SAM-e: Beat the blues, stop pain and ease fibromyalgia (FM) symptoms
By Stacey Booth •
October 18, 1999
When news of a supplement comes along that promises to lift depression, ease joint pain, reverse toxicity in the kidneys and, last but not least, bring relief from Fibromyalgia, a likely response may be made up of equal parts hope and skepticism. Yet, is this "too good to be true" attitude of today's consumer necessary? The product with all this promise is SAM-e (pronounce it "sammy"), and it's causing even the skeptics to give it serious attention.
What is SAM-e?
Not a prescription drug or an herb, SAM-e (S-adenosylmethionine) is a synthetic replication of a compound that the body makes naturally from methionine, an amino acid found in protein-rich foods. Used in Europe for over twenty years, SAM-e is just beginning to make national headlines in publications like Newsweek magazine and the Los Angeles Times and in books and on major television networks.
How Does it Work?
The key to understanding the way SAM-e works is by recognizing its role in a process called methylation. Methylation happens a billion times a second throughout the body and is responsible for, among other things, the regulation of brain function, preserving bone health and protecting against heart disease. It helps regulate various hormones and neurotransmitters including serotonin, melatonin, dopamine and adrenaline. During the methylation process a molecule in the body "gives up" a methyl group comprised of four atoms to another molecule, changing both the original molecule and the recipient of the methyl group in the process. "It [SAM-e] is involved in almost everything," says Teodoro Bottiglieri, Ph.D. and co-author of the book, "Stop Depression Now," which discusses his
extensive use of SAM-e to treat a number of illnesses.1
How does it ease depression?
There are a few theories. One may be SAM-e's regulation of serotonin and dopamine, which are mood-lifting neurotransmitters. This hypothesis was confirmed in one study where SAM-e was shown to cross the blood-brain barrier. This research further found that the cerebrospinal fluid levels of SAM-e were significantly lower in patients with severe depression, as compared to the control group. Researchers concluded that SAM-e has antidepressant effects.2
Actually, there is little, if any, debate over SAM-e's depression-easing abilities. In fact, SAM-e's ability to lift mood is comparable to that of standard antidepressants, yet without the possible side-effects of headache, stomach upset and sexual dysfunction that prescription drugs often bring.3 Richard Brown, who authored "Stop Depression Now" with Teodoto Bottiglieri and has treated several hundred patients with SAM-e, calls it, "...the best antidepressant I've ever prescribed. I've seen only benefits." 4
Can SAM-e Stop Pain?
SAMe was first given to patients for use in treating depression, but when some of those same patients began to report relief from osteoarthritis joint pain, researchers began to study this second benefit of the product. Over 22,000 arthritis sufferers reported, after only four weeks of treatment, that SAMe gave comparable results to NSAID pain relievers like ibuprofen.3 The vital distinction is that instead of causing stomach upset like NSAIDs often do, SAMe may actually protect the stomach lining.
Furthermore, animal studies show that SAMe could help restore damaged cartilage in addition to relieving pain.1 This happens when B-vitamins convert homocysteine into the antioxidant glutathione. This glutathione conversion yields molecules called sulfate groups that actually help to restore cartilage. Proof positive: the Arthritis Foundation recently stated that they were satisfied that SAMe "provides pain relief."
Can it Treat Fibromyalgia?
Drs. Brown and Bottiglieri dedicate an entire chapter on SAM-e's positive effects on Fibromyalgia in their book, "Stop Depression Now." They state that depression and soreness, of all of FM's symptoms, are the most stubborn. They are careful to point out that the depression that is common among FM's sufferers is not a symptom of the disease, but often a by-product of living with chronic illness. They support the benefit of SAM-e's non-prescription effects: "...fibromyalgia patients get the best of all worlds--relief from depression and muscle soreness without the side-effects or possible adverse interactions with other medications." 1
They are not alone in their findings. In a study of 47 FM patients treated daily with 200mg of SAM-e intramuscularly and 400mg orally, patients reported significant reduction in tender points, significant improvement in well-being, and significant reduction in the mean scores of the Hamilton Rating Scale for Depression, the Zung SelRating Scale, the Hamilton Rating Scale for Anxiety, and the Lorish and Maisiak's Face Scale. All reported that SAM-e was well-tolerated, with no adverse side effects.5
In another study of 30 patients with FM, Sjogren's Syndrome, or both, the patients were treated with 200mg of SAM-e daily through intramuscular injection. At the end of the four week study, the patients with Sjogren's Syndrome and FM reported a significant reduction in painful areas and tender points. The patients with only Sjogren's Syndrome reported a significant reduction on the Hamilton Rating Scale for Depression. Finally, the patients with FM finished the trial with significant reductions in symptoms of FM, numbers of tender point areas and painful areas, pain severity scores and depression scales.6
Which SAM-e Should I Take and How Much?
Not all SAM-e is created equal and those who wish to make SAM-e a part of their supplementation program should look for two distinctive qualities before purchasing: type and coating. First, look for full-strength SAM-e. Second, look for SAM-e tablets that are enteric coated, meaning that the tablets pass through the acidic environment of the stomach intact, and can be absorbed most efficiently by the body. Lastly, the amounts used in various SAM-e studies vary widely, leaving the consumer confused about effective dosage. The starting dose is 400mg of SAM-e daily on an empty stomach.1
Are There Are Precautions or Warnings About Taking SAM-e?
Even those who have jumped on the SAM-e bandwagon are clear to point out that it is not a "cure" for severe depression and advise consumers to consult with their physician before taking SAM-e (good advice for anyone beginning a new supplementation program).
There is at least one group of people who should avoid SAM-e: those with bi-polar disorder. Commonly called manic depression, these individuals should be aware that SAM-e may induce mania in those with the disorder.
Since the mass availability of SAM-e earlier this year, the buzz has been strong and the research to support it very promising, if not yet iron-clad. As stated above, it's a good idea to consult your physician when beginning any new supplementation program. However, it does appear that for those wishing to lift their mood, soothe painful joints and muscles, and lighten the load of FM's many symptoms, SAM-e is a safe complimentary treatment, nearly without side-effect.
1. Brown, Richard, M.D., Bottigileri, Teodoro, Ph.D., Colman, Carol. Stop Depression Now. New York, 1999.
2. J Neurol Neurosurg Psychiatry (England) Dec. 1990, 53 (12) p1096-8. "Cerebrospinal Fluid S-andenosylmethionine in Depression and Dementia: Effects of Treatment with Parenteral and Oral S-andenosylmethionine."
3. Cowley, Geoffrey and Underwood, Anne. "What is SAMe?" Newsweek, July 5, 1999.
4. Curr. Ther. Res. Clin. Exp. (USA), 1994, 55/7 (797-806). "Primary Fibromyalgia is Responsive to S-adenosylmethionine."
5. Curr. Ther. Res. Clin. Exp. (USA), 1994, 55/6 (699-706). "S-adenosylmethionine in Sjogren's Syndrome and Fibromyalgia."