![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 69 to 93 of 101. Go back in thread:
Posted by IsoM on March 22, 2002, at 19:14:51
In reply to Re: Sam-e and insomnia. » beardedlady, posted by vincent on March 22, 2002, at 19:08:42
Well, it looks like I won't be getting any SAM-e to try after all. Health Canada removed it from stores - don't know when this happened but I had seen it sold before here. Ordering over the internet is out as it's bloody expensive, then I pay exchange & shipping, which can almost double the cost.
I'll just make sure I keep my protein intake good & make sure I'm getting enough protein containing methionine. My B complex intake is already very good anyway. Ah well, considering all this, maybe it wouldn't have made a major difference, & the cost...
Posted by Ron Hill on March 22, 2002, at 21:25:37
In reply to oy vey! » Ron Hill, posted by beardedlady on March 22, 2002, at 13:33:27
Ms. Lady,
Thank you so much for taking the time to help me understand your case history. Having read your response, I have completely changed my mind. I think there is a very high probability that SAM-e will fix both your insomnia and your anxiety if you do the trial correctly. Sorry to have come off so negative before. I just did not have enough of your case history. Please read my responses to your answers. It’s kinda cluttered with 49 posts crammed into one, but you can figure it out.
> > Yes, but what does this have to do with the reason you are tapering off Serzone?
> Oh, the liver thing. Serzone has that new black box, so I thought it best if I either switch to something else (but I dunno what) or try to live as I have for the 36 years before this happened to me.My recommendation: Don't worry too much about those "lawyer (shark) TV adds". JohnX2 takes Serzone, and he has posted that he is not concerned about it. John seems to think it's a lot to do over nothing. Personally, I have not taken the time to look into it since it does not affect me directly. However, I would be willing to bet dollars to donuts that John has looked into this Serzone issue VERY extensively because he takes the stuff (and because he is John!). John knows a lot about meds. I'd trust his judgment unless you have something that shows without a doubt that Serzone is dangerous.
I'm like you, I'd rather be off all man made medications. But you write that the Serzone is working well. If it ain't broke don't fix it. If it were me, I'd keep the Serzone in place while ramping up the SAM-e. Do this for one week, and if all is well, begin to carefully wean yourself off Serzone.
> > What or who gave you the impression that SAM-e is an appropriate treatment for insomnia? What does your pdoc think of the SAM-e trial? I feel sure that SAM-e will not harm you in any way, however, using it specifically to treat insomnia is, as I understand it, untried.
> No one gave me that impression. But I will try anything that's not a drug. And if it makes me feel good, maybe I won't worry so much about sleep.I'm on your side now. Start with 200 mg/day, and take the dose in the am.
> > Why hasn't your pdoc prescribed either sleeping pills or benzos to combat the insomnia?
>
> When this first happened three and a half years ago, we tried Ambien (one pill, one time), but I was so anxious I couldn't break through it, so it didn't work. Then we tried Xanax, which worked for short spurts of nap (but I was only on about .5 mgs!). Then we tried Zoloft and Xanax, and I got worse. Then we tried Trazodone and Xanax, and that worked for a month. Then we changed some timing, and it worked again for a month. Then we tried Serzone and quit the Xanax (yea! I hated it!), and my sleep returned to normal in about a week, and it hasn't stopped working.Serzone is working for you. Do not throw it away too soon. To reiterate; ramp up the SAM-e first, then slowly taper the Serzone, reversing course is it ends up that you can't sleep without it.
> Occasionally, when real life stuff interferes, I have breakthrough anxiety, and I use Sonata--a great drug (we discussed this before re: shelf life, which my pharmacist says is bunk because it's already months old in the pharmacy, and it has an expiration date of longer than a year on his bottle).
Good. One more tool in the tool box if it is needed.
> > Also you can do a search on the web (and on this site also) for the term "sleep hygiene" which is a set of rules (e.g. no sleeping during the day, etc) for the patient to follow in order to facilitate better quality sleep. I'm probably telling you a bunch of stuff that you already know and you're just eager for me to shut up.
> Yes. I know everything about it. I have great sleep hygiene. I never had this problem until my daughter quit nursing cold turkey the weekend before I started a new teaching job, which was right after my father-in-law's funeral!
This is one of two important bits of information that made me change my mind regarding the probable effectiveness of SAM-e to treat your insomnia and anxiety. I now believe that your insomnia is due to low serotonin and not related to GABA. SAM-e is quite capable of increasing serotonin levels so you should be good to go.
> > Do you have the type of insomnia that causes you to wake up in the middle of the night and then preclude you from getting back to sleep, or do you have the kind of insomnia that makes it hard to fall asleep from the get go?
