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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by tonyz on May 1, 2009, at 11:39:54
I am wondering about those that have some experience taking SAM-e. How many years have you taken it and at what dosages? One of the potential complications with SAM-e is the increase in homosysteine levels. The homosysteine can be reduced by taking additional supplements which can reduce the need for taking larger amounts of SAM-e. This is stuff I read on the web about the methylation process. It makes sense, but I am looking for some supporting evidence. One article I read recommended supplementing SAM-e with 100 mg B6, 1mg B12, 500-2000 mg trimethylglycine and 1mg folic acid. From what I understand the B vitamins are water soluble so if you take too much your body will just eliminate them naturally; however, I don't know much about trimethylgycine and folic acid so I don't know of any complications with these levels?
Co-Q10 is also supposed to reduce homosysteine levels so I am wondering if that would be a good supplement as well.
The most effective antidepressants for me have been Nortrityline and SAM-e (NOT AT THE SAME TIME)
Taking tricyclics and SAM-e together can be very dangerouse because of the risk of serotonin shock.Everyone's mind and body reacts differently, it is unfortunate that there are no clinical tests that can determine what is the precise drug for each person.
I can't speak for others as to their symptoms and problems and how they choose to treat their illness, but for me I would prefer to avoid the pharmaceutical route if at all possible. The doc I am seeing now is supportive of this approach and I would encourage anyone to discuss with their doc before making any changes.
Lastly, I'm not sure if this is the right place to be posting this. I will also post on the alternative board.
Current meds/supplements taken now
diazepam 10mg
SAM-e 400mg
vitamin e 200mg
Daily vitamin
co-q10 100mg
Calcium 500mg
Vitamin C 500mgThanks in advance for any feedback.
Posted by uncouth on May 1, 2009, at 12:11:53
In reply to Opinions on Supplements with SAM-e, posted by tonyz on May 1, 2009, at 11:39:54
really? I'm up to 175mg nortriptyline and I'm also taking 800mg of SAMe. i've only been on this combo for 2 weeks, but so far, i haven't noticed any bad interactions or serotonin syndrome.
and I'm ALSO taking 120mg of Geodon, and 100mg of milnacipran a day, so i'm hitting serotonin from a bunch of different angles (and also taking some other junk, see my post below).
love,
al
Posted by Phillipa on May 1, 2009, at 12:17:02
In reply to Opinions on Supplements with SAM-e, posted by tonyz on May 1, 2009, at 11:39:54
I'm pretty sure folic acid is also a B vitamin. From my understanding you have bright yellow urine with too much so assuming excretion as water soluble is through the urine. I do know from past that B6 can be a mild diuretic as my ob-gyn years ago prescribed it for pms. Phillipa
Posted by tonyz on May 1, 2009, at 13:40:29
In reply to Re: Opinions on Supplements with SAM-e, posted by uncouth on May 1, 2009, at 12:11:53
Yup, serotonin shock is a real phenomenon from what I have read and also from discussions with my psych. 175mg of Notriptyline is a pretty healthy dosage - just curious if you've had a blood level on the Nortriptyline done. Severe constipation is a side effect for some people with Nortriptyline and I've had some doctors suggest eating higher fiber foods. The problem is fiber interferes with the absorption of Notriptyline. I surmise that if you space your eating of high fiber foods and your NTP doses far enough apart you may not have a problem. If you haven't done so already you might want to have a notriptyline blood level done. This is one of the few drugs where they actually can tell if it is at the right concentration to have a beneficial effect. Hopefully, your doc knows about the concomitant use of SAMe. I am not a medical professional of any kind but I would urge caution with this mix. Read up on serotonin shock.
Also excessive vitamin C also interferes with the absorption of Nortriptyline
Posted by bleauberry on May 1, 2009, at 16:57:30
In reply to Re: Opinions on Supplements with SAM-e, posted by uncouth on May 1, 2009, at 12:11:53
> really? I'm up to 175mg nortriptyline and I'm also taking 800mg of SAMe. i've only been on this combo for 2 weeks, but so far, i haven't noticed any bad interactions or serotonin syndrome.
