![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 77 to 101 of 101. Go back in thread:
Posted by Ron Hill on March 23, 2002, at 15:11:39
In reply to Re: SAM-e Trial » Ron Hill, posted by JohnX2 on March 23, 2002, at 9:13:53
John,
I was hoping you would weigh in on this topic. As you can see by some of the posts in this thread, several people are reporting favorable results with SAM-e. It is, of course, not the answer to every psychiatric disorder under the sun, but it sure gave me my life back!
My observation (not a scientific study) is that SAM-e seems to be of particular value to depressive (especially bipolar depressive) patients that are initially hypersensitive to AD's (favorable response in a matter of days to very low dosage), but soon thereafter, suffer anergy (low drive, low energy, etc.) and anhedonia (inability to fully experience pleasure, blunted emotions, etc.). It is my layman's opinion that AD's (SSRI's in particular) lower dopamine levels and or impede DA transmission in some (most?) patients and this, in turn, causes the aforementioned symptoms. I think SAM-e is particularly useful in treating anergy and anhedonia, and that it does so by increasing the amount of DA produced by the body. Further, I (layman) hypothesize that one reason SAM-e works so well is that it increases both serotonin and dopamine in a very balanced synergistic kind of way. Okay, enough rambling, let me respond to the issues you raise.
> Maybe if I try this again I need to address the dosing scheme much more carefully. I did try SAM-E nature made brand a long way back with a placebo effect, even at a high dose. I've also gotton a placebo effect on Depakote.
By "placebo effect" I am assuming you mean that you experienced some initial sense of benefit by taking SAM-e, but the improvement was due to psychological reasons instead of physiological improvement and, therefore, the benefits did not last. Do I understand you correctly? Did you take B-6, folic acid, and SUBLINGUAL bioactive B-12 (methylcobalamin)? If you've read my posts, you know how important I think B vitamins (especially sublingual bioactive B-12) are. Were you able to take the SAM-e on a relatively empty stomach? Each morning, I eat a good breakfast, take my vitamins, wait an hour or so, and take my SAM-e dose. In your prior trial, what meds were you on? How much SAM-e did you take and for how long? Nature Made is a good enough brand, so I doubt that it was a bad product issue.>So I wonder if these enteric coated tablets aren't getting absorbed well into my body. However, other enteric coated tablets do okay (like wellbutrin). What do you think?
I doubt that this is the problem.
> Are there good brands that maybe use different fillers/binders in the pill? Does it need to get absorbed through the intestines?
Yes, as I understand it, the supplemental SAM-e must be able to find its way to the small intestines intact in order for the body to absorb it efficiently. But again, I doubt that this is a problem for you. I go back to my usual mantra; were you taking sublingual bioactive B-12 at the time of the trial?
John, I read a high percentage of your posts so, to some degree, I stay aware of your current meds and your conditions. With the exception of your recent bout with hypomania, it seems like your current med combo is working fairly well. If I remember correctly you're taking Lamictal, Serzone, and I think a benzo or something {I would stop and look it up in one of your previous posts, but too many times I've lost partially completed posts in the dialogue box by surfing other pbabble links before completing and sending off the post. Have you ever done that? Make ya mad? Does me!}.
Since your meds are working, what is prompting you to ponder SAM-e? Due to the fact that AD's were so fickle (work one day, poop-out the next) in their effectiveness for me, I would attempt to replace Serzone with SAM-e if I were in your shoes. SAM-e is smooth, even, and highly repeatable every day. That was definitely not the case with AD's, but this is just my bias.
John, given the fact that merely missing two days of Serzone induced some hypomania, I am concerned that SAM-e might cause some hypomania for you as well. SAM-e induces hypomania in me if I take more than 200 mg/day. Does increasing your Lamictal dosage improve your stability against hypomania? Have you made any decision regarding the lithium add-on to the Lamictal for more anti-mania stability?
-- Ron
Posted by colin wallace on March 23, 2002, at 15:53:55
In reply to Re: SAM-e Trial » JohnX2, posted by Ron Hill on March 23, 2002, at 15:11:39
I'm really at a loss to explain this (I've been experimenting for a few weeks now to be entirely certain), but when I SPLIT a Sam-e (enteric coated)pill, I actually get a significantly greater antidepressant response than I do when taking the entire pill.I'm not just talking about immediacy, which would perhaps be explicable in terms of SOME Sam-e reaching the brain quicker than it otherwise would have, had the absorption been via the intended intestinal route.I mean, simply, a noticably better/quicker/sustained antidepressant response.
This I will concede, is entirely implausible, as Sam-e is NOT well absorbed through the stomach; indeed, all empirical evidence suggests that it is actually destroyed in the stomach (hence the need for an enteric coating).
