What is SAM-e?

SAM-e (pronounced "sammy") is short for S-adenosylmethionine and has become a big seller in the supplement industry. The compound supposedly eases the symptoms of both depression and osteoarthritis, a combination punch that no prescription drug can match. Even if you've never swallowed a SAM-e supplement, the compound is hard at work in your body. SAM-e, which forms naturally when the amino acid methionine combines with the energy-producing molecule ATP, helps build proteins, hormones, fatty acids, nucleic acids, and other crucial substances. Doctors in Europe regularly prescribe SAM-e, but until recently it received little attention in the United States. Since its introduction to the U.S. in February 1999, SAM-e has been regarded by some as a "miracle" drug, but critics charge that it doesn't live up to the hype.

Does SAM-e really ease depression?

This is still under debate, though studies look promising. Harvard researchers reviewed the small number of studies done to date and found that SAM-e was as effective as prescription antidepressants in relieving depression. They cautioned, however, that the effective dose of the substance has yet to be determined. They suggested that more studies be done to compare SAM-e to new antidepressants on the market and to identify the optimal dosage.

Can SAM-e help treat arthritis?

Results are promising: For easing the pain and inflammation of osteoarthritis, studies suggest that SAM-e may be as powerful as standard nonprescription drugs. In an Italian study of 734 patients with osteoarthritis of the hip, knee, spine, or hand, 1,200 mg of SAM-e per day was as effective as 750 mg of naproxen. And in a German survey of more than 20,000 patients taking SAM-e for osteoarthritis, 71 percent reported "very good" or "good" improvement in joint discomfort. The Arthritis Foundation recently endorsed SAM-e as an effective pain reliever, although it doesn't support the claim that it contributes to "joint health." The organization also recommends that you only take SAM-e under your doctor's supervision, and suggests taking supplemental B vitamins (800 mg of folic acid and 1,000 mg of B12 a day) to help your body get the most benefit from SAM-e.

If you decide to try SAM-e for arthritis, don't expect to see results right away. Findings from the German survey indicate that most people need to take the supplement for at least two weeks before noticing any improvement, and it usually takes at least a month to experience the full benefits.

Is SAM-e safe?

Compared to the standard medications for depression and arthritis, SAM-e is relatively free of side effects. It won't cause sexual dysfunction or insomnia the way some antidepressants can, and it won't give you ulcers associated with aspirin, ibuprofen, and naproxen. Still, SAM-e can cause problems, including gas, nausea, and headache. It may also cause anxiety in people suffering from depression. People who have manic-depressive disorders shouldn't take SAM-e because it can trigger episodes of mania, according to Dr. Maurizio Fava, the director of the clinical depression and research program at Massachusetts General Hospital.

There may be other side effects as well. The University of California's Berkeley Wellness Letter cautioned that SAM-e converts to homocysteine in the body, and high levels of homocysteine may raise the risk of heart disease. For that reason, they suggest that if you take SAM-e, you also take a multivitamin and be sure your diet is rich in fruits and vegetables -- elements in these foods can help lower your homocysteine levels.

Finally, researchers at the University of Pittsburgh Medical Center who reviewed all of the existing information on SAM-e advised that it "is not without risk of more significant psychiatric and cardiovascular adverse events." Because of these risks and the lack of information on the long-term effects of taking SAM-e, the University of Pittsburgh report suggests that it only be used under a doctor's supervision.

How is it taken?

SAM-e comes in pill form, and the recommended dosages vary depending on the condition and its severity. (A typical dose for depression is 1600 mg a day; a typical dose for osteoarthritis is between 600 and 1200 mg a day.) SAM-e is an unstable compound that may disintegrate rapidly if it's not stored properly. SAM-e isn't regulated by the FDA the way a drug is, so there's no guarantee that it will be handled properly by the manufacturer and shipper to arrive in your local drugstore intact. Higher-quality brands are coated and individually stored in blister packs. Be careful of cheaper versions because they may not contain enough, or any, of the substance. Consumer Reports tested 12 brands of SAM-e and reported their findings in the December 2000 issue of the magazine: eight brands had more SAM-e than indicated on their labels, and four brands had less. Only half of the brands were coated, which is an important step to prevent deterioration.

What's the final verdict on SAM-e?

The jury is still out. While SAM-e shows some promise as a tool to combat depression and the pain of arthritis, the long-term effects of this powerful compound aren't known. If you're thinking about trying SAM-e, talk to your doctor first to make sure you have all the facts you need to make the decision that is right for your health.

References

Wellness Guide to Dietary Supplements. UC Berkeley Wellness Letter, January 2000.

SAM-e. The Mood Disorders Support Group of New York City. Updated December 31, 2001.

Fetrow CW, Avila JR. Efficacy of the dietary supplement S-adenosyl-L-methionine. Ann Pharmacother 2001 Nov;35(11):1414-25.

Caruso I, Pietrogrande V. Italian double-blind multicenter study comparing S-adenosylmethionine, naproxen, and placebo in the treatment of degenerative joint disease. Am J Med, Vol. 20;83(5A):66-71

Leslie Knowlton. Investigating SAM-e for Depression. Psychiatric Times. May 2001;18(5).

SAM-e. Health. http://www.health.com/health/wellness/remedies/0,12884,215185,00.html

Mischoulon D, Fava M. Role of S-adenyl-L-methionine in the treatment of depression: a review of the evidence. Am J Clin Nutr, Vol. 76(5):1158S-61S.

SAM-e. Arthritis Today. Arthritis Foundation. http://www.arthritis.org/resources/arthritistoday/2000_archives/2000_01_02_sam_e.asp

Najm WI, et al. S-Adenosyl methionine (SAMe) versus celecoxib for the treatment of osteoarthritis symptoms: a double-blind cross-over trial. BMC Musculoskelet Disord. 2004 Feb 26;5(1):6.

SAM-e. Arthritis Today. Arthritis Foundataion. July 18, 2007. http://www.arthritis.org/sam-e.php

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