Herbs & Supplements

Should I take it?

SAM-e is a chemical that is produced in the body from the metabolism (break down) of methionine, one of the essential amino acids. Amino acids are used by the body primarily to make proteins. Essential amino acids are necessary for body functions, but the body cannot make them--they must be obtained from the diet in foods such as dairy products, fish, meat, and whole grains. Once methionine has been absorbed, enzymes change it into SAM-e, which is found in all cells of the body. In turn, SAM-e breaks down into several chemicals that are involved in a number of basic processes. Some of them maintain the stability and flexibility of cell walls. Others are necessary for the production of essential body components such as hormones and neurotransmitters. Chemicals from SAM-e assist with the processing of dietary fats in the liver and they also act as anti-inflammatory, antioxidant, and pain-controlling agents.

Much of the research on SAM-e has been done in Europe, particularly in Italy, where SAM-e was discovered in the 1950s. Approved as a prescription drug in Italy since 1976 and subsequently in other European countries, SAM-e was not introduced in the United States until the late 1990s. It is a non-prescription oral dietary supplement in this country. Although an ordinary diet usually supplies more than enough methionine to produce adequate amounts of SAM-e, certain groups of individuals, including strict vegetarians and individuals whose immune function has been weakened by chemotherapy or disease, may not produce sufficient amounts. Natural production of SAM-e decreases as individuals age, as well. Commercially available supplemental SAM-e is manufactured from fermented yeasts.

Dosage and Administration

SAM-e is produced within the body by the break down of methionine, which is an amino acid. Known as an essential amino acid because the body needs it to regulate activities such as processing fat in the liver, methionine cannot be made in the body like some of the other amino acids can. It must be taken in the diet or as supplements. Cheese, eggs, fish, meat, milk, nuts, and whole grains are good dietary sources of methionine. Smaller amounts are found in corn, peas, and spinach.

The body's ability to use SAM-e depends on the availability of other chemicals including folic acid, vitamin B6, and vitamin B12. These three ingredients are often included into a single dietary supplement tablet with SAM-e to make dosing easier and to assure adequate supplies of all four components. Most of the supplemental SAM-e available in the United States comes in enteric-coated tablets because SAM-e is not well absorbed when taken orally. Enteric-coated tablets are designed to resist stomach acid and dissolve in the small intestines, where more of the SAM-e may be absorbed. For the same reason, SAM-e is best taken on an empty stomach, at least one hour before a meal.

Although higher doses have been used in studies, the maximum daily dose of oral supplemental SAM-e is generally considered to be 1,600 mg (1.6 grams). Injectable SAM-e generally is more common in Europe than in the United States, although it may be available to American doctors and clinics. Different doses of SAM-e have been used to treat different conditions. Some common recommendations are:

Condition	Oral Dose Range (Daily)	Injected Dose Range (Daily)
AIDS myelopathy	No recommendation	800 mg
Cirrhosis	1200 mg to 1600 mg	No recommendation
Depression	400 mg to 1,600 mg	200 mg to 400 mg
Fibromyalgia	800 mg	No recommendation
Intrahepatic Cholestasis	1600 mg	800 mg
Osteoarthritis	600 mg	400 mg

Note: While some individuals have experienced a lessening of depression as soon as 3 days after beginning to take SAM-e, its full effects may take several weeks to develop.

Summary

A substance that results from the breakdown of the dietary amino acid, methionine by the body, SAM-e has shown effectiveness for relieving depression, treating arthritis, and preventing liver damage. It may also be useful in delaying or preventing the deterioration of mental functioning caused by dementia.

Risks

Individuals with Parkinson's disease should avoid using SAM-e because it may worsen symptoms. Small children and women who are pregnant or breast-feeding are advised not to take supplemental SAM-e, and individuals with bipolar disorder or major depression should use SAM-e only with the advice and supervision of a healthcare professional.

Side Effects

A slightly increased risk of serotonin syndrome--a dangerously high level of serotonin in the blood--may be associated with using SAM-e. Its more common and less serious side effects may include:

• Anxiety
• Constipation
• Diarrhea
• Dizziness
• Headache
• Insomnia
• Nausea
• Sweating

Interactions

SAM-e may increase the chance of developing serotonin syndrome if it is taken with prescription drugs such as SSRI or TCA antidepressants or certain pain-relieving drugs, the non-prescription cough and cold product dextromethorphan, or St. John's wort. The risk of developing side effects including confusion and high blood pressure may be higher if SAM-e is taken within 2 weeks of antidepressants known as MAOIs and related drugs.

Last Revised May 25, 2007