I cannot even hazard a guess as to what's occurring here- any theories are most welcome.Afterthought:
As I delve deeply into the vaguaries of memory,I recall reading an article explaining that l-tryptophan was a poor supplemental choice, due to seratonin mechanisms being somehow used and (seratonin) being abstracted by the stomach prior to reaching the brain; 5htp supplements circumvented this problem, instantly crossing the blood/brain barrier (excuse the blurred science here, this is dredged up from an equally blurred memory).
Any connection here?I'll admit, I'm fumbling in the dark, and will duly go and do some research!!
Posted by Ron Hill on March 23, 2002, at 17:40:57
In reply to Re: SAM-e Oddity., posted by colin wallace on March 23, 2002, at 15:53:55
Colin,
Now you've got me wanting to cut one in half and try your experiment out on myself.
-- Ron
-------------------------> I'm really at a loss to explain this (I've been experimenting for a few weeks now to be entirely certain), but when I SPLIT a Sam-e (enteric coated)pill, I actually get a significantly greater antidepressant response than I do when taking the entire pill.I'm not just talking about immediacy, which would perhaps be explicable in terms of SOME Sam-e reaching the brain quicker than it otherwise would have, had the absorption been via the intended intestinal route.I mean, simply, a noticably better/quicker/sustained antidepressant response.
> This I will concede, is entirely implausible, as Sam-e is NOT well absorbed through the stomach; indeed, all empirical evidence suggests that it is actually destroyed in the stomach (hence the need for an enteric coating).
> I cannot even hazard a guess as to what's occurring here- any theories are most welcome.
>
> Afterthought:
> As I delve deeply into the vaguaries of memory,I recall reading an article explaining that l-tryptophan was a poor supplemental choice, due to seratonin mechanisms being somehow used and (seratonin) being abstracted by the stomach prior to reaching the brain; 5htp supplements circumvented this problem, instantly crossing the blood/brain barrier (excuse the blurred science here, this is dredged up from an equally blurred memory).
> Any connection here?I'll admit, I'm fumbling in the dark, and will duly go and do some research!!
Posted by beardedlady on March 23, 2002, at 18:37:08
In reply to Re: SAM-e Oddity. » colin wallace, posted by Ron Hill on March 23, 2002, at 17:40:57
Doesn't this coating simply keep you from getting a stomach ache?
beardy : )>
Posted by davex on March 23, 2002, at 19:36:20
In reply to Re: SAM-e Trial » JohnX2, posted by Ron Hill on March 23, 2002, at 15:11:39
Ron,
I'm totally in accordance with what you write in your post, but there is a thing that is important to clear better. It is important cause it explaines the real difference between sam-e and other AD class.
You write "sam-e....by increasing the amount of DA produced by the body. Further, I (layman) hypothesize that one reason SAM-e works so well is that it increases both serotonin and dopamine"
This is not properly the true:
Same is a methilic group donor, it release into our body lot quantity of ione CH3-.
This is a molelcule that, connecting to the nutrient substances (vitamins, proteines, hormones,.....) make them to be absorbed better by the cells.
Methilic goup is the key of the cell's door.
In this way Sam-e do not increase the total level of dopamine or serotonine you have in your body, but it makes to improve the quantity of them that can be used by your body: your engine can use better the gasoline it has!.
That's the why sam-e is not correlated to all disease and side effect that happends on AD, it do not work on receptor and synapse but make more easy the transports into the cells.
In this way sam-e is unique antidepressant.
bye
Posted by Ron Hill on March 23, 2002, at 21:10:30
In reply to enteric coating, posted by beardedlady on March 23, 2002, at 18:37:08
> Doesn't this coating simply keep you from getting a stomach ache?
Beardy,
No. the enteric coat is to protect the SAM-e from the stomach acids so that it will make it to the small intestines where it is absorbed.
-- Ron
Posted by Ron Hill on March 23, 2002, at 21:17:44
In reply to Re: SAM-e Trial » Ron Hill, posted by davex on March 23, 2002, at 19:36:20
Posted by IsoM on March 23, 2002, at 21:29:43
In reply to Re: SAM-e Trial » JohnX2, posted by Ron Hill on March 23, 2002, at 15:11:39
"Pharmacology and possible mechanisms: SAM-e appears to increase serotonin turnover, inhibit the reuptake of Norepinephrine in a temperature-dependent fashion, and to augment dopaminergic activity. SAMe also increases folate levels and donates a methyl group to catecholeamines (Baldessarini, 1987)."
It's the donation of the methyl group that's supposed to help so much.
Posted by IsoM on March 23, 2002, at 21:39:41
In reply to Re: SAM-e Trial » Ron Hill, posted by davex on March 23, 2002, at 19:36:20
I found two studies written on SAM-e. The first is titled S-ADENOSYLMETIONINE: A DRUG FOR THE BRAIN? & the page can be found at:
http://www.boehringer-ingelheim.es/workshop-methionina/anglesa/cap25.htmThe next is titled S-ADENOSYLMETHIONINE AS ANTIDEPRESSANT. RECENT PRECLINICAL EXPERIMENTAL EVIDENCE & that page is found at:
http://www.boehringer-ingelheim.es/workshop-methionina/anglesa/cap26.htmIt may be too technical for some, but for those interested in learning more about the pharmokinetics of SAM-e, it may be just what you're looking for.