> It started while I was nursing with waking up at 2:00 a.m. and lying there until I fell asleep at 4:00. This happened maybe five times in four months. On the rare nights (rare now, anyway) that I can't fall back to sleep at all (I lie there in bed "resting" all night anyway because I often can get another three hours if I'm patient), I have trouble falling asleep the next night.This also sounds like low serotonin.
> > Also, how do you know that the key to curing your panic is to cure the insomnia (first). How do you know it is not the other way around (solve panic to cure insomnia)? What does the pdoc think, chicken or egg?
> It's obviously the insomnia that caused the panic. I forgot to add that I took a diet pill (phentermine) when she quit nursing. I was on them for about a month or two a year before I got pregnant, and they not only worked on my weight but made me feel happy and energetic, so I wanted that again after nursing a baby. But it gave me insomnia, and I stopped taking it. The insomnia didn't go away, so I started to panic that I wouldn't be able to take care of my daughter. I panicked because of sleep, and that's all.
Okay, I hear you now. Your reaction to the diet pill is the second important bit of information that made me change my mind regarding the probable effectiveness of SAM-e to treat your insomnia and anxiety. This diet pill story makes me think that you will benefit from a small boost of dopamine. And SAM-e can certainly do that.
> Thanks for asking.
I feel like I hurt your feelings with my last post. At the time, I needed more info. Thanks for filling me in. I'm sorry that I caused hurt. Forgive me?
> So the reason I'm thinking SAM-e is that I might stop worrying if I feel good, which might let me rest at night once I'm off the Serzone (or on a really reduced dose). Otherwise, it might keep my liver healthy to counteract the possible liver toxicity of Serzone.
One thing is for sure, we won't know unless you try the SAM-e. Have you bought it yet? What day do you plan to start the SAM-e trial? Please post your results daily. You have my best wishes and I will try to remember to pray for you daily this coming week.-- Ron
P.S. My wife teaches fourth grade at a public charter school. Are you still teaching?
Posted by Ron Hill on March 22, 2002, at 22:54:34
In reply to No SAM-e after all..., posted by IsoM on March 22, 2002, at 19:14:51
IsoM,
Another, less expensive approach is to supplement your diet with the raw materials used by the human body to synthesize SAM-e. The idea is to improve the body's ability to make SAM-e (as opposed to feeding the body "ready-made SAM-e", as we have been discussing on this board).
A couple months ago, I bought one such supplement product called "SAM-e Kick Start". I have not yet tried it. Here is what the label says:
Serving Size: 2 capsules
Amounts listed are per serving (i.e. 2 capsules)Trimethylglycine (TMG); 695 mg
L-Methionine; 250 mg
Dimethylglycine (DMG); 185 mgB-6; 15 mg
Folic Acid; 800 mcg
B-12; 200 mcgDirections: One capsule twice daily, as a nutritional supplement.
Since you are already taking your B-vitamins, and provided you eat enough meat, you're getting enough l-methionine. Therefore, forget about the "SAM-e Kick Start" product and just go to the health food store and buy some TMG and DMG. Take them and your vitamins with you meal (include meat or an alternate l-methionine source with meal). Some people say you just need TMG, while others say it's best to take both (TMG and DMG).-- Ron
-----------------------------------------> Well, it looks like I won't be getting any SAM-e to try after all. Health Canada removed it from stores - don't know when this happened but I had seen it sold before here. Ordering over the internet is out as it's bloody expensive, then I pay exchange & shipping, which can almost double the cost.
>
> I'll just make sure I keep my protein intake good & make sure I'm getting enough protein containing methionine. My B complex intake is already very good anyway. Ah well, considering all this, maybe it wouldn't have made a major difference, & the cost...
Posted by IsoM on March 23, 2002, at 2:57:28
In reply to More Than One Way To Skin A Cat » IsoM, posted by Ron Hill on March 22, 2002, at 22:54:34
Thanks Ron. I'll look up TMG & DMG tomorrow morning to find more about it - getting too tired now, bed-time soon. I don't think my body chemistry is malfunctioning so I figure if I provide the needed precursors, I'll do pretty good. Thanks again!
Posted by beardedlady on March 23, 2002, at 6:06:50
In reply to Hola, toma notas! » beardedlady, posted by Ron Hill on March 22, 2002, at 21:25:37
Oh, heavens no, you didn't upset me! I felt a little "iffy" about SAMe, but not upset by you. (I have my own design/writing business, and I write articles and poetry, so I don't have a problem being "out there." I have a little pile (3) of rejection letters this year because my goal is to send everything out and have nothing sitting here. I also have a huge self-esteem problem. (The problem is that my self-esteem is HUGE!)