>
> and I'm ALSO taking 120mg of Geodon, and 100mg of milnacipran a day, so i'm hitting serotonin from a bunch of different angles (and also taking some other junk, see my post below).
>You are hitting serotonin from different angles, but not at powerful levels. Nortriptyline is almost completely just norepinephrine, milnacipran is two thirds norepinephrine, and Geodon probably doesn't have any significant effect on increasing brain levels of serotonin. SAMe has been used in USA university clinical studies at very high doses incombination with high doses of Lexapro, and serotonin syndrome did not happen with anyone.
So I think you are safe from that concern.
That said, people have gotten serotonin syndrome from a single SSRI without any other drug involved, so risk is always present. That is rare though.
Posted by Larry Hoover on May 1, 2009, at 18:20:13
In reply to Opinions on Supplements with SAM-e, posted by tonyz on May 1, 2009, at 11:39:54
> One article I read recommended supplementing SAM-e with 100 mg B6, 1mg B12, 500-2000 mg trimethylglycine and 1mg folic acid. From what I understand the B vitamins are water soluble so if you take too much your body will just eliminate them naturally; however, I don't know much about trimethylgycine and folic acid so I don't know of any complications with these levels?
I wouldn't jump into taking that combination. The additive effect could be more than you're looking for, and you wouldn't know where to adjust things.
There are three routes for your body to recycle homocysteine to methionine. There is one that uses trimethylglycine (TMG, which is also known as betaine), via the enzyme BHMT (betaine-homocysteine methyltransferase), to donate the required methyl group. The enzyme is inducible, meaning that if your body is exposed to a source of TMG, it will make the enzyme that will utilize it. Although I have previously recommended this as my first choice, I have since discovered evidence that it may be insufficiently effective to normalize homocysteine levels on its own. In contrast to the other main option, it appears to not require co-factors (the B-vitamins). Zinc deficiency can block this enzyme, because it requires a zinc atom at the active site.
The second option utilizes 5-methyltetrahydrofolate (an activated form of folate) as the methyl donor, and cobalamin (B-12) as the transfer vehicle, in the enzyme known as MTR (5-methyltetrahydrofolate-homocysteine methyltransferase). Some people have problems forming 5-MTHF, which is why supps like Metafolin or Deplin may be beneficial.
The third enzyme is an odd-ball, IMHO, as it consumes SAMe to convert homocysteine to methionine. Methionine is the precursor to SAMe, and the SAMe consumed in the reaction goes on to form more homocysteine. Therefore, there is no net benefit, but I don't know how to avoid it, except by utilizing other methods to decrease homocysteine.
No matter how you reduce your homocysteine, you increase your methionine stores, which will lead to greater innate formation of SAMe. Which kind of begs the question whether on not simply optimizing your own homocysteine recycling might not be the first thing to try.
Lar
Posted by tonyz on May 5, 2009, at 12:23:21
In reply to Re: Opinions on Supplements with SAM-e » tonyz, posted by Larry Hoover on May 1, 2009, at 18:20:13
Lar and others,
Thanks for your reply, I guess you are suggesting that the supplementation of sam-e with folate and b-12 might be a good place to start considering that I have already started with the SAMe.
I've had some luck with Sam-e in the past.
I have also used Notriptyline, Notriptyline and Seroquel, and Notriptyline and Wellbutrin and some other things. Have been taking Clonazepam or Diazepam since November at varying dosages. Had been down to 2.5mg of valium but the sleep became an issue. Doc advised adding trazodone which was not helping that much. Valium had also been increased to about 7mg. Now the valium is back up to 10 mg have been off the trazodone for about 5 days (had been taking 100mg, 50mg last day and then stopped). At this point 10mg valium, and 600mg of SAMe, multivitamin, co-q10 and some other supplements which should have no effect. Haven't added the b-vitamins and/or tmg yet. There is more to add but it would take too long.
I am trying to get off the valium but I think that is the only thing that is helping me sleep at least 4 hours a night. I don't want to increase it - that will only add further reliance and I think it is adding to my daytime fuzziness.