Posted by Ron Hill on March 23, 2002, at 22:10:14
In reply to Short Blurb on SAM-e Possible Action » Ron Hill, posted by IsoM on March 23, 2002, at 21:29:43
Posted by Ron Hill on March 23, 2002, at 22:29:50
In reply to Two Scientific Studies on SAM-e, posted by IsoM on March 23, 2002, at 21:39:41
Posted by colin wallace on March 24, 2002, at 4:36:39
In reply to Two Scientific Studies on SAM-e, posted by IsoM on March 23, 2002, at 21:39:41
Have you thought about disguising yourself as an adult male Sprague Dawley rat, before crossing the border with the states?If you're captured, you may be lucky enough to be administered 100mg sam-e per kg for a number of weeks, for free.
Of course, they may want to slice into your hippocampus afterward, but you could always call it a day once you've started to feel any benefits....Just a thought,
Col.
Posted by jazzdog on March 24, 2002, at 12:44:13
In reply to Two Scientific Studies on SAM-e, posted by IsoM on March 23, 2002, at 21:39:41
Hi Iso -
Thanks for the articles. I'm one of those for whom the language is too technical, but my limited reading provokes two questions. First, what is the article saying in layman's terms about the long-term effect of AD's. And second, isn't 100mg/kg a huge dose?
Thanks again - Jane
Posted by IsoM on March 24, 2002, at 13:28:15
In reply to Re: Two Scientific Studies on SAM-eisoM, posted by colin wallace on March 24, 2002, at 4:36:39
Posted by lizzyg on March 25, 2002, at 7:38:04
In reply to Re: Anxiety Meds » lizzyg, posted by Ron Hill on March 22, 2002, at 6:18:39
Hi Ron - I probably confused you because I was having a little joke with Colin about how under-informed our British GPs are about depression and anxiety medications.
I think my diagnosis would fall into the category of 'classic' endogenous major depression, with associated anxiety. At the moment, I'm only taking SAM-e and it HAS had an anti-depressant effect, but I would say not as good as previous treatment with tricyclics (I can't tolerate SSRIs). However, with the tricyclics I found the anxiety diminished along with the depression, but this hasn't been the case (so far) with the SAM-e.
Benzos have worked fine in the past for treating the anxiety which has gone hand in hand with the depression, but it's only been short-term usage until the ADs kicked in properly. And the British medical establishment seem completely paranoid about benzos and will only really prescribe for a couple of weeks. So I don't think benzos would be a long-term solution for the anxiety. I don't know about gabapentin (Neurontin), so will do some reading up about that.
Like you, Ron, I find exercise a life-saver and try to swim three times a week, which helps with both the depression and the anxiety.
I'm loath to give up on the SAM-e so will give it a while longer. If there's no improvement on the anxiety, I think I'll probably have to try a prescription AD again. I'm thinking Nefazodone/Serzone would probably be high on the list of options (Mirtazapine/Remeron was too sedating for me) although my GP seems to be pushing Venlafaxine. Any views?
Thanks
Lizzy
Posted by Ron Hill on March 25, 2002, at 10:48:07
In reply to Re: Anxiety Meds » Ron Hill, posted by lizzyg on March 25, 2002, at 7:38:04
Lizzy,
Thank you for the update! It sounds like your situation may require bigger guns than SAM-e can bring to the battle. How much SAM-e are you currently taking? Also, it is very important that you take a sublingual (under the tongue) bioactive B-12 (methylcobalamin) vitamin daily (in addition to an oral B-complex). I take a 1000 mcg sublingual tablet twice a day. Although I do not suffer from anxiety to the extent that you do, I can report that as I hold the B-12 under my tongue, I experience a very noticeable calming, peaceful effect. Are you taking a sublingual bioactive B-12? If so, how much and what biochemical compound is it?
With regard to which AD to try if it turns out that SAM-e/B-vitamins will not abate your anxiety, I agree with you that Serzone would be a good choice to try first. As you know, in the lower dose range Serzone treats anxiety and in the higher dose range it is an effective AD. Personally, I would NOT take Effexor (venlafaxine) because, as you know, in the higher dose range it is an SNRI and, for me, an increase in norephrinepine will increase anxiety. But that's just me, and your mileage may vary.
Using Neurontin (gabapentin) to treat anxiety in a unipolar, such as your self, would probably be considered as a second line approach by most pdocs (and pbabblers). As a bipolar, I've been looking at Neurontin for more than a year for possible use as an add-on to my Lithobid. Neurontin has a fairly benign side effect profile (which is important to me) and the GABA effects might help my slight GAD symptoms. But I'm not going to change anything for a long while because I WILL NOT risk screwing up my current EXCELLENT combo (600 mg/day Lithobid and 200 mg/day SAM-e). Ask JohnX2 and others your AD questions. John takes Serzone so he would be a good one to ask.
