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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by bleauberry on May 4, 2008, at 18:07:47
Came across this at pubmed. It was interesting to see that adding a large dose of SAMe to ssri did not result in serotonin syndrome, and did result in 43% remission of people who had not adequately responded to ssri alone. Despite the usual disclaimer at the bottom indicating a placebo controlled trial is warranted, this small trial did pretty good. I mean, to get a 50% response and 43% remission from any group with one augmentation effort is unusually good.
Depression Clinical and Research Program, Massachusetts General Hospital, Department of Psychiatry, Harvard Medical School, Boston, MA 02114, USA. jalpert@partners.org
BACKGROUND: The purpose of this open trial was to evaluate the safety, tolerability, and efficacy of oral S-adenosyl-L-methionine as an antidepressant adjunct among partial and nonresponders to serotonin reuptake inhibitors or venlafaxine. METHOD: Thirty antidepressant-treated adult outpatients with persisting major depressive disorder received 800 to 1600 mg of S-adenosyl-L-methionine tosylate over a 6-week trial. RESULTS: Intent-to-treat analyses based on the Hamilton Depression Rating Scale revealed a response rate of 50% and a remission rate of 43% following augmentation with S-adenosyl-L-methionine. Gastrointestinal symptoms and headaches were the most common side effects. CONCLUSION: Augmentation of selective serotonin reuptake inhibitors or venlafaxine with S-adenosyl-L-methionine warrants a placebo-controlled trial in resistant depression.
PMID: 15538131 [PubMed - indexed for MEDLINE]
Posted by Phillipa on May 4, 2008, at 19:29:50
In reply to SAMe Combined with Antidepressants., posted by bleauberry on May 4, 2008, at 18:07:47
SAMe is over the counter right? Phillipa
Posted by g_g_g_unit on May 4, 2008, at 19:46:05
In reply to SAMe Combined with Antidepressants., posted by bleauberry on May 4, 2008, at 18:07:47
does SAM-e potentiate all the effects of an SSRI, i.e. if you were taking it for say panic disorder could you experience more anxiety relief from the addition of SAM-e? or is it more of an additive & depression-related thing?
Posted by bulldog2 on May 4, 2008, at 22:56:46
In reply to Re: SAMe Combined with Antidepressants. » bleauberry, posted by g_g_g_unit on May 4, 2008, at 19:46:05
> does SAM-e potentiate all the effects of an SSRI, i.e. if you were taking it for say panic disorder could you experience more anxiety relief from the addition of SAM-e? or is it more of an additive & depression-related thing?
SAMe can make one quite agitated. Might be good as an augment agent as an AD but anxiety is often a side effect.
Posted by Sigismund on May 5, 2008, at 4:31:10
In reply to Re: SAMe Combined with Antidepressants. » bleauberry, posted by g_g_g_unit on May 4, 2008, at 19:46:05
200mg SAMe was fine with tianeptine for me.
SAMe and Parnate was awful, averting my eyes as I passed people.
Posted by SLS on May 5, 2008, at 5:01:11
In reply to SAMe Combined with Antidepressants., posted by bleauberry on May 4, 2008, at 18:07:47
I am just wondering, though, if Deplin might actually produce a greater concentration of S-AMe in the locales necessary to produce an antidepressant effect. Deplin pours through the blood-brain barrier unhampered. The other advantage to using Deplin is that its methylation processes consume homocysteine.
Alpert et al. are great investigators of clinically applicable issues.
- Scott> Came across this at pubmed. It was interesting to see that adding a large dose of SAMe to ssri did not result in serotonin syndrome, and did result in 43% remission of people who had not adequately responded to ssri alone. Despite the usual disclaimer at the bottom indicating a placebo controlled trial is warranted, this small trial did pretty good. I mean, to get a 50% response and 43% remission from any group with one augmentation effort is unusually good.