Anyway, enough about me. I'll take your advice, but I have to talk to the pdoc on Thursday to make sure it's okay with Serzone. I'm already tapering off (at 250, down from 300, for the past month); it's better to be on a lower dose, at least. I'm really sleeping like a rock since I started Bs and a Tums at night before bed! I am not eager to mess with anything at the moment. But when I reduce to 200, I'll probably add SAMe. I'll let you know!
I teach English at a local university.
So thanks for caring, but no hurt feelings here. Just hurt fingers and wrists (carpal tunnel). (Maybe SAMe can cure that? Otherwise, I'm having surgery in May.)
Buh-bye,
Beardy : )>
Posted by Mauro on March 23, 2002, at 7:35:17
In reply to Re: Sam-e was amazing for me » vincent, posted by beardedlady on March 22, 2002, at 13:41:22
Hi to all,
I've found out an interesting article at the link:
http://sopsi.archicoop.it/rivista/1999/vol5-1/delle.htm
"Combined analysis of two controlled, multicentric, double blind studies to assess efficacy and safety of Sulfo-Adenosyl-Methionine (SAMe) vs. placebo (MC1) and SAMe vs. clomipramine (MC2) in the treatment of Major Depression"
It's from the Italian Review of Psicopatology, and it is indipendent from any producer or seller of meds.
The most part of the article is in italian, but summary is even in english.
The results are that sam-e is less effective than cloromipramine (tca) but it has a real efficacy and, most important, it has the same side effect than "fresh water".
Bye
Posted by JohnX2 on March 23, 2002, at 9:13:53
In reply to Re: SAM-e Trial » Ritch, posted by Ron Hill on March 18, 2002, at 16:16:00
Hi Ron,Maybe if I try this again I need to address the dosing scheme much more carefully. I did try SAM-E nature made brand a long way back with a placebo effect, even at a high dose. I've also gotton a placebo effect on Depakote. So I wonder if these enteric coated tablets aren't getting absorbed well into my body.
However, other enteric coated tablets do okay (like wellbutrin).What do you think?
Are there good brands that maybe use different fillers/binders in the pill? Does it need to get absorbed through the intestines?
John
> Mitch,
>
> Thanks for the progress report. Give the SAM-e trial at least a week or two before drawing any firm conclusions.
>
> I'm surprised by your sleepiness side effect. Most people find it to be slightly stimulating (increase in dopamine) in a smooth calm kind of way. My pdoc warned me against taking it to close to bedtime since it can make it hard to sleep. In fact, I did this once and sure enough I had a very poor nights sleep. As I have mentioned before in my prior posts, SAM-e is an important methylating agent essential for our bodies to manufacture neurotransmitters (serotonin and dopamine, in particular). SAM-e is also involved in the production of melatonin which, as you know, is a neurotransmitter that regulates the sleep/wake cycle. Just a guess, but maybe your daytime sleepiness is somehow connected to melatonin production. And further, this may be a short term effect provided you implement good sleep hygiene protocol ASAP.
>
> Mitch, you know more about this brain chemistry stuff than I do. I'm just offering my opinion in hopes of helping you. Good sleep hygiene includes (among other things) staying awake during the day. I encourage you to use whatever tricks needed to stay awake during the daytime. Drink coffee; go for brisk walks, etc. And I don't need to tell you how important it is for us bipolars to get good regular sleep. SAM-e has improved my sleep, but no daytime sleeping is allowed.
>
> Here is the SAM-e dosing schedule that seems to work best for me:
>
> 1. Get up in the morning and eat a good healthy breakfast within thirty minutes of rising.
>
> 2. Immediately after breakfast, take oral (down-the-hatch) vitamins followed by sublingual (under the tongue) B-12.
>
> 3. Wait for at least 30 minutes or an hour, and then take a 200 mg tablet of SAM-e. This wait time is important because SAM-e is adsorbed in the small intestines more effectively if there is not food present to compete for absorption. IMHO, I think it is important to have the B vitamins in the body ready and waiting for the SAM-e dose. I also think it is VERY IMPORTANT to take the B-12 in a bioactive sublingual form.