Do you plan to continue to use SAM-e/B-vitamins as an add-on if you begin your Serzone trial? That's what I would do.
-- Ron
-------------------------------
> Hi Ron - I probably confused you because I was having a little joke with Colin about how under-informed our British GPs are about depression and anxiety medications.
>
> I think my diagnosis would fall into the category of 'classic' endogenous major depression, with associated anxiety. At the moment, I'm only taking SAM-e and it HAS had an anti-depressant effect, but I would say not as good as previous treatment with tricyclics (I can't tolerate SSRIs). However, with the tricyclics I found the anxiety diminished along with the depression, but this hasn't been the case (so far) with the SAM-e.
>
> Benzos have worked fine in the past for treating the anxiety which has gone hand in hand with the depression, but it's only been short-term usage until the ADs kicked in properly. And the British medical establishment seem completely paranoid about benzos and will only really prescribe for a couple of weeks. So I don't think benzos would be a long-term solution for the anxiety. I don't know about gabapentin (Neurontin), so will do some reading up about that.
>
> Like you, Ron, I find exercise a life-saver and try to swim three times a week, which helps with both the depression and the anxiety.
>
> I'm loath to give up on the SAM-e so will give it a while longer. If there's no improvement on the anxiety, I think I'll probably have to try a prescription AD again. I'm thinking Nefazodone/Serzone would probably be high on the list of options (Mirtazapine/Remeron was too sedating for me) although my GP seems to be pushing Venlafaxine. Any views?
>
> Thanks
>
> Lizzy
Posted by Cindylou on March 25, 2002, at 18:44:35
In reply to Anyone respond to subtherapeutic med doses only ?, posted by colin wallace on March 16, 2002, at 11:42:10
Hi Colin,
It's pretty late for me to respond to your post, and it sounds like things are working out for you okay by now, but I thought I'd mention that I did well on 5 mg. of Prozac -- but the good effects only lasted for 2 months, and then I "crashed out." I couldn't get the good results back by increasing or decreasing the dose, so I stopped the med. I tried it again a couple years later, and the same thing happened -- did well on 5 mg. -- then crashed hard after 2 months.For the record, I used Liquid Prozac -- much easier to measure out those low doses.
Anyway, I do respond to very low doses of medications -- probably 1/4 of the normal therapeutic dose. My problem is that I either can't tolerate the side effects, or the positive effects don't last. I am bipolar II -- it took 13 years to get to this diagnosis (I have always been treated for unipolar depression until recently.)
Hope you are doing well. Maybe I'll try that SAM-e one of these days. Can it be combined with Lamictal?
take care,
cindy> Prozac trial: I take one 20mg capsule, and within hours feel uplifted, a slightly dizzying or tipsy feeling, and music enters my mind so that I feel like whistling!Hmmmm. A (slightly)giddying state in which to go about one's ordinary life, but great for a Saturday night.Much preferable to feeling like crap-but needs some tuning down I think.
> Next day: 200mg Sam-e.Terrific- achieved just the right 'pitch', and life's back in focus.
> Next day: 20mg prozac- Yeuch...not fun at all! WAY overstimulated....don't raise your voice at me or I'll ******* pulverize you!!Snarl!Hmmmm.
> Must tone this down!Where's my genial good nature gone?? And the whistling...?
> Next day: 200mg sam-e- still far too strung out, but human and sociable again by the evening.
> Okay, try again.... two days washout.
> next day.20mg prozac- whistlin' dixie.
> next three days in a row-200mg Sam-e...nothing else.
> Fifth day: cautious 20mg prozac...wait for it...aah, a telltale foot tapping to the radio, a breezy 'hello' on the telephone.... a brief whistle and a tentative early morning stiffie, perhaps heralding....anyway, you get the picture here.
> Question: Can the therapeutic window of Prozac, or indeed any SSRI be THAT narrow? Can I really benefit from less than 5mg a day?Am I med. hypersensitive? This perhaps seems a plausible explanation.This may well explain my wholesale rejection of all things SSRI in the past.No wonder I turned into Hannibal Lecter on 150mg effexor.Pause for thought.Like the feel of prozac (at infant-like doses),seems to complement sam-e very well.But have to put up with feeling 'overly upbeat and stupefied' every fifth day, till things settle down.
> So, I wondered if anyone else has had a similar reaction/overreaction to Prozac , or another ssri.Anyone tried liquid prozac?? (didn't particularly like celexa either..)
> Just coming back down to earth..........
>
> (whistlin') Col.
Posted by colin wallace on March 26, 2002, at 4:26:37
In reply to Anyone respond to subtherapeutic med doses only ?, posted by colin wallace on March 16, 2002, at 11:42:10
Hi Cindy,
I'm discovering more and more people who seem to fare better on sub. therapeutic doses.
