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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 bulldog2 on January 28, 2008, at 14:38:33
With all this talk of deplin as an adjunct to an AD I was wondering about Sam-e. I know it has a role in creating neurotransmitters so in theory would that be a good supplement to go with a ad?
Posted by Phillipa on January 29, 2008, at 12:12:09
In reply to Sam-e as an adjunct to an AD, posted by bulldog2 on January 28, 2008, at 14:38:33
Good question. I'd like to know too. Phillipa
Posted by Jamal Spelling on January 29, 2008, at 12:26:35
In reply to Sam-e as an adjunct to an AD, posted by bulldog2 on January 28, 2008, at 14:38:33
SAMe may trigger mania, so that would be a risk to consider when combining it with other ADs.
Some studies suggest SAMe has an efficacy comparable to tricyclic ADs, so it need not be used as an adjunct to prescription ADs. In Italy, SAMe is in fact a prescription AD.
I find SAMe to be highly stimulating. I never use it for more than a month at a time, because (a) it is very expensive, (b) anything that potent almost seems unhealthy, and (c) I do not want to risk permanently altering my neurochemistry from long-term use.
Posted by Sigismund on January 29, 2008, at 19:10:23
In reply to Re: Sam-e as an adjunct to an AD, posted by Jamal Spelling on January 29, 2008, at 12:26:35
For me it was terrible with Parnate and OK with tianeptine.
I took 200 or 400 mg/d.
Posted by Racer on January 30, 2008, at 16:49:34
In reply to Sam-e as an adjunct to an AD, posted by bulldog2 on January 28, 2008, at 14:38:33
In many places, it's sold as an anti-depressant in its own right. I buy it at Costco, which sells the Mood Plus brand for about $40 for 90 200mg tablets. I take it BID, on my pdoc's advice, and it has certainly kicked up the juice on my Wellbutrin/Concerta combo. My pdoc cautioned, though, that it can affect homocysteine levels, and prescribed Metan-X to counter that effect. He also said what Jamal Spelling said: it's been known to trigger mania.
Obviously, I am an outlier on these things: I suffer from severe recurrent melancholic depression with comorbid anxiety disorder, and have had at best mixed results from conventional antidepressants. My husband, who has primarily an anxiety disorder, with mild to moderate depression mixed in, also takes SAMe, which he finds much more tolerable than the conventional antidepressants his doctor prescribed for him. (Then again, he was getting the prescriptions from his GP, whom I was not impressed by. In fact, he used to be my GP, until I fired him for cause.) He's not sure how much it helps, but at least as much as the Wellbutrin his GP prescribed -- that's right, Wellbutrin for an anxiety disorder, go figure [rolls eyes]. He thinks it's helping enough to keep taking it.
So, yes, it can be very helpful. Do be aware, if you're bipolar or have any bipolar symptoms, that it's worth being on the watch for manic symptoms, and do consider discussing homocysteine levels with your doctor. If you start taking it along with other antidepressants, let your doctor know -- it will affect other medications you're taking.
Hope that helps.
Posted by bulldog2 on January 30, 2008, at 17:07:46
In reply to Re: Sam-e as an adjunct to an AD » bulldog2, posted by Racer on January 30, 2008, at 16:49:34
> In many places, it's sold as an anti-depressant in its own right. I buy it at Costco, which sells the Mood Plus brand for about $40 for 90 200mg tablets. I take it BID, on my pdoc's advice, and it has certainly kicked up the juice on my Wellbutrin/Concerta combo. My pdoc cautioned, though, that it can affect homocysteine levels, and prescribed Metan-X to counter that effect. He also said what Jamal Spelling said: it's been known to trigger mania.
>
> Obviously, I am an outlier on these things: I suffer from severe recurrent melancholic depression with comorbid anxiety disorder, and have had at best mixed results from conventional antidepressants. My husband, who has primarily an anxiety disorder, with mild to moderate depression mixed in, also takes SAMe, which he finds much more tolerable than the conventional antidepressants his doctor prescribed for him. (Then again, he was getting the prescriptions from his GP, whom I was not impressed by. In fact, he used to be my GP, until I fired him for cause.) He's not sure how much it helps, but at least as much as the Wellbutrin his GP prescribed -- that's right, Wellbutrin for an anxiety disorder, go figure [rolls eyes]. He thinks it's helping enough to keep taking it.
>
> So, yes, it can be very helpful. Do be aware, if you're bipolar or have any bipolar symptoms, that it's worth being on the watch for manic symptoms, and do consider discussing homocysteine levels with your doctor. If you start taking it along with other antidepressants, let your doctor know -- it will affect other medications you're taking.
>
> Hope that helps.Yes thank you for you helpful post! I'm looking for something to punch up my response to luvox which is very sedating and also has me feeling lazy and apathetic.
Posted by Phillipa on January 30, 2008, at 19:59:52
In reply to Re: Sam-e as an adjunct to an AD, posted by bulldog2 on January 30, 2008, at 17:07:46
Shall I join you? Then you need deplin too. Phillipa
Posted by bleauberry on January 30, 2008, at 20:15:04
In reply to Sam-e as an adjunct to an AD, posted by bulldog2 on January 28, 2008, at 14:38:33
I have seen SAMe combined with tricyclics in studies. I don't recall seeing it with ssris, though I'm sure it has been done. I took it with prozac for a couple weeks, but prozac was already too stimulating at that time of my life and SAMe made it even more so. It did have a good effect though in the ways you are looking for.
Most people who buy SAMe at the drug store are elderly folks using it for arthritis, joint pains, or liver health. I suspect many of them are on other drugs including psychiatric drugs. So it is my guess these combos happen by the hundreds or thousands every day.
As Racer said, two issues to watch for are homocysteine and mania. Homocysteine can be lowered with suggestion from Racer, or with 200%RDA of folic acid and B12. Deplin would also be a good candidate for the mood and homocysteine stuff. SAMe is usually stimulating, especially in the first weeks before adjusting to it. Common side effects could be agitation, irritation, and insomnia, which would be hard to distinguish as early side effects or triggering a dysphoric type of mania. Just be on the lookout, go slow and easy. Maybe start with 200mg every other day, work up to 200mg every day, then bump it up slowly higher if needed and all is well. If mania happens it is my guess it would creep in with a subtle fashion, not an overnight explosion kind of thing. Keeping a daily diary would help spot any troublesome changes. All that being said, SAMe can be highly effective and free of side effects. It's just that most websites promote all the good stuff but don't warn much about the possible negatives, or they just briefly mention the negatives.
I have browsed a lot of forums looking at people who have tried SAMe. Honestly, most of them do experience the stimulation side of it, most of them do get some kind of benefit from it, and I have not actually seen anyone report mania from it.
Serotonin syndrome. I doubt this would happen. But, it would be a good idea to google it, become familiar with the symptoms, and keep a watch out.
I just like to play it safe. Honestly, I think SAMe should be smooth sailing if you go slow and easy.
This is the end of the thread.
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