>
> Depression Clinical and Research Program, Massachusetts General Hospital, Department of Psychiatry, Harvard Medical School, Boston, MA 02114, USA. jalpert@partners.org
>
> BACKGROUND: The purpose of this open trial was to evaluate the safety, tolerability, and efficacy of oral S-adenosyl-L-methionine as an antidepressant adjunct among partial and nonresponders to serotonin reuptake inhibitors or venlafaxine. METHOD: Thirty antidepressant-treated adult outpatients with persisting major depressive disorder received 800 to 1600 mg of S-adenosyl-L-methionine tosylate over a 6-week trial. RESULTS: Intent-to-treat analyses based on the Hamilton Depression Rating Scale revealed a response rate of 50% and a remission rate of 43% following augmentation with S-adenosyl-L-methionine. Gastrointestinal symptoms and headaches were the most common side effects. CONCLUSION: Augmentation of selective serotonin reuptake inhibitors or venlafaxine with S-adenosyl-L-methionine warrants a placebo-controlled trial in resistant depression.
>
> PMID: 15538131 [PubMed - indexed for MEDLINE]
>
Posted by bulldog2 on May 5, 2008, at 9:09:27
In reply to Re: SAMe Combined with Antidepressants. » bleauberry, posted by SLS on May 5, 2008, at 5:01:11
> I am just wondering, though, if Deplin might actually produce a greater concentration of S-AMe in the locales necessary to produce an antidepressant effect. Deplin pours through the blood-brain barrier unhampered. The other advantage to using Deplin is that its methylation processes consume homocysteine.
>
> Alpert et al. are great investigators of clinically applicable issues.
>
>
> - Scott
>
> > Came across this at pubmed. It was interesting to see that adding a large dose of SAMe to ssri did not result in serotonin syndrome, and did result in 43% remission of people who had not adequately responded to ssri alone. Despite the usual disclaimer at the bottom indicating a placebo controlled trial is warranted, this small trial did pretty good. I mean, to get a 50% response and 43% remission from any group with one augmentation effort is unusually good.
> >
> > Depression Clinical and Research Program, Massachusetts General Hospital, Department of Psychiatry, Harvard Medical School, Boston, MA 02114, USA. jalpert@partners.org
> >
> > BACKGROUND: The purpose of this open trial was to evaluate the safety, tolerability, and efficacy of oral S-adenosyl-L-methionine as an antidepressant adjunct among partial and nonresponders to serotonin reuptake inhibitors or venlafaxine. METHOD: Thirty antidepressant-treated adult outpatients with persisting major depressive disorder received 800 to 1600 mg of S-adenosyl-L-methionine tosylate over a 6-week trial. RESULTS: Intent-to-treat analyses based on the Hamilton Depression Rating Scale revealed a response rate of 50% and a remission rate of 43% following augmentation with S-adenosyl-L-methionine. Gastrointestinal symptoms and headaches were the most common side effects. CONCLUSION: Augmentation of selective serotonin reuptake inhibitors or venlafaxine with S-adenosyl-L-methionine warrants a placebo-controlled trial in resistant depression.
> >
> > PMID: 15538131 [PubMed - indexed for MEDLINE]
> >
>
>yes that is an advantage of deplin that it consumes homocycsteine which is a marker for heart disease.Even though deplin helps create sam-e it felt different to me from actually taking sam-e. Mood effect a little smoother.
Posted by bleauberry on May 5, 2008, at 19:04:00
In reply to Re: SAMe Combined with Antidepressants. » bleauberry, posted by SLS on May 5, 2008, at 5:01:11
Ok Scott, you've sold me on Deplin. My homocysteine levels are elevated, if no other reason. My problem with SAMe is the methione part of it. I don't do well with strong sulfury things. Deplin is an attractive alternative.
My GP favors whole-body non-pharmaceutical stuff and trys to keep hardcore medicine as low as possible, so I know he'll love the idea. I've followed all your posts, so I am well educated on the timeframe of response, pattern of response, and dosing quirks. Thanks much for all that. Very helpful.
Posted by SLS on May 5, 2008, at 20:03:53
In reply to Re: SAMe Combined with Antidepressants. » SLS, posted by bleauberry on May 5, 2008, at 19:04:00
> I've followed all your posts, so I am well educated on the timeframe of response, pattern of response, and dosing quirks. Thanks much for all that. Very helpful.
I am glad to be of help. I just want to make you aware that I have still not established the minimum effective dosage for myself. I deteriorated after 3 days at 3.75mg. Lowering the dosage was an experiment to attempt to relieve myself of sleep disturbances. It might be an effect of combining it with Nardil. Having returned to the higher dosage, I feel much better this evening. I'm praying that this is the right move. I really didn't want to screw around too much, as I have a school exam tomorrow. In any event, it is my belief that one should start Deplin at 7.50mg. If it is tolerated, you will probably not see significant results for a month or two. I will be curious to see what your pattern of response is.