Yesterday, after much wrangling, I persuaded my GP to lavish me with free Zoloft.(only after rhythmically banging my head on her desk in an effort to explain that Sam-e does not, in combination with ssri's, lead to sertonin syndrome- her canny explanation for my previous ssri overreactions- which were actually caused by singly administered ssri's at too high doses).
So now I'm at 200mg sam-e, 12.5 mg zoloft, and doing quite well.
I don't have any knowledge of Lamactil quite honestly, but I can say that sam-e has no known drug interactions, other than its ability to induce mania in bipolars (like any other antidepressant).Ron Hill safely uses Sam-e with a mood stabalizer.... but then again, he's madder than a pumpkin....Col.
Posted by jazzdog on March 26, 2002, at 12:24:58
In reply to Subtherapeutic meds CindyLou, posted by colin wallace on March 26, 2002, at 4:26:37
Posted by Ron Hill on March 26, 2002, at 12:27:44
In reply to Subtherapeutic meds CindyLou, posted by colin wallace on March 26, 2002, at 4:26:37
> Yesterday, after much wrangling, I persuaded my GP to lavish me with free Zoloft.(only after rhythmically banging my head on her desk in an effort to explain that Sam-e does not, in combination with ssri's, lead to sertonin syndrome- her canny explanation for my previous ssri overreactions- which were actually caused by singly administered ssri's at too high doses).
Colin,
Any permanent damage to the GP's desk? IMHO, some GP's and pdocs should spend less time being spoon fed by the drug company reps and more time doing some independent research.
> So now I'm at 200mg sam-e, 12.5 mg zoloft, and doing quite well.
Stay in touch regarding the long term effectiveness of this combo.
> I don't have any knowledge of Lamactil quite honestly, but I can say that sam-e has no known drug interactions, other than its ability to induce mania in bipolars (like any other antidepressant).Ron Hill safely uses Sam-e with a mood stabalizer.... but then again, he's madder than a pumpkin....
I think SAM-e could compliment Lamictal quite well. And yes you're correct, I do like pumpkin pie. How'd ya know?
-- Ron
Posted by colin wallace on March 26, 2002, at 12:55:13
In reply to Re: Subtherapeutic meds CindyLou » colin wallace, posted by Ron Hill on March 26, 2002, at 12:27:44
Hi there Ron,
I took to Zoloft like a duck to water-no problems with the Prozac transition. I find it compliments Sam-e a little better than Prozac, in that it feels slightly less 'coarse'. We can only get scored 50mg pills here, so I split one in half, then attempt the near impossibility of a further split into a quarter.For this reason (and because I really need to build up a mental prophylactic before we plunge into next years gloomy winter), I'll most prob. try things out at 25mg.
Incidentally, I also take 10mg (tiny dose)of amitriptyline to help with insomnia (have done for years), and a small dose benzo. (diazepam) 5mg...most days I split it and make do with just 2.5mg.This is for the residual anxiety that I now seem to have pretty much under control-it was very severe at one point.Eventually, I may grab me some of them there 100mg Sammy pills,and try things at 300mg.More sammy = less fibromyalgia pain/stiffness, but you know what it feels like when you go too high too soon!!Stay well (and mad!!)
Col.
Ps. agree with you entirely about docs lapping up med. rep propaganda!
Posted by JohnX2 on April 6, 2002, at 15:23:05
In reply to Re: SAM-e Trial » JohnX2, posted by Ron Hill on March 23, 2002, at 15:11:39
> John,
>
> I was hoping you would weigh in on this topic. As you can see by some of the posts in this thread, several people are reporting favorable results with SAM-e. It is, of course, not the answer to every psychiatric disorder under the sun, but it sure gave me my life back!
>
> My observation (not a scientific study) is that SAM-e seems to be of particular value to depressive (especially bipolar depressive) patients that are initially hypersensitive to AD's (favorable response in a matter of days to very low dosage), but soon thereafter, suffer anergy (low drive, low energy, etc.) and anhedonia (inability to fully experience pleasure, blunted emotions, etc.). It is my layman's opinion that AD's (SSRI's in particular) lower dopamine levels and or impede DA transmission in some (most?) patients and this, in turn, causes the aforementioned symptoms. I think SAM-e is particularly useful in treating anergy and anhedonia, and that it does so by increasing the amount of DA produced by the body. Further, I (layman) hypothesize that one reason SAM-e works so well is that it increases both serotonin and dopamine in a very balanced synergistic kind of way. Okay, enough rambling, let me respond to the issues you raise.
>
> > Maybe if I try this again I need to address the dosing scheme much more carefully. I did try SAM-E nature made brand a long way back with a placebo effect, even at a high dose. I've also gotton a placebo effect on Depakote.