>
> 4. About mid-afternoon, at least an hour after lunch and at least an hour before dinner, I take my second 200 mg tablet of SAM-e
>
> As side notes, I also take a 500 mg gel cap of a phosphatidylserine complex containing 100 mg of phosphatidylserine (PS). This helps my brain with a mood stabilizer kind of effect, whereas, SAM-e helps my brain in an AD kind of way. Although it is like comparing apples and oranges (MS vs. AD), the benefits I experience from SAM-e are much more profound than that of PS. IMHO, PS helps because it improves brain cell plasticity. Unfortunately, PS is expensive (about $1 per gel cap). Also included on my list of helpful "medications" are exercise and omega-3 fatty acids.
>
> Mitch, as you read in my previous post above, I discontinued my low-dose (12.5 mg/d) of Zoloft a couple of days ago due to breakthrough anergic side effects. Therefore, SAM-e is my sole "AD" at this point. So far I'm doing extremely well! It's been many years and many med trials looking for the right med combo. I truly think I've finally found an "AD" that will work long term for me, a bipolar. A little Lithobid (600 mg/d) and a little SAM-e (400 mg/d) and I'm good to go. I expect this good result to last, but only time will tell for sure.
>
> >I just got the cheapest stuff-hey it's a trial.
>
> Cheap in the short run is not necessarily cost effective in the long run. The problem with SAM-e is that it is expensive to manufacture in a biochemically stable form. Also, care must be taken in packaging and shipping to retain product integrity and freshness and, thereby, to maintain true stated SAM-e content quantity. What brand did you buy? What formulation (e.g. tosylate)?
>
> >I must say that whatever it does-mustn't be too bad. I feel calm enough to restart dexedrine again.
>
> I will not presume to tell you what to do, but if it were me, I'd limit it to one trial at a time. Give the SAM-e at least a week or two. Please refresh my memory by listing all of your current meds. Also, your formal dx is BP II with comorbid ADHD, right? Will you also tell me the active ingredient in your sublingual B-12. Is it the bioactive form, methylcobalamin? It is sublingual, correct?
>
> -- Ron
> ----------------------------------------------
>
>
> > Hey Ron,
> >
> > You wanted to know how my SAM-e trial would go. Well, I bought some yesterday after checking out several stores. I just got the cheapest stuff-hey it's a trial. Well, I must say that I got very *tired* and *sleepy* after I ate lunch and took all my vitamins and the SAM-e (just one 200mg tablet). I got so drowsy I started to nap (that was around 5-6pm-about three hours later). I slept plenty the nite before-so I think it could be attributable to the SAM-e. It was a pleasant kind of nap-like thing. I didn't get any nausea or anything. I took a 2nd dose of it today at the same time and re-experienced a pleasant *grogginess* at about the same time of day. I must say that whatever it does-mustn't be too bad. I feel calm enough to restart dexedrine again.
> >
> > Mitch
Posted by BarbaraCat on March 23, 2002, at 10:46:01
In reply to Re: SAM-e Trial » Ron Hill, posted by JohnX2 on March 23, 2002, at 9:13:53
John,
Nature's Made is reportedly the best brand. Some lab analyses were done about 2 years ago to test the bioavailability and accuracy of actual product levels in a number of nutritional products and Nature's Made won hand's down. It's also the brand Costco carries for the best price. I take mine with coffee which seems to rev it up. Also, you might be interested in exploring glutathione. Taking glutatione by itself doesn't seem to be effective. N-acetyl-cysteine which you mentioned is a good precursor to it. There were some studies that showed large amounts were neurotoxic if taken daily. Also, some leaching out of zinc and copper with high daily doses. There are also some denatured whey protein products that claim to raise glutatione levels in the cells. I'm taking one to combat my fibromyalgia and it seems to lesson some of the symptoms. Anyhow, here's a chem profile:
http://www.genome.ad.jp/kegg/pathway/map/map00480.html
Posted by Ron Hill on March 23, 2002, at 15:11:39
In reply to Re: SAM-e Trial » Ron Hill, posted by JohnX2 on March 23, 2002, at 9:13:53
John,
I was hoping you would weigh in on this topic. As you can see by some of the posts in this thread, several people are reporting favorable results with SAM-e. It is, of course, not the answer to every psychiatric disorder under the sun, but it sure gave me my life back!
My observation (not a scientific study) is that SAM-e seems to be of particular value to depressive (especially bipolar depressive) patients that are initially hypersensitive to AD's (favorable response in a matter of days to very low dosage), but soon thereafter, suffer anergy (low drive, low energy, etc.) and anhedonia (inability to fully experience pleasure, blunted emotions, etc.). It is my layman's opinion that AD's (SSRI's in particular) lower dopamine levels and or impede DA transmission in some (most?) patients and this, in turn, causes the aforementioned symptoms. I think SAM-e is particularly useful in treating anergy and anhedonia, and that it does so by increasing the amount of DA produced by the body. Further, I (layman) hypothesize that one reason SAM-e works so well is that it increases both serotonin and dopamine in a very balanced synergistic kind of way. Okay, enough rambling, let me respond to the issues you raise.
