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From April '99 Ask the Expert... Q. I heard a brief mention of a new drug to treat depression. It was reported to have negligible side effects, and was called something like "Sammy." Can you tell me more about it? A. You may be thinking of S-adenosyl-L- methionine (SAM). This is an active form of the amino acid methionine, and it acts as a "methyl donor" in a variety of biochemical pathways. (A methyl group consists of one carbon and three hydrogen atoms.) SAM may boost the activity of several brain chemicals involved in mood, such as norepinephrine and dopamine. In some studies, SAM has shown antidepressant effects equivalent to those of the old tricyclic agents, and it is also capable of precipitating manic reactions in some patients. For more details, see Baldessarini et al, American Journal of Medicine 1987;83:95-103, and Carney et al, British Journal of Psychiatry 1989;154:48-51. http://www.mhsource.com/expert/exp1041299b.html Question: What is SAM-e? Is it a drug? or a supplement? (whatever that means) Answer: (from Walgreens site) SAM-e (S-adenosylmethionine) is a naturally occurring compound found in all living organisms. In humans, SAM-e is distributed throughout the body and is involved in many important biochemical reaction. SAM-e is critical in the manufacture of joint cartilage and in the maintenance of neural cell membrane function. Because significant amounts of SAM-e are not readily available through the diet, the body is responsible for making its own SAM-e. Scientists know that certain groups of people, including the elderly, have low levels of SAM-e in their bodies. Numerous clinical studies involving thousands of people indicate that supplementation with SAM-e supports and promotes the health of a multitude of body functions including: Joint health, mobility and joint comfort. Mood and emotional well-being. Liver health. SAM-e is popular in Europe where doctors have administered it for over 20 years. The benefits of SAM-e have been demonstrated by its long term use. Actimet, the stable and bio-available form of SAM-e, is now available in the U.S. mass market as a dietary supplement - only form Nature Made. Short and long term clinical studies show that SAM-e is a very safe and non-toxic product in levels of supplementation of up to 1,600 mg a day. Instructions Take 1 tablet twice a day. Some people may achieve additional benefits with a higher level of supplementation. The best time to take SAM-e is on an empty stomach at least 30 minutes before a meal. See package insert for more specific information. Ingredients S-adenosylmethionine 1, 4-butanedisulfonate, Cellulose, Sodium Starch Glycolate, Methocrylic Acid Copolymer, Talc, Polyethylene Glycol, Silica, Magnesium Stearate, Polysorbate 80, Sodium Hydroxide, Iron Oxide, Simethicone http://www.walgreens.com/store/product.jhtml?PRODID=352229&CATID=100183 Above is the "economical" variety... Walgreens also has... Finest SAM-e, 200 mg at twice the price... Walgreens offer this Disclaimer... This statement has not been evaluated by the Food & Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease. And... Walgreens-Brand Guarantee: Your Satisfaction is 100% guaranteed on all Walgreens-brand products! If you are not completely satisfied, return the unused portion and we will refund the full price, regardless of quantity returned. You can buy it on-line... http://www.walgreens.com/default.jhtml Question: Has it been tested (peer reviewed study with double blind etc.)? Answer: SAMe is an extraordinarily expensive supplement at present. Full dosages can easily cost more than $200US per month. But Walgreens appears to have it for 80 cents a day...? And... Nutralife SAM-e contains 200mg SAM-e Kosher supplement... 60 caplets ... Now for Only $26 Wholesale.... http://www.bwell101.com/samenutralife.htm That's only $26 bucks a month... 400mg. / day Or... $104 bucks a month ... 1600mg. / day They did say "very safe and non-toxic product in levels of supplementation of up to 1,600 mg a day" didn't they? An isn't more always better? Say what? Manic? And... Hey! Has it been tested??? Well... In 1999 Dr. Brown said... http://more.abcnews.go.com/sections/living/inyourhead/allinyourhead_36.html AND... "SAMe can help fight depression. Since the 1970s, researchers have published 40 clinical studies involving roughly 1,400 patients. And though the studies are small by FDA standards, the findings are remarkably consistent. In 1994 Dr. Giorgio Bressa, a psychiatrist at the University Cattolica Sacro Cuore in Rome, pooled results from a dozen controlled trials and found that "the