>
> By "placebo effect" I am assuming you mean that you experienced some initial sense of benefit by taking SAM-e, but the improvement was due to psychological reasons instead of physiological improvement and, therefore, the benefits did not last. Do I understand you correctly? Did you take B-6, folic acid, and SUBLINGUAL bioactive B-12 (methylcobalamin)? If you've read my posts, you know how important I think B vitamins (especially sublingual bioactive B-12) are. Were you able to take the SAM-e on a relatively empty stomach? Each morning, I eat a good breakfast, take my vitamins, wait an hour or so, and take my SAM-e dose. In your prior trial, what meds were you on? How much SAM-e did you take and for how long? Nature Made is a good enough brand, so I doubt that it was a bad product issue.
>Ron, by placebo, I'm thinking more like "sugar pill". But at the time that I was trying SAM-E I was experimenting with so many other supplements and medicines it wasn't really a controlled trial. I just know that the SAM-E that I was taking (Nature Made) at a max dose of I think 800 mg, was not giving me a substantial AD boost. I don't remember if I was taking vitamins at the time. I did go on a vitamin binge, but I don't remember when. Also, I would like to note that I tend to get AD responses in the typical therapeutic range, not at the lower sub-therapeutic doses. Dr. Kramer mentioned that his SAM-E patients generally responded in the 1200-1600 mg range? I had seen those figures before.
> >So I wonder if these enteric coated tablets aren't getting absorbed well into my body. However, other enteric coated tablets do okay (like wellbutrin). What do you think?
>
> I doubt that this is the problem.
>
> > Are there good brands that maybe use different fillers/binders in the pill? Does it need to get absorbed through the intestines?
>
> Yes, as I understand it, the supplemental SAM-e must be able to find its way to the small intestines intact in order for the body to absorb it efficiently. But again, I doubt that this is a problem for you. I go back to my usual mantra; were you taking sublingual bioactive B-12 at the time of the trial?No I wasn't taking sublingual B-12's. I have tried them though, and I haven't noticed that they made much difference in mean (you mentioned that they gave you a "calming effect?).
>
> John, I read a high percentage of your posts so, to some degree, I stay aware of your current meds and your conditions. With the exception of your recent bout with hypomania, it seems like your current med combo is working fairly well. If I remember correctly you're taking Lamictal, Serzone, and I think a benzo or something {I would stop and look it up in one of your previous posts, but too many times I've lost partially completed posts in the dialogue box by surfing other pbabble links before completing and sending off the post. Have you ever done that? Make ya mad? Does me!}.
>Yep!
> Since your meds are working, what is prompting you to ponder SAM-e? Due to the fact that AD's were so fickle (work one day, poop-out the next) in their effectiveness for me, I would attempt to replace Serzone with SAM-e if I were in your shoes. SAM-e is smooth, even, and highly repeatable every day. That was definitely not the case with AD's, but this is just my bias.
>I always thought SAM-E was a good concept. I believed it could work. The only thing I don't like about it is the price.
> John, given the fact that merely missing two days of Serzone induced some hypomania, I am concerned that SAM-e might cause some hypomania for you as well. SAM-e induces hypomania in me if I take more than 200 mg/day. Does increasing your Lamictal dosage improve your stability against hypomania? Have you made any decision regarding the lithium add-on to the Lamictal for more anti-mania stability?
I have a weird problem with Lamictal and some other meds, if I raise the dose above a certain level, they induce myofacial pain and sometimes they blunt out my emotions. Zoloft was really bad. Lamictal does this at doses above 150 mg. Serzone fixes this problem. It seems to be related to a gating of serotonin/dopamine interactions (Serzone blocking offensive serotonin receptors). Specifically blockade of 5-ht2 receptors increases dopamine in the (pre)frontal cortex where there are dopamine neurons that inhibit facial muscle contractions, also hypodopaminergic states in the frontal cortex lead to "blunted emotions" such as symtoms similarly described like a "negative psychosis" in schizophrenia. That's why the atypical neuroleptics block the serotonin 5-ht2a receptors (as does serzone and remeron). (Maybe some swagging on behalf here...)
Regards,
John>
> -- Ron
Posted by Ron Hill on April 8, 2002, at 13:11:31
In reply to Re: SAM-e Trial » Ron Hill, posted by JohnX2 on April 6, 2002, at 15:23:05
John,
Thanks for your reply. Just a couple comments:
> I always thought SAM-E was a good concept. I believed it could work. The only thing I don't like about it is the price.
A Double E worried about a couple bucks a day for a month or two to facilitate the trial? ($2 for 800 mg/day). What's wrong with this picture?
