S-adenosylmethionine is of fundamental importance in a number of biochemical reactions and has been trialled previously in the treatment of FM. It is quite a mouthful, isn’t it? The abbreviation SAMe (pronounced samm-ee) is much easier to say. Its chemical structure and name are derived from two materials you may (or may not) have heard about already: methionine, a sulfur-containing amino acid; and adenosine triphosphate (ATP), the body’s main energy molecule.
The evidence for SAMe for the treatment of depression is provocative but far from definitive. Several double-blind, placebo-controlled studies have found it effective in relieving depression, but most were small and poorly reported, and many used an injected form of the supplement.
Four double-blind trials have studied the use of SAMe for FM, three of them finding it to be helpful. Unfortunately, most of these studies used SAMe given either intravenously or as an injection into the muscles, sometimes in combination with oral doses. The effects, when taken in this manner, can be quite different from when you take it orally. For that reason, these studies are of questionable relevance to most of us.
Nonetheless, the one double-blind study that used only oral SAMe did find positive results. In this trial, 44 people with FM took 800 mg of SAMe or placebo for 6 weeks. Compared to the group taking placebo, those taking SAMe had improvements in disease activity, pain at rest, fatigue, and morning stiffness, and in one measurement of mood. In other respects, such as the amount of tenderness in their tender points, the group taking SAMe did no better than those taking the placebo.
However, it isn’t clear whether SAMe is helping FM through its antidepressant effects, or by some other mechanism.
The body makes all the SAMe it needs, so there is no dietary requirement. However, deficiencies in methionine, folate, or vitamin B12 can reduce SAMe levels. SAMe is not found in appreciable quantities in foods, so it must be taken as a supplement.
It has been suggested that the supplement trimethylglycine (TMG) might indirectly increase SAMe levels; however, this is yet to be proven.
A typical full dosage of SAMe is 400 mg taken 3 to 4 times per day (which can be quite expensive). If this dosage works for you, take it for a few weeks and then try reducing the dosage. As little as 200 mg twice daily may suffice to keep you feeling better once the full dosage has “broken through” the symptoms.
However, some people develop mild stomach distress (just what people who suffer with IBS want to hear!) if they start full dosages of SAMe at once. To get around this, you may need to start low and work up to the full dosage gradually.
Some labelling suggests a dosage of 200 mg twice daily. This dosage makes SAMe appear more affordable (if you’re only taking 400 mg per day, you’ll spend only about a third or a fourth of what you’d pay for the proper dosage), but it is unlikely that SAMe will actually work when taken at such a low dosage.
- SAMe appears to be quite safe, according to both human and animal studies. The most common side effect is mild digestive distress. However, SAMe does not actually damage the stomach.
- Like other substances with antidepressant activity, SAMe might trigger a manic episode in those with bipolar disease (manic-depressive illness).
- Safety in young children, pregnant or nursing women, or those with severe liver or kidney disease has not been established.
- SAMe might interfere with the action of the Parkinson’s drug levodopa. In addition, there may also be risks involved in combining SAMe with standard antidepressants. For this reason, you shouldn’t try either combination except under physician supervision.
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