I think I mentioned that I met another patient of my doctor's who is doing remarkably well upon the addition of Deplin 7.50mg to Cymbalta and tryptophan. She never felt as well as she does now after 16 years of trying. She tolerates Deplin very well. Listen, I might go for doubling the dosage. I hate to seem so cavalier in my dosing of this drug, but I don't think there is yet enough experience with it to have a good feel for how best to use it. The kinetics demonstrated by the paper Ron Hill posted a link to provides some rationale as to why it takes 1-3 months for Deplin to become effective. It takes that long for it to reach its maximal concentration in the brain.
Good luck with Deplin. I hope it provides you with as robust an antidepressant response as it has given me. It would be helpful for you to post your experiences so that we can all learn more about the behavior of this substance.
On another note, I'm curious if you had the chance to read letter I wrote to the NJ legislature. Do you know whether this is a problem in any other state?
http://www.dr-bob.org/babble/20080430/msgs/826866.html
Thanks.
- Scott
Posted by bulldog2 on May 9, 2008, at 19:45:53
In reply to Re: SAMe Combined with Antidepressants. » bleauberry, posted by SLS on May 5, 2008, at 20:03:53
> > I've followed all your posts, so I am well educated on the timeframe of response, pattern of response, and dosing quirks. Thanks much for all that. Very helpful.
>
> I am glad to be of help. I just want to make you aware that I have still not established the minimum effective dosage for myself. I deteriorated after 3 days at 3.75mg. Lowering the dosage was an experiment to attempt to relieve myself of sleep disturbances. It might be an effect of combining it with Nardil. Having returned to the higher dosage, I feel much better this evening. I'm praying that this is the right move. I really didn't want to screw around too much, as I have a school exam tomorrow. In any event, it is my belief that one should start Deplin at 7.50mg. If it is tolerated, you will probably not see significant results for a month or two. I will be curious to see what your pattern of response is.
>
> I think I mentioned that I met another patient of my doctor's who is doing remarkably well upon the addition of Deplin 7.50mg to Cymbalta and tryptophan. She never felt as well as she does now after 16 years of trying. She tolerates Deplin very well. Listen, I might go for doubling the dosage. I hate to seem so cavalier in my dosing of this drug, but I don't think there is yet enough experience with it to have a good feel for how best to use it. The kinetics demonstrated by the paper Ron Hill posted a link to provides some rationale as to why it takes 1-3 months for Deplin to become effective. It takes that long for it to reach its maximal concentration in the brain.
>
> Good luck with Deplin. I hope it provides you with as robust an antidepressant response as it has given me. It would be helpful for you to post your experiences so that we can all learn more about the behavior of this substance.
>
> On another note, I'm curious if you had the chance to read letter I wrote to the NJ legislature. Do you know whether this is a problem in any other state?
>
> http://www.dr-bob.org/babble/20080430/msgs/826866.html
>
> Thanks.
>
>
> - ScottI think that if you use deplin that you should do blood workups for homocysteine. I agree with Scott that lowering homocysteine is a good thing as high homocysteine is one of the markers of heart attacks..But also don't want to go to low..
