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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Julia on October 18, 2002, at 10:28:28
I hve had problems with agitated depression for 2 years, eventually responded to phenelzine, was by then hooked on 3 mg lorazepam.Over 15 months managed to wean myself off phenelzine,and down to 0.5 mg lorazepam.Then depression recuurred, and was again given phenelzine and lorazepam: resulting in bizarre motor side-effects including myoclonic jerks.benzos seem to depress me and I was not responding this time round,so went into hospital for 'detox'.this was too acute (they tried to get me off 2.25 mg lorazepam in 10 days0 Came ou on 12,5 diazepam,now 3 months later am on 6 mg and intend to wean at 1mg per fortnight.Agitation and despair have been bad, so restarted an a/d namely trimipramine -am taking 110mg.this helps me sleep, and eases the agitation but does nothing for the despair.Tried mirtazipine before trimipramine but this also gave me myoclonic jerks and postural drop.Read about SAM-e,have started it 2 weeks ago ,now on 400mg.Cannot tell whether it is making me better or worse:I am still agitated,profoundlty depressed and also have bad ME(totally exhausted and can only walk for 1-2mins.I know some of this is diazepam withdrawal,but does anyone know if SAM-e is safe/ a good idea in this situation, or will it exacerbate the agitation.I am using 'nature made' and I suppose I could increase to 800mg.Also ,can you stop itsuddenly or does it need to be tapered.Would be glad of advice ,also encouragement from any other benzo withdrawees! I hope I will improve when I am off them.I do have a sympathetic doc. but he hasn't used SAM-e before.
Posted by BrittPark on October 18, 2002, at 15:45:16
In reply to SAM-e, agitated depression and benzo withdrawal, posted by Julia on October 18, 2002, at 10:28:28
I'm sorry you're having such a lousy time of it. Have you considered the possibility that what you've been experiencing coming off of benzos is the reappearence of symptoms rather than withdrawal. I know many doctors are benzo averse, but in truth there's little evidence to show harm from long term benzo use.
You said that lorazepam was making you more depressed. Xanax has been shown to have mildly antidepressant effects and is excellent for agitation and anxiety. Not all benzos are alike.
Just some thoughts.
I don't know anything about SAM-e but I hope it helps.
You will feel better,
Britt
Posted by Julia on October 19, 2002, at 4:34:11
In reply to Re: SAM-e, agitated depression and benzo withdraw » Julia, posted by BrittPark on October 18, 2002, at 15:45:16
I took 400mg SAM-e this am.Yesterday I thought it made my thoghts race and made me restless for a few hoursToday I feel the same.Could this beSAm-e (or even just my anxiety about taking it) I know i feel really wierd,detatched from reality etc and worry that it is doing me some harm.Has anypne experienced jitteriness on SAM-e??
thanks for yourcomments on bzds Britt.I am pretty convinced that benzos make me feel lousy-obviously i won't know for sure until i am off them ,but am determined to be benzo free and cope with cognitive therapy.
Posted by ZeeZee on October 19, 2002, at 14:50:17
In reply to am I going hyper on SAM-e, posted by Julia on October 19, 2002, at 4:34:11
SAM-e is contraindicated for anyone who is manic, suffers from an anxiety disorder or has agitation as a symptom, as it increases all of the above.
Posted by Julia on October 20, 2002, at 3:24:08
In reply to Re: am I going hyper on SAM-e » Julia, posted by ZeeZee on October 19, 2002, at 14:50:17
> SAM-e is contraindicated for anyone who is manic, suffers from an anxiety disorder or has agitation as a symptom, as it increases all of the above.
thanks.Is it ok to stop it suddenly(Ihave been on 200mg for 1 week and then 400mg for a week.) Where did you get the info. about SAM-e being contra-indicated in agitation? I have tried to find out about it, but couldn't find definite advice about using it in agitated depression/anxiety
Posted by Babak on October 20, 2002, at 11:40:30
In reply to Re: am I going hyper on SAM-e, posted by Julia on October 20, 2002, at 3:24:08
I just posted a note about feeling more irritable than usual on SAM-e and I know agitation is one my main symptoms. So I would also like to know where the information in the last posting comes from. Thanks anyway
Posted by ZeeZee on October 20, 2002, at 17:15:39
In reply to Re: am I going hyper on SAM-e, posted by Babak on October 20, 2002, at 11:40:30
I resonded to this post earlier but don't know what happened to it.
