Depression is a common mental health disorder and even though medications are available for treatment, the majority of patients develop either disturbing side effects or resistance. In most cases, the antidepressant fails to work over the long term. Now finally there is a study that shows that use of S-adenosyl methionine (SAMe) with an SSRI can help improve outcome in chronically depressed patients. SAMe has been around for more than 30 years and is well known for its long term anti depressant effects. However, its short-term benefits were known until recently.
So far, treatment of resistant depression has been a challenge. Many drugs and supplements have been tried out in the past but the results have been abysmal. The recent trial with SAMe showed significant improvements in depression compared to previous therapies. SAMe was also found to be well tolerated. Of the side effects, a few patients did develop slightly elevated blood pressure that researchers feel is of medical significance
In the last decade, many isolated reports have suggested that SAMe may be effective as monotherapy for depression but this is the first controlled study showing that SAMe can be used as adjunctive therapy. How SAMe works is not known but there is speculation that it affects certain brain neurotransmitters.
A few patients with depression have been found to have low levels of SAMe in the cerebrospinal fluid, but this is not a universal finding and bears no correlation to severity of depression. However, some researchers have shown that an increase in SAMe correlates well with depression. SAMe concentrations also appear to increase in some patients who do respond to the tricyclic antidepressant, desipramine.
SAMe is well tolerated and the labels in health food stores do carry a warning that it may induce mania in bipolar patients. Even though SAMe is readily available as a dietary supplement, its synthesis is not easy. The majority of formulations of SAMe tested in the last decade have shown that many products contain less than the stated amount of the supplement.
Additionally SAMe is also prohibitively expensive. A month's supply can cost anywhere from $140-$200 and there is no guarantee that it contains the right dosage. Moreover, SAMe is not covered by Medicare or medical insurance.
Long-term data on safety of SAMe are not available but from what is known over the past 30 years, the supplement appears to be safe. SAMe has also been shown to have moderate pain relieving activities. There are countless reports from arthritic patients that the supplement does work well for pain relief. For depression, the dose of SAMe is between 800-1600 mg per day. Optimal dosage or the safe upper limits have not yet been determined.
The era of making novel pharmaceutical drugs based on amine uptake inhibition appears to have come to an end. The focus now is to search for natural supplements that may help boost the effects of the available drugs. Even though this study showed that SAMe may help reverse resistant depression, more studies are required to confirm these findings. Individuals who are thinking of buying SAMe from health stores need to make sure that they buy from a reputable store because fakes and counterfeit supplies continue to infiltrate the health supplement market.
http://ajp.psychiatryonline.org/cgi/content/full/167/8/889