SAMe (S-adenosyl-L-methionine)

CAM (involved in production of serotonin, norephinephrine, dopamine)

Dosing

Depression (400-1600 mg/d). Start 400mg in am x7days then 800mg in am. Take on an empty stomach to improve absorption.

$40-100/month

Management

In depression, works as augmentation or monotherapy, and relieves sexual SE of SSRI. Also good for Parkinson’s disease, dementia (improves cognition), HIV, osteoarthritis, fibromyalgia, and liver disease (alcoholic/viral hepatitis, cirrhosis, and cholestasis).

Main problem is that the pills are fragile (must be enteric coated and blister packed) and even when stable have low bioavailability (only 1% absorbed). This is probably why there are negative trials, and better to use the more reliable l-methylfolate (which operates through a similar mechanism).

TOLERABILITY: No problems.

RISKS: Mania.

EMR Text