Posted by Phillipa on May 9, 2008, at 20:38:38
In reply to Re: SAMe Combined with Antidepressants., posted by bulldog2 on May 9, 2008, at 19:45:53
Hey guys got an official brochure at my pdocs yesterday finally its out. I could copy the many pages and post it as it explains Deplin clearer in the brochure.It does say 67% of people are partial responders or no response.Here is part of a particular paragraph " Research indicates that depressed patients with low L-methylfolate levels in the brain who have not reponded to antidepressants (ie SSRI, SNRI) may need extra L-methyfolate to boost the production of serotonin, norepinephrine, and dopamine. Why an inaddequate response to ad? Several reasons that the brain is not developing enough neurotransmitters due to in sufficient folate in the brain. This means some people might not produce enough neurotransmitts for an antidepressant to work fully.In 7 out of l0 individuals with depression they may have a specific genetic factor that limits their ability to convert folic acid to folate from the diet to L-methylfolate. This is important becuae L-methylfolate is the only form of folated used by the brain to correct a neurtransmitter imbalance linked to depression.Side effect? it is well tolerated in both short-term and long-term trials. Side effects did not differ from a sugar pill(placebo) Deplin is not associated with weight gain, sexual dysfunction. You will begin to notice a difference after taking Deplin for l-2 weeks, but the full effect may take 4-6 weeks. You may feel improvement in one or more of the following: motivation, initiative, alertness, concentration, mood, sociability. Many more pages and info. But the gist is there. Phillipa
Posted by Phillipa on May 9, 2008, at 20:40:35
In reply to Re: SAMe Combined with Antidepressants., posted by Phillipa on May 9, 2008, at 20:38:38
Forgive my typos nothing about Samme in the brochure? Love Phillipa
Posted by bulldog2 on May 10, 2008, at 9:46:27
In reply to Re: SAMe Combined with Antidepressants., posted by Phillipa on May 9, 2008, at 20:40:35
> Forgive my typos nothing about Samme in the brochure? Love Phillipa
It's on their web site. There's a part for professional health workers. Shows a chart conversion of homocysteine to SAMe.
Posted by Phillipa on May 10, 2008, at 20:05:46
In reply to Re: SAMe Combined with Antidepressants., posted by bulldog2 on May 10, 2008, at 9:46:27
Thanks bulldog but I like to have something in my hand to read and since it's harmless not being rude it doesn't matter to me what it turns into. I feel that if it was important for the patient to know would be in the brochure???? Unless a person is allergic or reacts badly to SAMe. Love Phillipa ps need a pedicure.
Posted by bulldog2 on May 11, 2008, at 17:15:07
In reply to Re: SAMe Combined with Antidepressants. » bulldog2, posted by Phillipa on May 10, 2008, at 20:05:46
> Thanks bulldog but I like to have something in my hand to read and since it's harmless not being rude it doesn't matter to me what it turns into. I feel that if it was important for the patient to know would be in the brochure???? Unless a person is allergic or reacts badly to SAMe. Love Phillipa ps need a pedicure.
okay I'm om my way...sometimes info is pertinent..some ppl way become agitated on sam-e
Posted by bulldog2 on May 11, 2008, at 17:15:39
In reply to Re: SAMe Combined with Antidepressants. » bulldog2, posted by Phillipa on May 10, 2008, at 20:05:46
> Thanks bulldog but I like to have something in my hand to read and since it's harmless not being rude it doesn't matter to me what it turns into. I feel that if it was important for the patient to know would be in the brochure???? Unless a person is allergic or reacts badly to SAMe. Love Phillipa ps need a pedicure.
okay I'm om my way...sometimes info is pertinent..some ppl way become agitated on sam-e
Posted by bulldog2 on May 11, 2008, at 17:15:49
In reply to Re: SAMe Combined with Antidepressants. » bulldog2, posted by Phillipa on May 10, 2008, at 20:05:46
> Thanks bulldog but I like to have something in my hand to read and since it's harmless not being rude it doesn't matter to me what it turns into. I feel that if it was important for the patient to know would be in the brochure???? Unless a person is allergic or reacts badly to SAMe. Love Phillipa ps need a pedicure.
okay I'm om my way...sometimes info is pertinent..some ppl way become agitated on sam-e
Posted by undopaminergic on May 11, 2008, at 18:01:22
In reply to Re: SAMe Combined with Antidepressants., posted by bulldog2 on May 11, 2008, at 17:15:49
I have yet to notice any effect at all from SAMe. A few minutes ago, I took 4 grams, as 10 enteric coated 400 mg tablets; this is my largest dose so far.
Posted by tarheelex on May 14, 2008, at 15:57:13
In reply to Re: SAMe Combined with Antidepressants., posted by undopaminergic on May 11, 2008, at 18:01:22
I have found Sam-e to work moderately well at smaller doses. 400 mgs seems to be ok although there is some mild anxiety and gastro side effects. It seems to be hitting NE receptors more significantly than serotonin. Currently augmenting with trazodone for the anxiety and some insomnia. 5 days into this augmentation trial. Sam-e builds up in your system over time and the hope is that I can eventually go down to 200 mgs although I am typically a decent responder at low doses.
This is the end of the thread.
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