> > John, given the fact that merely missing two days of Serzone induced some hypomania, I am concerned that SAM-e might cause some hypomania for you as well. SAM-e induces hypomania in me if I take more than 200 mg/day. Does increasing your Lamictal dosage improve your stability against hypomania? Have you made any decision regarding the lithium add-on to the Lamictal for more anti-mania stability?> I have a weird problem with Lamictal and some other meds, if I raise the dose above a certain level, they induce myofacial pain and sometimes they blunt out my emotions. Zoloft was really bad. Lamictal does this at doses above 150 mg. Serzone fixes this problem. It seems to be related to a gating of serotonin/dopamine interactions (Serzone blocking offensive serotonin receptors). Specifically blockade of 5-ht2 receptors increases dopamine in the (pre)frontal cortex where there are dopamine neurons that inhibit facial muscle contractions, also hypodopaminergic states in the frontal cortex lead to "blunted emotions" such as symtoms similarly described like a "negative psychosis" in schizophrenia. That's why the atypical neuroleptics block the serotonin 5-ht2a receptors (as does serzone and remeron). (Maybe some swagging on behalf here...)
What about about using a low dose of lithium as an add-on to the Lamictal to improve anti-mania stability? If I remember correctly, you were thinking about doing this a few weeks ago. In your case, I would be concerned that SAM-e might induce hypomania without more mood stabilizer.
-- Ron
Posted by JohnX2 on April 8, 2002, at 17:41:14
In reply to Re: SAM-e Trial » JohnX2, posted by Ron Hill on April 8, 2002, at 13:11:31
> John,
>
> Thanks for your reply. Just a couple comments:
>
> > I always thought SAM-E was a good concept. I believed it could work. The only thing I don't like about it is the price.
>
> A Double E worried about a couple bucks a day for a month or two to facilitate the trial? ($2 for 800 mg/day). What's wrong with this picture?
>It was much more expensive when I tried it a while back! Actually, money is not a big concern for me (unless what I am spending it on is not helping). It seemes like I'd have to walk out of the store with a cart full of boxes though, the way the package just a few pills in a huge box. :-)
> > > John, given the fact that merely missing two days of Serzone induced some hypomania, I am concerned that SAM-e might cause some hypomania for you as well. SAM-e induces hypomania in me if I take more than 200 mg/day. Does increasing your Lamictal dosage improve your stability against hypomania? Have you made any decision regarding the lithium add-on to the Lamictal for more anti-mania stability?
>I don't know about increasing my Lamictal dose because I can't tolerate it. I don't think lamictal in general is good for mania. I think it is good for cycling and depression.
> > I have a weird problem with Lamictal and some other meds, if I raise the dose above a certain level, they induce myofacial pain and sometimes they blunt out my emotions. Zoloft was really bad. Lamictal does this at doses above 150 mg. Serzone fixes this problem. It seems to be related to a gating of serotonin/dopamine interactions (Serzone blocking offensive serotonin receptors). Specifically blockade of 5-ht2 receptors increases dopamine in the (pre)frontal cortex where there are dopamine neurons that inhibit facial muscle contractions, also hypodopaminergic states in the frontal cortex lead to "blunted emotions" such as symtoms similarly described like a "negative psychosis" in schizophrenia. That's why the atypical neuroleptics block the serotonin 5-ht2a receptors (as does serzone and remeron). (Maybe some swagging on behalf here...)
>
> What about about using a low dose of lithium as an add-on to the Lamictal to improve anti-mania stability? If I remember correctly, you were thinking about doing this a few weeks ago. In your case, I would be concerned that SAM-e might induce hypomania without more mood stabilizer.
>
I'm supposed to get some testing done this week and then try a lithium add-on. Any more ADs at this stage will likely set me off. I would however consider swapping in SAM-E for Serzone, but the problem is that Serzone is doing something specific to help with myofacial pain that I'm not sure SAM-E would help. If the lithium helps with the myofacial pain, then I may be open for more strategies.Regards,
John> -- Ron
Posted by disney4 on October 8, 2002, at 7:13:28
In reply to Re: SAM-e Trial » Ron Hill, posted by JohnX2 on March 23, 2002, at 9:13:53
>
> Hi Ron,
>
> Maybe if I try this again I need to address the dosing scheme much more carefully. I did try SAM-E nature made brand a long way back with a placebo effect, even at a high dose. I've also gotton a placebo effect on Depakote. So I wonder if these enteric coated tablets aren't getting absorbed well into my body.
> However, other enteric coated tablets do okay (like wellbutrin).
>
> What do you think?
>
> Are there good brands that maybe use different fillers/binders in the pill? Does it need to get absorbed through the intestines?
>
> John
>
>
>
> > Mitch,
> >
> > Thanks for the progress report. Give the SAM-e trial at least a week or two before drawing any firm conclusions.
> >
> > I'm surprised by your sleepiness side effect. Most people find it to be slightly stimulating (increase in dopamine) in a smooth calm kind of way. My pdoc warned me against taking it to close to bedtime since it can make it hard to sleep. In fact, I did this once and sure enough I had a very poor nights sleep. As I have mentioned before in my prior posts, SAM-e is an important methylating agent essential for our bodies to manufacture neurotransmitters (serotonin and dopamine, in particular). SAM-e is also involved in the production of melatonin which, as you know, is a neurotransmitter that regulates the sleep/wake cycle. Just a guess, but maybe your daytime sleepiness is somehow connected to melatonin production. And further, this may be a short term effect provided you implement good sleep hygiene protocol ASAP.