I think the SAM-e can help. I take it at 7:30am and then a second dose at 11:30am (400/200mg) I have only been on it for a few days and just added the second dosage yesterday. I figure this is early enough in the day so it shouldn't be adding to the insomnia, but with all the switches coming off the trazodone, tweaking the valium to compensate, etc. it is hard to know.
At this point I am not sure how to proceed.
Anyone else out there trying to treat their depression and insomnia/anxiety with SAMe that can share their experiences.
Thanks.
Posted by Sigismund on May 6, 2009, at 18:11:33
In reply to SAMe, Insomnia, and effects of other meds, posted by tonyz on May 5, 2009, at 12:23:21
I have long term poor sleep with low grade depression.
400mg SAMe first thing in the morning does not worsen my sleep, AFAIK, but I would be cautious about more.
I have all these suspects for things that ruin my sleep.....green tea, black tea, flavanoids, blueberries, grape seed extract. You never know what's doing it.
Posted by Phillipa on May 6, 2009, at 20:22:09
In reply to Re: SAMe, Insomnia, and effects of other meds » tonyz, posted by Sigismund on May 6, 2009, at 18:11:33
Sigi hormones. And I drink both green and black teas. Sleep well with the lowering doses of benzos. Strange isn't it? Love PJ
Posted by raisinb on May 6, 2009, at 21:06:43
In reply to Opinions on Supplements with SAM-e, posted by tonyz on May 1, 2009, at 11:39:54
Please be careful with this supplement. I'm sure my experience is atypical, but it made me extremely manic. I took it for about two weeks when I was struggling with suicidal depression a year ago. It gave me disordered, grandiose thinking, insomnia, jittery-feelings.
It was a lesson to me about how powerful OTC supplements can be.
Posted by tonyz on May 10, 2009, at 21:30:45
In reply to Re: Opinions on Supplements with SAM-e » tonyz, posted by raisinb on May 6, 2009, at 21:06:43
Appreciate all the comments. Doc has suggested SAM-e with an 800mg daily dose with 2 400mg daily doses spaced about 4 hours apart with the last one around 12pm. Actually this was my suggestion and doc agreed. Also added a small dosage of remeron 7.5mg, and have been taking 10mg of valium which I am slowly trying to taper.
The SAMe has worked for me in the past. It is really hard to gauge the level of effectiveness. Sometimes I think it was as good as Nortriptyline at very high dosages. The insomnia is a big issue. The Nortriptyline just trashes my body -- difficult to explain w/o going into a lot of details but my body is so much better w/o Nortriptyline. I think SSRIs would be too stimulating they have never worked for me in the past, but then I have never been on any of them for that long. My depression has a lot of anxiety so even with the sedating antidepressants I would require some adjunct to help me get some sleep. Ambien, Lunesta, Sonata have not proven to be helpful.
The small amount of remeron seems to be doing something but it is hard to tell. My doc is not an expert on using SAM-e. In general, I think it is hard to find one that is. I would like to add some cofactors like B-vitamins and folate or trimethylglycine, but I don't feel comfortable making this decision on my own. I understand to a limited extent the methylation process and the byproduct homocysteine which is produced which is not a good thing. The co-factors can help recycle this which allows the body to produce more SAMe on its own. At least that is my understanding.
I looked at the alternative board and I didn't come across anything on SAMe. Maybe I missed something.
Anyway we'll see how it goes. Best of luck to all of us. This sucks but we'll manage to get through it.
Posted by Sigismund on May 12, 2009, at 16:18:26
In reply to Re: Opinions on Supplements with SAM-e, posted by tonyz on May 10, 2009, at 21:30:45
>I would like to add some cofactors like B-vitamins and folate or trimethylglycine, but I don't feel comfortable making this decision on my own. I understand to a limited extent the methylation process and the byproduct homocysteine which is produced which is not a good thing. The co-factors can help recycle this which allows the body to produce more SAMe on its own.
I took SAMe for years and while doing so my homocysteine levels were checked. To my surprise they were always OK. I took the usual multivitamin thing.
This is the end of the thread.
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