et al. S-adenosyl methionine (SAMe) versus celecoxib for the treatment of osteoarthritis symptoms: A double-blind cross-over trial. BMC Musculoskelet Disord. 2004;5:6.
Last reviewed April 2009 by EBSCO CAM Review Board
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