I believe the package insert states something about SAM-e causing stimulation or is not to be taken by someone who is manic - can't remember. However I have read on countless occassions that since it is energizing it should not be used by people who suffer from anxiety or mania (you'll have to do the research). I ruled this drug out for me a couple of yrs ago as a result of this recommendation since I have panic disorder and do not need to be stimulated or energized. SAM-e seems to be ideal for those suffering from mild to moderate depression with no mania, anxiety or agitation, and with melancholy symptoms (in other words, in need of the energizing effect).
Good Luck
Posted by ZeeZee on October 20, 2002, at 17:29:04
In reply to Re: am I going hyper on SAM-e » Babak, posted by ZeeZee on October 20, 2002, at 17:15:39
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SAM-e Dosage, Side Effects & PrecautionsSAMe Dosage Guidelines
SAMe tablets are enterically coated to enable them to pass through the stomach intact and be absorbed in the small intestine. Best results are obtained when SAMe is taken on an empty stomach but it can be taken with meals if necessary to avoid stomach irritation. Since SAMe is unstable at higher temperatures, it should be kept refrigerated whenever possible.It is probably best to take SAMe during the day and avoid evening doses because the bodys natural rhythm is to have SAMe levels high during the day and low at night. This is a complement to the melatonin cycle which has melatonin levels low in the day and high at night. SAMe facilitates the conversion of serotonin to melatonin.
Below are dosage ranges of SAMe that have been used as nutritional support for various conditions.
SAMe can cause nausea and gastrointestinal upset in some sensitive people, so we recommend starting with the lower dosage and increasing the dosage as tolerated. Some individuals may benefit from lower dosages as well.
Depression -- Four hundred milligrams, three to four times daily. Start at a dosage of 200 milligrams twice daily for the first day. Increase to 400 milligrams twice daily on day three, 400 milligrams three times daily on day ten, and finally to the full dosage of 400 milligrams four times daily after 20 days, if required.
Osteoarthritis -- Start by following the guidelines for depression. After 21 days at a dosage of 1,200 milligrams daily, reduce dosage to a maintenance dosage (minimum dosage required to alleviate symptoms) of two hundred milligrams a day.
Fibromyalgia -- Two hundred milligrams to four hundred milligrams, two times daily.
Liver Disorders -- Two hundred milligrams to four hundred milligrams, two to three times daily.
Migraine Headaches --Two hundred milligrams to four hundred milligrams, two times daily (Requires long term use of SAMe for maximum effectiveness).
SAMe Side Effects & Precautions
SAMe is extremely safe and non-toxic. In clinical studies, SAMe is typically compared against placebo and other compounds for benefits and side effects. While SAMe usually produces beneficial effects superior to drugs and other nutrients, it often produces an incidence of side effects that are lower than the placebo!While antidepressants can cause liver damage, SAMe has been shown in numerous studies to be liver-protective. SAMe also has no withdrawal reaction, commonly found when antidepressants are stopped abruptly.
After beginning SAMe supplementation, a positive response is often felt within a week of starting the program, and often within days, but it may take as long as four weeks.
In a few sensitive individuals, SAMe may cause gastric irritation or an upset stomach. While it is preferable to take SAMe on an empty stomach, it can be taken with meals if necessary to avoid upset stomach.
In general, the longer SAMe is used, the more beneficial the results. It can be used safely during pregnancy and lactation.
SAMe's antidepressant activity may lead to the manic phase in individuals with bipolar (manic) depression.
******Though not reported in the literature, higher doses may occasionally lead to anxiety even in non-bipolar individuals. If the anxiety continues even on the lowest dose, the product should be discontinued.**********************
There are no reported negative interactions with other medications or nutritional supplements.
To avoid conversion of SAMe into high levels of homocysteine, known for its increasing the risk of cardiovascular disease, you should also be taking the cofactors, vitamin B6 (50 mg), vitamin B12 (1000 mcg), and folic acid (800 mcg), to enhance production of the SAMe precursor, methionine.
The information in this article is not intended to provide personal medical advice, which should be obtained from a medical professional, and has not been approved by the U.S. FDA
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