> Maybe if I try this again I need to address the dosing scheme much more carefully. I did try SAM-E nature made brand a long way back with a placebo effect, even at a high dose. I've also gotton a placebo effect on Depakote.
By "placebo effect" I am assuming you mean that you experienced some initial sense of benefit by taking SAM-e, but the improvement was due to psychological reasons instead of physiological improvement and, therefore, the benefits did not last. Do I understand you correctly? Did you take B-6, folic acid, and SUBLINGUAL bioactive B-12 (methylcobalamin)? If you've read my posts, you know how important I think B vitamins (especially sublingual bioactive B-12) are. Were you able to take the SAM-e on a relatively empty stomach? Each morning, I eat a good breakfast, take my vitamins, wait an hour or so, and take my SAM-e dose. In your prior trial, what meds were you on? How much SAM-e did you take and for how long? Nature Made is a good enough brand, so I doubt that it was a bad product issue.>So I wonder if these enteric coated tablets aren't getting absorbed well into my body. However, other enteric coated tablets do okay (like wellbutrin). What do you think?
I doubt that this is the problem.
> Are there good brands that maybe use different fillers/binders in the pill? Does it need to get absorbed through the intestines?
Yes, as I understand it, the supplemental SAM-e must be able to find its way to the small intestines intact in order for the body to absorb it efficiently. But again, I doubt that this is a problem for you. I go back to my usual mantra; were you taking sublingual bioactive B-12 at the time of the trial?
John, I read a high percentage of your posts so, to some degree, I stay aware of your current meds and your conditions. With the exception of your recent bout with hypomania, it seems like your current med combo is working fairly well. If I remember correctly you're taking Lamictal, Serzone, and I think a benzo or something {I would stop and look it up in one of your previous posts, but too many times I've lost partially completed posts in the dialogue box by surfing other pbabble links before completing and sending off the post. Have you ever done that? Make ya mad? Does me!}.
Since your meds are working, what is prompting you to ponder SAM-e? Due to the fact that AD's were so fickle (work one day, poop-out the next) in their effectiveness for me, I would attempt to replace Serzone with SAM-e if I were in your shoes. SAM-e is smooth, even, and highly repeatable every day. That was definitely not the case with AD's, but this is just my bias.
John, given the fact that merely missing two days of Serzone induced some hypomania, I am concerned that SAM-e might cause some hypomania for you as well. SAM-e induces hypomania in me if I take more than 200 mg/day. Does increasing your Lamictal dosage improve your stability against hypomania? Have you made any decision regarding the lithium add-on to the Lamictal for more anti-mania stability?
-- Ron
Posted by colin wallace on March 23, 2002, at 15:53:55
In reply to Re: SAM-e Trial » JohnX2, posted by Ron Hill on March 23, 2002, at 15:11:39
I'm really at a loss to explain this (I've been experimenting for a few weeks now to be entirely certain), but when I SPLIT a Sam-e (enteric coated)pill, I actually get a significantly greater antidepressant response than I do when taking the entire pill.I'm not just talking about immediacy, which would perhaps be explicable in terms of SOME Sam-e reaching the brain quicker than it otherwise would have, had the absorption been via the intended intestinal route.I mean, simply, a noticably better/quicker/sustained antidepressant response.
This I will concede, is entirely implausible, as Sam-e is NOT well absorbed through the stomach; indeed, all empirical evidence suggests that it is actually destroyed in the stomach (hence the need for an enteric coating).
I cannot even hazard a guess as to what's occurring here- any theories are most welcome.Afterthought:
As I delve deeply into the vaguaries of memory,I recall reading an article explaining that l-tryptophan was a poor supplemental choice, due to seratonin mechanisms being somehow used and (seratonin) being abstracted by the stomach prior to reaching the brain; 5htp supplements circumvented this problem, instantly crossing the blood/brain barrier (excuse the blurred science here, this is dredged up from an equally blurred memory).
Any connection here?I'll admit, I'm fumbling in the dark, and will duly go and do some research!!
Posted by Ron Hill on March 23, 2002, at 17:40:57
In reply to Re: SAM-e Oddity., posted by colin wallace on March 23, 2002, at 15:53:55
Colin,
Now you've got me wanting to cut one in half and try your experiment out on myself.
