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| SAM-e By Joel Morris MD
02-01-2010
Over the past several months, numerous individuals have asked me about SAM-e and 5-HTP. Both are products used for depression. I have outlined some basic information, which I hope many will find helpful and informative.
SAM-e
SAM-e (pronounced Sammy) is considered a dietary supplement, and can be purchased over the counter in the US. In Europe it is sold as a prescription medication.
What is SAM-e? SAM-e is an amino acid and coenzyme involved in more than 40 metabolic reactions involving nucleic acid (DNA and RNA), proteins, and lipids. Most living cells produce this molecule. It’s involved in a process called methylation, which means that CH3 (a carbon and 3 Hydrogen) are transferred to a neighbor molecule. This can happen a billion times per second in the body. Methylation is one of the necessary processes for life.
What does it do? SAM-e is involved in the expression of genes, fetal development of the brain, preservation of fatty membranes, and regulation of many hormones and neurotransmitters.
What are the therapeutic uses? SAM-e has been shown to boost mood, alleviate joint pain, and lesson liver conditions. Additionally, it may be useful for Alzheimer’s disease. In more than 12 clinical trials, SAM-e was found to be as effective as pharmaceutical meds for joint pain, without the GI side effects typical of standard treatment. Additionally, SAM-e may restore the cartilage. SAM-e has been found to be as helpful as antidepressants.
What are the side effects? SAM-e may trigger manic episodes in vulnerable individuals. Insomnia, lack of appetite, constipation, nausea, dry mouth, sweating, and anxiety are some reported side effects. What is most worrisome is that if there is not enough vitamin B6, B12, and Folic Acid, Homocysteine can accumulate. Homocysteine is correlated with heart, liver, and arterial disease. Consequently, it is recommended that Vitamin B’s are take along with the SAM-e.
How Much and How to take? SAM-e is absorbed through the GI tract; the enteric coated variety is the best so that it passes through the stomach intact to the small intestine. Buying product in blister pack will keep the SAM-e more stable; the SAM-e should be stored away from heat as well. Experts advise taking it twice daily on an empty stomach. For arthritis, 400 mg is the daily dose. For a mood problem, 400 mg to 1600 mg is the dose.
What do I look for? SAM-e comes in 2 forms: tosylate and butanedisulfonate. Nature Made and GNC products are reliable. Prices vary from $2.50 to $19.00 for 400 mg.
If you are taking an antidepressant or have a diagnosis of bipolar disorder, please contact your physician before trying this product.
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5-HTP
As the diagram indicates, 5-HTP is a precursor for serotonin, a neurotransmitter which became well know for mood improvement, after Prozac went on the market. The SSRIs and SNRIs are groups of antidepressants which inhibit the reuptake of serotonin from the synapse, the space where neurons speak with each other. Many people taking SSRIs have a recurrence of their depression, requiring ongoing increases of the medications. Unlike the SSRIs which aren’t equipped to increase the overall serotonin level, 5-HTP helps to replenish the serotonin.
L-Tryptophan → 5-HTP→Serotonin→Melatonin
What is 5-HTP? 5-HTP is an amino acid derived from the amino acid (a building block of protein) L-Tryptophan. Serotonin is found in the brain, the gut, and platelets. Serotonin is converted to melatonin in the pineal gland. Unlike L-tryptophan which competes with other amino acids for a transport system, 5-HTP easily moves through the blood brain barrier.
What does it do? Serotonin is involved with mood disorders, appetite control, eating disorders, autism, premenstrual disorders, fibromyalgia, pain control of migraines, and others. Many studies have demonstrated that 5-HTP increases serotonin levels.
What are the therapeutic uses? Serotonin is particularly useful for depression and anxiety conditions, insomnia, pain control, and impulse control problems. It is better for the kinds of depression characterized by anxiety, irritability, and agitation. It may assist in obsessive compulsive disorder and addictions.
What are the side effects? 5-HTP should not be taken with the following meds: carbidopa, Imitrex, Zomig, Maxalt, and MAOIs. Safety during pregnancy has not been determined. There can be stomach upsets, headaches and hypomania (for those with bipolar disorder). The most common concern is what is called the Serotonin Syndrome which is a serious and possibly fatal condition, and has been seen with over dosages of multiple serotonin medications. There are no published reports of combining SSRIs and 5-HTP.
How Much and How to take? If you plan to take more than 100 mg, do so under the guidance of a physician. There are studies which do demonstrate that up to 300 mg of 5-HTP is helpful for depression.
¬What do I look for? Take from a reputable source only. Most are derived from the Griffonia Simplicifolia, a West African plant.
Joel Morris, MD is a psychiatrist in private practice and uses integrative, Western and Eastern approaches for mental health.
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