SAMe (pronounced “sammy”) is the abbreviation for a molecule already made by your body, S-adenosylmethionine. Some good clinical studies have shown that SAMe supplements are effective for three seemingly unrelated conditions: depression, arthritis, and liver disease.
SAMe became the hot new supplement a few years ago when it was favorably reviewed as a potential alternative to both conventional antidepressants and the NSAID (aspirin-like) family of pain medications for arthritis. It’s quite safe and free of side effects, works quickly, and can be used in combination with other medications and supplements.
The major downside to SAMe is the price, which at the doses recommended costs about $60 a month. But if you’re reluctant to use a conventional prescription antidepressant, SAMe might be very helpful for you because it is effective.
How it works
Many metabolic processes throughout the body require the presence of a molecular structure called a methyl group in a chemical reaction called transmethylation. This methyl group contributes to the manufacture of a long list of hormones, neurotransmitters, and proteins.
Conventional antidepressants and the herb St. John’s wort raise levels of serotonin (and other neurotransmitters) by blocking the recycling mechanism in which “used” serotonin is returned to brain cells, thus leaving more active serotonin to keep mood up.
By comparison, SAMe simply helps the brain make more serotonin by speeding up the manufacturing process of three neurotransmitters: serotonin, dopamine, and norepinephrine. It’s this effect on boosting neurotransmitters that’s prompted SAMe research into depression, anxiety, fibromyalgia, chronic fatigue, and even Alzheimer’s disease.
Regarding SAMe’s role in arthritis and liver disease: SAMe is a natural anti-inflammatory, a nutrient that helps restore the capacity of the liver to detoxify, and an essential molecule in cartilage growth and repair.
What it’s used for
Based on good clinical trials, European physicians regularly prescribe SAMe for both depression and osteoarthritis pain. In my own practice, I mainly use SAMe (along with St. John’s wort and 5HTP) for mild to moderate depression and other Triple Whammy disorders like anxiety, fibromyalgia, and chronic fatigue syndrome. I also recommend SAMe for arthritis in combination with such natural products as glucosamine sulfate, chondroitin sulfate, and turmeric.
What to buy
You need to look for coated tablets (sometimes called enteric tablets) because SAMe is a delicate molecule that can be destroyed by stomach acid. Read the label carefully. There are two forms of SAMe: tosylate and butanedisulfonate. It’s the second of these you want because it contains more active SAMe and has a longer shelf life. SAMe comes in 200-mg and 400-mg tablets. Since most studies using SAMe were in the range of 800 mg to 1,200 mg per day, you’ll save considerable money by purchasing the 400-mg tablets
How to take it
You must take SAMe on an empty stomach for best absorption. This means taking it either one hour before a meal or two hours afterward. I suggest you take two 400-mg doses daily, one immediately on waking and the second midway between lunch and dinner. This is the dose for treating depression and arthritis, and for liver detoxification. Don’t take SAMe in the evening as it may interfere with sleep.
Generally SAMe is very well tolerated. The most common reported side effects are with high doses—more than 1,200 mg—and include mild upset stomach, gas, and bloating. Like other antidepressants, if SAMe is taken by a person with bipolar disorder, it may trigger agitation and a hypomanic state.
Reasons not to take
SAMe can be safely used with other natural treatments for depression, like St. John’s wort and 5HTP. However, high doses of SAMe (more than 1,600 mg per day) when combined with high doses of prescription SSRI antidepressants may result in too much serotonin. Symptoms of this so-called serotonin syndrome include anxiety, agitation, and tremors.
We carry SAMe in our natural apothecary. Call or visit our apothecary store to order one.
David Edelberg, MD