-- Ron
-------------------------> I'm really at a loss to explain this (I've been experimenting for a few weeks now to be entirely certain), but when I SPLIT a Sam-e (enteric coated)pill, I actually get a significantly greater antidepressant response than I do when taking the entire pill.I'm not just talking about immediacy, which would perhaps be explicable in terms of SOME Sam-e reaching the brain quicker than it otherwise would have, had the absorption been via the intended intestinal route.I mean, simply, a noticably better/quicker/sustained antidepressant response.
> This I will concede, is entirely implausible, as Sam-e is NOT well absorbed through the stomach; indeed, all empirical evidence suggests that it is actually destroyed in the stomach (hence the need for an enteric coating).
> I cannot even hazard a guess as to what's occurring here- any theories are most welcome.
>
> Afterthought:
> As I delve deeply into the vaguaries of memory,I recall reading an article explaining that l-tryptophan was a poor supplemental choice, due to seratonin mechanisms being somehow used and (seratonin) being abstracted by the stomach prior to reaching the brain; 5htp supplements circumvented this problem, instantly crossing the blood/brain barrier (excuse the blurred science here, this is dredged up from an equally blurred memory).
> Any connection here?I'll admit, I'm fumbling in the dark, and will duly go and do some research!!
Posted by beardedlady on March 23, 2002, at 18:37:08
In reply to Re: SAM-e Oddity. » colin wallace, posted by Ron Hill on March 23, 2002, at 17:40:57
Doesn't this coating simply keep you from getting a stomach ache?
beardy : )>
Posted by davex on March 23, 2002, at 19:36:20
In reply to Re: SAM-e Trial » JohnX2, posted by Ron Hill on March 23, 2002, at 15:11:39
Ron,
I'm totally in accordance with what you write in your post, but there is a thing that is important to clear better. It is important cause it explaines the real difference between sam-e and other AD class.
You write "sam-e....by increasing the amount of DA produced by the body. Further, I (layman) hypothesize that one reason SAM-e works so well is that it increases both serotonin and dopamine"
This is not properly the true:
Same is a methilic group donor, it release into our body lot quantity of ione CH3-.
This is a molelcule that, connecting to the nutrient substances (vitamins, proteines, hormones,.....) make them to be absorbed better by the cells.
Methilic goup is the key of the cell's door.
In this way Sam-e do not increase the total level of dopamine or serotonine you have in your body, but it makes to improve the quantity of them that can be used by your body: your engine can use better the gasoline it has!.
That's the why sam-e is not correlated to all disease and side effect that happends on AD, it do not work on receptor and synapse but make more easy the transports into the cells.
In this way sam-e is unique antidepressant.
bye
Posted by Ron Hill on March 23, 2002, at 21:10:30
In reply to enteric coating, posted by beardedlady on March 23, 2002, at 18:37:08
> Doesn't this coating simply keep you from getting a stomach ache?
Beardy,
No. the enteric coat is to protect the SAM-e from the stomach acids so that it will make it to the small intestines where it is absorbed.
-- Ron
Posted by Ron Hill on March 23, 2002, at 21:17:44
In reply to Re: SAM-e Trial » Ron Hill, posted by davex on March 23, 2002, at 19:36:20
Posted by IsoM on March 23, 2002, at 21:29:43
In reply to Re: SAM-e Trial » JohnX2, posted by Ron Hill on March 23, 2002, at 15:11:39
"Pharmacology and possible mechanisms: SAM-e appears to increase serotonin turnover, inhibit the reuptake of Norepinephrine in a temperature-dependent fashion, and to augment dopaminergic activity. SAMe also increases folate levels and donates a methyl group to catecholeamines (Baldessarini, 1987)."
It's the donation of the methyl group that's supposed to help so much.
Posted by IsoM on March 23, 2002, at 21:39:41
In reply to Re: SAM-e Trial » Ron Hill, posted by davex on March 23, 2002, at 19:36:20
I found two studies written on SAM-e. The first is titled S-ADENOSYLMETIONINE: A DRUG FOR THE BRAIN? & the page can be found at:
http://www.boehringer-ingelheim.es/workshop-methionina/anglesa/cap25.htmThe next is titled S-ADENOSYLMETHIONINE AS ANTIDEPRESSANT. RECENT PRECLINICAL EXPERIMENTAL EVIDENCE & that page is found at:
http://www.boehringer-ingelheim.es/workshop-methionina/anglesa/cap26.htmIt may be too technical for some, but for those interested in learning more about the pharmokinetics of SAM-e, it may be just what you're looking for.