efficacy of SAMe in treating depressive syndromes... is superior [to] that of placebo and comparable to that of standard... antidepressants." This isn't the first natural substance to show promise as a mood booster. Small studies suggest that St. John's wort can ease low-grade melancholy, but SAMe has been tested against far more serious disorders. In one of several small U.S. studies, researchers at the University of California, Irvine, gave 17 severely depressed patients a four-week course of SAMe (1,600 mg daily) or desipramine, a well-established antidepressant. The SAMe recipients enjoyed a slightly higher response rate (62 percent) than the folks on desipramine (50 percent). No one has found SAMe significantly more effective than a prescription antidepressant, but it's clearly less toxic. The drugs that predate Prozac (tricyclics and MAO inhibitors) can be deadly in overdose, or in combination with other medications. Newer antidepressants, such as Prozac, Zoloft and Paxil, are less dangerous, but their known side effects range from headaches and diarrhea to agitation, sleeplessness and sexual dysfunction. And SAMe? Studies suggest that like other antidepressants, it may trigger manic episodes in people with bipolar disorder. Aside from that, the most serious side effect is a mild stomach upset." http://www.biopsychiatry.com/sameart.html The Natural Pharmacist: TNP Encyclopedia: SAMe http://www.tnp.com/encyclopedia/substance/212/ Other Proposed Treatments for Parkinson's Disease Three natural treatments have been studied for use in depression or dementia accompanying Parkinson's disease. In addition, several other treatments have been suggested for prevention or treatment of Parkinson's disease as a whole. SAMe Whether a symptom of the disease or a response to disability, depression affects many people with Parkinson's disease, and long-term use of levodopa may contribute to this problem. Research suggests that levodopa can deplete the brain of a substance called S-adenosylmethionine (SAMe for short).14,15 As SAMe has been found in a number of small studies to have antidepressant effects,16 it is possible that depleting it might trigger depression. Researchers conducted a trial to determine if taking SAMe supplements could decrease depression in 21 individuals with Parkinson's disease who were taking levodopa.17 In this double-blind study, each participant received either a combination of oral and injected SAMe or placebo daily for 30 days, followed by the alternate treatment for another 30 days. Although other symptoms of Parkinson's didn't change, 72% of people taking SAMe felt that their depression was improved after 2 weeks, while only 30% noted improvement with placebo. It is not yet known if oral SAMe alone would have similar effects. Although SAMe might appear to be an excellent accompaniment to levodopa, there is another side to the issue. During treatment with levodopa, SAMe participates in breaking it down and gets used up in the process. It is possible that taking extra SAMe could lead to decreased effectiveness of levodopa.18 In the short-term study described above, SAMe did not interfere with levodopa's effects, but longer-term use might do so. The bottom line: If you have Parkinson's disease, it's safest to use SAMe—if at all—only under the supervision of a physician. The dose in this study was 400 mg of oral SAMe twice a day along with a daily SAMe injection of 200 mg. When oral SAMe is used by itself for other conditions, it is typically taken in dosages of 400 mg 3 to 4 times per day. This regimen may easily exceed $200 a month. In order to reduce costs, some people take this dosage for a few weeks, then try decreasing it. As little as 200 mg twice daily may suffice to keep people feeling better once the full dosage has "broken through" the symptoms. 14. Liu X, Lamango N, Charlton C. L-dopa depletes S-adenosylmethionine and increases S-adenosyl homocysteine: Relationship to the wearing-off effects [abstract]. Soc Neurosci Abstracts 1998;24:1469. 15. Bottiglieri T, Hyland K, Reynolds EH. The clinical potential in ademetionine (S-adenosylmethionine) in neurological disorders. Drugs. 1994;48:137–152. http://www.tnp.com/encyclopedia/condition/260/190/ For a discussion of safety issues regarding SAMe, see the full article. http://www.tnp.com/encyclopedia/substance/212/ The bottom line: If you have Parkinson's disease, it's safest to use SAMe—if at all—only under the supervision of a physician. And.. $200US = $300Can. (actually more...) Yikes! (now, that's depressing...) Cheers ...... murray [log in to unmask] ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn