How fast does same work

Several years ago, when Sandy Cooper felt her major depression return, she was dreading going back on Lexapro. She had stopped taking the antidepressant more than a year before, after it led her to gain more than 20 pounds in a few months. Still, Cooper, of Louisville, Kentucky, knew she needed to do something to counter the weepiness, irritability, fatigue, and feelings of hopelessness that had begun to overtake her. She felt encouraged when an online search led to her discovery of SAMe, a natural supplement.

And she was even more excited when, after buying a box over the counter at Target, she started feeling better in a couple of weeks. She stayed on the supplement for months, until she felt well enough to work on staying healthy via lifestyle changes, something she was familiar with as a blogger helping women maintain balance in their lives.

Its effectiveness for depression stems from its key part in the physiological process known as methylation, which turns our biological switches on and off.

According to a review of the research on SAMe published in the Journal of Clinical Psychiatry , methylation has been documented to be a factor in depression. Still, researchers are in the early stages of fully understanding exactly how SAMe and other methyl-group chemicals work. What they do know is that preliminary studies of SAMe for depression have been encouraging. The experts we spoke to for this story are especially high on this remedy now that a high-quality version has returned to the US market after a long lull.

As with the better-known herb St. Stonnington, psychiatrist and chair of the department of psychiatry and psychology at the Mayo Clinic College of Medicine and Science. Nineteen studies compared the chemical to a placebo, while 21 tested it against prescription antidepressants.

That launched his investigation and clinical use of SAM-e. Since then, SAM-e "has been evaluated for various disorders in more than 75 clinical trials involving over 23, people," Brown said. However, the first clinical study of SAM-e's use for depression was not completed until the s Agnoli et al.

Brown explained that SAM-e is produced in the body from methionine, a sulfur-containing amino acid, and the energy-producing compound adenosine triphosphate. SAM-e is a physiologically essential compound, he said, adding that some chemists believe it ranks with adenosine triphosphase ATP as a pivotal molecule in living cells. Distributed throughout the body, SAM-e is most concentrated in the brain and liver and is crucial to three central pathways of metabolism that stimulate more than 35 different reactions.

This process probably contributes to the antidepressant action" Andreoli et al. Brown said that donation of carbon groups by SAM-e protects catecholamine neurons and that SAM-e improves nerve cell membrane uptake of phospholipids, enabling the coupling of protein receptors to second messengers within a more fluid lipid bilayer and enhancing transmission of impulses by neurons. Moreover, the form of SAM-e found in food is not stable.

It oxidizes too rapidly to absorb well. Our bodies can only generate a small amount of SAM-e Therefore, SAM-e levels are most easily increased through dietary supplementation.

According to Brown, lower than normal levels of SAM-e are found in cerebral spinal fluid in some patients with depression, Alzheimer's disease, dementia, Parkinson's disease treated with levodopa Atamet, Sinemet , disorders of folate metabolism and other illnesses Bottiglieri et al.

In , American psychopharmacologists Bell and colleagues conducted a double-blind, randomized, two-week trial comparing IV SAM-e to oral imipramine. Since , double- and single-blind studies using higher doses of SAM-e have shown it to be effective in treating major depression Bressa, ; Delle Chiaie and Boissard, ; Delle Chiaie et al.

Both groups were comparably improved by week 6" De Vanna and Rigamonti, He added that the longest controlled-trial studies of SAM-e efficacy for depression were 42 days Delle Chiaie et al. Brown noted that American companies only sell SAM-e in 50 mg, mg and mg tablets.

He recommended a daily dose of mg for mild depression. This can be switched to mg before breakfast after a few weeks. Brown continued, "As with most medications, clinical sense indicates starting with lower doses in geriatric, medically ill and anxious patients. SAM-e, like all antidepressants, should be used with some caution in patients with a history of cardiac arrhythmia. He stressed that there have been surprisingly little data on the use of SAM-e in pregnancy and that the patient should "make a decision about SAM-e and pregnancy and lactation after discussing the pros and cons [with her doctor].

SAM-e has been used to treat cholestasis of pregnancy in numerous studies with no adverse effects on mothers or children, Brown said. However, there are no definitive prospective long-term studies to exclude the possibility of teratogenic or neurodevelopmental effects Brown et al. He added that since high levels of SAM-e are normal for infants, it is unlikely they would be harmed by the amount of SAM-e received through breast-feeding.

In several depression studies, SAM-e induced mania in a significant proportion of patients who had a prior history of bipolar disorder De Vanna and Rigamonti, ; Kagan et al. Treatment for severe depression, Brown said, generally requires higher doses. Side effects occurring at the higher doses include mild jitteriness, loose bowels and headaches. To date, SAM-e has not been systematically studied in well-defined samples of psychotic or bipolar depressed patients-Ed.

Brown noted that SAM-e is generally available in two forms: a butanedisulfonate form and a tosylate form. That is a relatively low rate compared to placebo discontinuation rates. In study after study, the investigators said there was no difference from placebo in the side effect rate. The biggest study of SAM-e, Brown said, was a two-year postmarketing study of 20, patients conducted in Germany after SAM-e was approved for treatment of osteoarthritis Berger and Nowak, At higher doses, there are some "mild, temporary side effects.

Reports of drug interactions have been nearly nonexistent, according to Brown. He mentioned a case report of an elderly woman who was given clomipramine together with SAM-e.

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