Posted by Ron Hill on March 23, 2002, at 22:10:14
In reply to Short Blurb on SAM-e Possible Action » Ron Hill, posted by IsoM on March 23, 2002, at 21:29:43
Posted by Ron Hill on March 23, 2002, at 22:29:50
In reply to Two Scientific Studies on SAM-e, posted by IsoM on March 23, 2002, at 21:39:41
Posted by colin wallace on March 24, 2002, at 4:36:39
In reply to Two Scientific Studies on SAM-e, posted by IsoM on March 23, 2002, at 21:39:41
Have you thought about disguising yourself as an adult male Sprague Dawley rat, before crossing the border with the states?If you're captured, you may be lucky enough to be administered 100mg sam-e per kg for a number of weeks, for free.
Of course, they may want to slice into your hippocampus afterward, but you could always call it a day once you've started to feel any benefits....Just a thought,
Col.
Posted by jazzdog on March 24, 2002, at 12:44:13
In reply to Two Scientific Studies on SAM-e, posted by IsoM on March 23, 2002, at 21:39:41
Hi Iso -
Thanks for the articles. I'm one of those for whom the language is too technical, but my limited reading provokes two questions. First, what is the article saying in layman's terms about the long-term effect of AD's. And second, isn't 100mg/kg a huge dose?
Thanks again - Jane
Posted by IsoM on March 24, 2002, at 13:28:15
In reply to Re: Two Scientific Studies on SAM-eisoM, posted by colin wallace on March 24, 2002, at 4:36:39
Posted by lizzyg on March 25, 2002, at 7:38:04
In reply to Re: Anxiety Meds » lizzyg, posted by Ron Hill on March 22, 2002, at 6:18:39
Hi Ron - I probably confused you because I was having a little joke with Colin about how under-informed our British GPs are about depression and anxiety medications.
I think my diagnosis would fall into the category of 'classic' endogenous major depression, with associated anxiety. At the moment, I'm only taking SAM-e and it HAS had an anti-depressant effect, but I would say not as good as previous treatment with tricyclics (I can't tolerate SSRIs). However, with the tricyclics I found the anxiety diminished along with the depression, but this hasn't been the case (so far) with the SAM-e.
Benzos have worked fine in the past for treating the anxiety which has gone hand in hand with the depression, but it's only been short-term usage until the ADs kicked in properly. And the British medical establishment seem completely paranoid about benzos and will only really prescribe for a couple of weeks. So I don't think benzos would be a long-term solution for the anxiety. I don't know about gabapentin (Neurontin), so will do some reading up about that.
Like you, Ron, I find exercise a life-saver and try to swim three times a week, which helps with both the depression and the anxiety.
I'm loath to give up on the SAM-e so will give it a while longer. If there's no improvement on the anxiety, I think I'll probably have to try a prescription AD again. I'm thinking Nefazodone/Serzone would probably be high on the list of options (Mirtazapine/Remeron was too sedating for me) although my GP seems to be pushing Venlafaxine. Any views?
Thanks
Lizzy
Posted by Ron Hill on March 25, 2002, at 10:48:07
In reply to Re: Anxiety Meds » Ron Hill, posted by lizzyg on March 25, 2002, at 7:38:04
Lizzy,
Thank you for the update! It sounds like your situation may require bigger guns than SAM-e can bring to the battle. How much SAM-e are you currently taking? Also, it is very important that you take a sublingual (under the tongue) bioactive B-12 (methylcobalamin) vitamin daily (in addition to an oral B-complex). I take a 1000 mcg sublingual tablet twice a day. Although I do not suffer from anxiety to the extent that you do, I can report that as I hold the B-12 under my tongue, I experience a very noticeable calming, peaceful effect. Are you taking a sublingual bioactive B-12? If so, how much and what biochemical compound is it?
With regard to which AD to try if it turns out that SAM-e/B-vitamins will not abate your anxiety, I agree with you that Serzone would be a good choice to try first. As you know, in the lower dose range Serzone treats anxiety and in the higher dose range it is an effective AD. Personally, I would NOT take Effexor (venlafaxine) because, as you know, in the higher dose range it is an SNRI and, for me, an increase in norephrinepine will increase anxiety. But that's just me, and your mileage may vary.
Using Neurontin (gabapentin) to treat anxiety in a unipolar, such as your self, would probably be considered as a second line approach by most pdocs (and pbabblers). As a bipolar, I've been looking at Neurontin for more than a year for possible use as an add-on to my Lithobid. Neurontin has a fairly benign side effect profile (which is important to me) and the GABA effects might help my slight GAD symptoms. But I'm not going to change anything for a long while because I WILL NOT risk screwing up my current EXCELLENT combo (600 mg/day Lithobid and 200 mg/day SAM-e). Ask JohnX2 and others your AD questions. John takes Serzone so he would be a good one to ask.
