SAMe – An Alternative or Adjunct to Antidepressants

Last issue I wrote an article about long-term antidepressant use and how side-effects may impact our ability to initiate or maintain an intimate relationship. The main theme of the article centered on the chemical changes in the brain that occur due to antidepressant use which may affect our ability to fall in love and stay in love. (Watson, 2012)

Clinical studies show that antidepressants will improve mood and decrease depression up to 50% or more.  This increase can take a person who is not functioning to a functioning level (e.g. a person not able to work can now go back to work).  However, the optimal state is to be at 100% remission of symptoms. Lingering symptoms of depression take the joy out of life and also increase relapse of depression.  (Fava, 2006) So even taking an antidepressant doesn’t ensure that you will be relieved of all your depressive symptoms. I believe it is reasonable to expect full recovery from your depressive symptoms. With that expectation comes the encouragement that you should seek out whatever treatment you need to arrive at a state where you enjoy life and feel good the majority of the time.

SAMe, also known as S-adenosylmethionine, could be an alternative to consider instead of or as an adjunct with an antidepressant medication. SAMe is a supplement that has been a mainstreamed antidepressant in my many European countries for over 20 years. Fourteen countries have approved it as a drug.  SAMe doesn’t have the adverse effect, even in high doses, that antidepressants often have, which gives us clear reasons to consider its use. And the good news about SAMe is that the FDA has ranked it as safe enough in the United States for sale over the counter without a prescription.  Although this means the FDA has not approved it, there have been numerous studies over the past 20 years in these other countries which show that SAMe can be a viable option in the treatment of depression. (Cowley & Underwood, 1999)

SAMe is not an herb or a hormone.  It is a molecule that all living cells, including our own, produce constantly. SAMe has been found to enhance the mood-elevators in our system such as serotonin and dopamine. SAMe may either regulate their break down, speed up the production of the receptor molecules they latch on to, or make existing receptors more responsive.  Regardless of how it happens, there is good evidence that SAMe can help fight depression.  In 40 clinical studies involving 1400 patients, it was found that “the efficacy of SAMe in treating depressive syndromes . . . is superior (to) that of a placebo and comparable to that of standard . . . antidepressants.” (Cowley & Underwood, 1999)

Although no study has found SAMe significantly more effective than a prescription antidepressant, they have found it to be clearly less toxic. Typical side effects of antidepressants can include headaches, diarrhea, agitation, sleeplessness, sexual dysfunction and weight gain. The side effects of SAMe may include a mild stomach upset and, like antidepressants, may trigger manic episodes in people with bipolar disorder.

Usual oral dosage of SAMe is between 800 and 1600 mg per day. SAMe is activating, therefore, it helps to energize patients whose depression includes symptoms of low energy, tiredness, low motivation, and hypersomnia. It is best if taken 20-30 minutes before meals or 2 hours after a meal so the stomach is empty.  Because it is activating, it is best not taken later in the day as it may interfere with your sleep.  Also, because it is activating, it can occasionally exasperate anxiety, panic, or agitation.  It may be that starting on a low dosage for a few days and then slowly increasing that dosage after the level is tolerated will prove helpful.

Finally, low levels of B vitamins have been found to be associated with those that have depression. Adding 1,000 mcg/day B12, 800 mcg folate, and 50-100 mg/day B6 will enhance the antidepressant effects of SAMe and other antidepressant medications. (Brown, Gerbarg, & Muskin, 2009)

The drawback of using SAMe is its cost.  Prices range from $20 to $60 for a package of 20 tablets, 400 mg. which can make the higher doses costing $148 per month. But if this proves to be cost prohibitive, SAMe can be used as an adjunct with your antidepressant, requiring a smaller dosage in conjunction with a reduced dose of the prescription antidepressant. This would be helpful for reducing side effects of the prescription antidepressant to a more tolerable level as you add a more affordable dose of SAMe.  (Brown, Gerbarg, & Muskin, 2009)

Obviously, all of this needs to be investigated and researched by your best advocate:  you; if you decide you want to try this, talk to your doctor to set up options for incorporating SAMe into your health care regimen.  And whether you are on an antidepressant, or not, consider daily use of the B Vitamins to prevent depression or to help you out of depression.  Take charge of your health care as it is reasonable to expect a full remission from depression.

Works Cited

Brown, R. P., Gerbarg, P. L., & Muskin, P. R. (2009). How to use herbs, nutrients & yoga in mental health care. New York: W.W. Norton & Company.

Cowley, G., & Underwood, A. (1999, July). Newsweek. Retrieved January 13, 2012, from biopsyciatry.com.

Fava, M. (2006). Pharmacological approaches to the treatment of residual symptoms. Journal of Psychopharmacology , 20.

Nelson, C. M. (2012, August 1). S-Adenosyl methionine (SAMe) augmentation in major depressive disorder. Retrieved January 13, 2012, from Psychiatryonline. American Journal of Pscyhiatry.

Watson, J. P. (2012). Can using antidepressants make a person fall out of love? Wholeness Healing Today , 3.

Tags: SAMe, SAMe – An Alternative or Adjunct to Antidepressants, SAMe as an adjunct with an antidepressant, SAMe versus an antidepressant