News & Perspectives

The SAMe Solution

For some, the holidays can arouse painful memories or heighten feelings of loneliness, bringing on a bad case of the blues. SAMe, a dietary supplement that has been much in the news of late, may offer a natural way of coping with depression, whether it's holiday-related or not. In addition, proponents claim that SAMe can relieve arthritis pain and rejuvenate damaged livers.

Taken for two decades by Europeans as a remedy for depression and arthritis, SAMe (pronounced "sammy," short for S-adenosylmethionine) was introduced in the U.S. in the late 90's. Its supporters maintain this natural supplement can alleviate the symptoms of depression safely and more rapidly than standard antidepressants. And in the case of SAMe, these claims are backed by some convincing data.

SAMe is a naturally occurring compound that regulates the action of key brain chemicals such as serotonin and dopamine, which may play a role in combating depression. It also generates enzymes that may help repair joints and the liver.

SAMe was discovered by Italian scientists in 1952, and much of the research on the compound and its possible benefits has been conducted in Italy and other European countries. Because it's being marketed as a supplement in the U.S., SAMe has not been subjected to the rigorous clinical testing required for FDA approval. However, it has been evaluated over the years as a treatment for depression, arthritis, and certain forms of liver disease in dozens of European trials involving thousands of patients. Approved as a prescription drug in Italy, Germany, Spain, and Russia, SAMe has been given successfully for two decades without producing any significant adverse effects, though mild digestive upset occasionally occurs.

Banishing the blues
Levels of SAMe are lower than normal in many people with depression, and a 1994 study by University of California researchers found that as the symptoms of depression eased, SAMe blood levels rose. Also in 1994, a major review in Acta Scandinavica Neurologica evaluated the results of more than a dozen clinical trials of SAMe for depression. This analysis revealed that SAMe was consistently more effective than a placebo in relieving depressive symptoms and that its efficacy was comparable to that of standard antidepressants. It appears that about 70% of depressed patients respond to SAMe, roughly the same proportion that benefit from treatment with the tricyclics or newer antidepressants such as Prozac.

Two important pluses for SAMe: It doesn't cause the side effects that have been linked to antidepressant drugs, including dry mouth, blurred vision, headache, drowsiness, insomnia, nervousness, and poor sexual function; and it typically works much more rapidly than the prescription drugs. "Most people taking SAMe see some effect within 10 days," says Baylor University's director of neuropharmacology, Teodoro Bottiglieri, Ph.D. By contrast, people often have to take standard antidepressants for several weeks--even a month or more-before the clouds of depression start to lift.

Although those with mild mood problems might well benefit from a trial of SAMe, experts caution that anyone experiencing serious depression should use the supplement only under the supervision of a physician or psychiatrist. In addition, SAMe should not be taken by anyone with manic depression (bipolar disorder), because it may intensify the manic "up" episodes.

Easing arthritis pain
There is also evidence that SAMe can foster joint health by preserving the gellike, shock-absorbing nature of cartilage, and it may even help repair damaged cartilage. That SAMe could relieve more than low spirits became apparent when some individuals who had been taking the compound for depression reported an unexpected bonus--relief from painful and often long-standing symptoms of osteoarthritis.

More than a decade ago, a large trial in Italy found that SAMe was more effective than a placebo, and as effective as the NSAID pain reliever naproxen, in relieving the pain of osteoarthritis. It also appeared to be safer, causing none of the stomach bleeding that occurs in some patients taking NSAIDs.

Protecting the Liver
Ongoing research suggests that SAMe may be effective for liver disease. SAMe is the body's major source of glutathione, sometimes dubbed the "master antioxidant," a substance that detoxifies harmful compounds and helps repair liver damage. By boosting glutathione levels, SAMe protects tissues from damage by oxygen free radicals. For example, a controlled trial in Spain (Journal of Hepatology, 6/99) found that long-term use of SAMe may delay the need for a liver transplant and improve survival rates in patients with alcohol-induced cirrhosis. Some doctors combine SAMe with the herb milk thistle for serious liver ailments; further study is needed.

Easing fibromyalgia
SAMe has also shown promise in treating fibromyalgia. A 1991 European study that compared SAMe with a placebo in 44 fibromyalgia sufferers found the supplement eased symptoms of the disorder, including pain, fatigue, and depression.

Suggested dose: SAMe is sold in 200 mg pills; it is quite costly, ranging from around $1 to $2 per pill. Take twice a day, an hour before breakfast and lunch for best absorption. Also take folic acid (800 mcg a day) and vitamin B12 (1,000 mcg a day) because SAMe will not work when levels of these vitamins are low. Depression: Start with 200 mg twice daily (400 mg a day); gradually increase, if necessary, to 800 or even 1,600 mg a day. Arthritis: 400 to 800 mg a day. Liver ailments:1,200 mg a day. Fibromyalgia: 800 mg a day.

Further reading
Richard Brown, M.D., and Teodoro Bottiglieri, Ph.D., Stop Depression Now (Putnam's, 1999); Sol Grazi, M.D., SAMe (Prima Publishing, 1999)

For More Information
See our feature articles: "Shopping for SAMe: Costly, and It's Not All the Same," "Helpful Supplements for Arthritis," and "Eat, Drink, and Take Milk Thistle."

For an in-depth medical review of specific medical complaints, see our healing paths on Depression, Arthritis, and Fibromyalgia.

Date Published: 01/14/2000
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