Do you plan to continue to use SAM-e/B-vitamins as an add-on if you begin your Serzone trial? That's what I would do.
-- Ron
-------------------------------
> Hi Ron - I probably confused you because I was having a little joke with Colin about how under-informed our British GPs are about depression and anxiety medications.
>
> I think my diagnosis would fall into the category of 'classic' endogenous major depression, with associated anxiety. At the moment, I'm only taking SAM-e and it HAS had an anti-depressant effect, but I would say not as good as previous treatment with tricyclics (I can't tolerate SSRIs). However, with the tricyclics I found the anxiety diminished along with the depression, but this hasn't been the case (so far) with the SAM-e.
>
> Benzos have worked fine in the past for treating the anxiety which has gone hand in hand with the depression, but it's only been short-term usage until the ADs kicked in properly. And the British medical establishment seem completely paranoid about benzos and will only really prescribe for a couple of weeks. So I don't think benzos would be a long-term solution for the anxiety. I don't know about gabapentin (Neurontin), so will do some reading up about that.
>
> Like you, Ron, I find exercise a life-saver and try to swim three times a week, which helps with both the depression and the anxiety.
>
> I'm loath to give up on the SAM-e so will give it a while longer. If there's no improvement on the anxiety, I think I'll probably have to try a prescription AD again. I'm thinking Nefazodone/Serzone would probably be high on the list of options (Mirtazapine/Remeron was too sedating for me) although my GP seems to be pushing Venlafaxine. Any views?
>
> Thanks
>
> Lizzy
Posted by Cindylou on March 25, 2002, at 18:44:35
In reply to Anyone respond to subtherapeutic med doses only ?, posted by colin wallace on March 16, 2002, at 11:42:10
Hi Colin,
It's pretty late for me to respond to your post, and it sounds like things are working out for you okay by now, but I thought I'd mention that I did well on 5 mg. of Prozac -- but the good effects only lasted for 2 months, and then I "crashed out." I couldn't get the good results back by increasing or decreasing the dose, so I stopped the med. I tried it again a couple years later, and the same thing happened -- did well on 5 mg. -- then crashed hard after 2 months.For the record, I used Liquid Prozac -- much easier to measure out those low doses.
Anyway, I do respond to very low doses of medications -- probably 1/4 of the normal therapeutic dose. My problem is that I either can't tolerate the side effects, or the positive effects don't last. I am bipolar II -- it took 13 years to get to this diagnosis (I have always been treated for unipolar depression until recently.)
Hope you are doing well. Maybe I'll try that SAM-e one of these days. Can it be combined with Lamictal?
take care,
cindy> Prozac trial: I take one 20mg capsule, and within hours feel uplifted, a slightly dizzying or tipsy feeling, and music enters my mind so that I feel like whistling!Hmmmm. A (slightly)giddying state in which to go about one's ordinary life, but great for a Saturday night.Much preferable to feeling like crap-but needs some tuning down I think.
> Next day: 200mg Sam-e.Terrific- achieved just the right 'pitch', and life's back in focus.
> Next day: 20mg prozac- Yeuch...not fun at all! WAY overstimulated....don't raise your voice at me or I'll ******* pulverize you!!Snarl!Hmmmm.
> Must tone this down!Where's my genial good nature gone?? And the whistling...?
> Next day: 200mg sam-e- still far too strung out, but human and sociable again by the evening.
> Okay, try again.... two days washout.
> next day.20mg prozac- whistlin' dixie.
> next three days in a row-200mg Sam-e...nothing else.
> Fifth day: cautious 20mg prozac...wait for it...aah, a telltale foot tapping to the radio, a breezy 'hello' on the telephone.... a brief whistle and a tentative early morning stiffie, perhaps heralding....anyway, you get the picture here.
> Question: Can the therapeutic window of Prozac, or indeed any SSRI be THAT narrow? Can I really benefit from less than 5mg a day?Am I med. hypersensitive? This perhaps seems a plausible explanation.This may well explain my wholesale rejection of all things SSRI in the past.No wonder I turned into Hannibal Lecter on 150mg effexor.Pause for thought.Like the feel of prozac (at infant-like doses),seems to complement sam-e very well.But have to put up with feeling 'overly upbeat and stupefied' every fifth day, till things settle down.
> So, I wondered if anyone else has had a similar reaction/overreaction to Prozac , or another ssri.Anyone tried liquid prozac?? (didn't particularly like celexa either..)
> Just coming back down to earth..........
>
> (whistlin') Col.
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