> >
> > Mitch, you know more about this brain chemistry stuff than I do. I'm just offering my opinion in hopes of helping you. Good sleep hygiene includes (among other things) staying awake during the day. I encourage you to use whatever tricks needed to stay awake during the daytime. Drink coffee; go for brisk walks, etc. And I don't need to tell you how important it is for us bipolars to get good regular sleep. SAM-e has improved my sleep, but no daytime sleeping is allowed.
> >
> > Here is the SAM-e dosing schedule that seems to work best for me:
> >
> > 1. Get up in the morning and eat a good healthy breakfast within thirty minutes of rising.
> >
> > 2. Immediately after breakfast, take oral (down-the-hatch) vitamins followed by sublingual (under the tongue) B-12.
> >
> > 3. Wait for at least 30 minutes or an hour, and then take a 200 mg tablet of SAM-e. This wait time is important because SAM-e is adsorbed in the small intestines more effectively if there is not food present to compete for absorption. IMHO, I think it is important to have the B vitamins in the body ready and waiting for the SAM-e dose. I also think it is VERY IMPORTANT to take the B-12 in a bioactive sublingual form.
> >
> > 4. About mid-afternoon, at least an hour after lunch and at least an hour before dinner, I take my second 200 mg tablet of SAM-e
> >
> > As side notes, I also take a 500 mg gel cap of a phosphatidylserine complex containing 100 mg of phosphatidylserine (PS). This helps my brain with a mood stabilizer kind of effect, whereas, SAM-e helps my brain in an AD kind of way. Although it is like comparing apples and oranges (MS vs. AD), the benefits I experience from SAM-e are much more profound than that of PS. IMHO, PS helps because it improves brain cell plasticity. Unfortunately, PS is expensive (about $1 per gel cap). Also included on my list of helpful "medications" are exercise and omega-3 fatty acids.
> >
> > Mitch, as you read in my previous post above, I discontinued my low-dose (12.5 mg/d) of Zoloft a couple of days ago due to breakthrough anergic side effects. Therefore, SAM-e is my sole "AD" at this point. So far I'm doing extremely well! It's been many years and many med trials looking for the right med combo. I truly think I've finally found an "AD" that will work long term for me, a bipolar. A little Lithobid (600 mg/d) and a little SAM-e (400 mg/d) and I'm good to go. I expect this good result to last, but only time will tell for sure.
> >
> > >I just got the cheapest stuff-hey it's a trial.
> >
> > Cheap in the short run is not necessarily cost effective in the long run. The problem with SAM-e is that it is expensive to manufacture in a biochemically stable form. Also, care must be taken in packaging and shipping to retain product integrity and freshness and, thereby, to maintain true stated SAM-e content quantity. What brand did you buy? What formulation (e.g. tosylate)?
> >
> > >I must say that whatever it does-mustn't be too bad. I feel calm enough to restart dexedrine again.
> >
> > I will not presume to tell you what to do, but if it were me, I'd limit it to one trial at a time. Give the SAM-e at least a week or two. Please refresh my memory by listing all of your current meds. Also, your formal dx is BP II with comorbid ADHD, right? Will you also tell me the active ingredient in your sublingual B-12. Is it the bioactive form, methylcobalamin? It is sublingual, correct?
> >
> > -- Ron
> > ----------------------------------------------
> >
> >
> > > Hey Ron,
> > >
> > > You wanted to know how my SAM-e trial would go. Well, I bought some yesterday after checking out several stores. I just got the cheapest stuff-hey it's a trial. Well, I must say that I got very *tired* and *sleepy* after I ate lunch and took all my vitamins and the SAM-e (just one 200mg tablet). I got so drowsy I started to nap (that was around 5-6pm-about three hours later). I slept plenty the nite before-so I think it could be attributable to the SAM-e. It was a pleasant kind of nap-like thing. I didn't get any nausea or anything. I took a 2nd dose of it today at the same time and re-experienced a pleasant *grogginess* at about the same time of day. I must say that whatever it does-mustn't be too bad. I feel calm enough to restart dexedrine again.
> > >
> > > Mitch
>
> Hi Guys,I am new to this message board and Sam-e. I think the Sam-e is helping, but it also makes me tired after taking it. I had the same responce to Luvox, which could mean that the Sam-e is giving me a positive AD and anti anxiety effect. I started with the Nature Made brand, but have now ordered the Source Naturals, which is supposed to be identical to the Nutralife, and has also passed the Consumer Lab test. I also ordered their sublinguial, bioactive B complex. Why is it important to use the bioactive form? Ron, I noticed you discontinued the Sam-e for a while. Have you resumed it again? I also heard Sam-e could lower glucose levels, but I'm not sure what that would mean for my chemistry. Do you know? Thanks for any suggestions or thoughts!!
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