DRHOOK- Not the SAMe: This extra drug helps fight depression

the handsome doctor John Hong

Sam I am, and I do not like green eggs and ham. Dr. Seuss was a genius! (Or he ate bad eggs one day and they came up green.) 

I don't blame him, though. I know we should be open-minded enough to eat most anything. Look at Andrew Zimmern from Bizarre Foods. Andrew is the opposite of Mikey of Life Cereal: he hates everything! Andrew eats everything from foul-smelling durian (though he haaaaaates it) to weird insects that look like monsters. Hmm, maybe it isn't such a bad idea to be Dr. Seuss' Sam at times, huh?

What happens when you put the "e" in Sam? Will it cure depression?

 SAMe is S-adenosyl methionine, which comes from the amino acid methionine. SAMe is made naturally in the body and is involved in three important biochemical pathways. In particular, it participates in the construction of NCA and RNA nucleic acids. It also works in the production of neurotransmitters (the chemicals that let nerves work). In fact, it appears to protect nerves to keep them healthy, wealthy, and alive. (SAMe does a lot of other things, but it's like explaining nuclear physics so this is enough.)

SAMe is being looked at mostly as a treatment of cardiovascular disease, depression, fibromyalgia, and osteoarthritis. Although it became available in the US in 1996, I hadn't heard of over-the-counter use of SAMe for depression until a few of my patients introduced me to it around 2005.

While it hasn't been proven to be effective in treatment of depression, a study conducted by researchers at Harvard Medical School indicated it might be a good adjunct therapy, which means that folks who are not feeling better on a prescription antidepressant might have improved results when SAMe is added to their regimen. 

Quite a few people remain depressed while on an antidepressant and/or undergoing counseling. SAMe is thought to improve brain levels of serotonin and dopamine (neurotransmitters that are important in creating a good mood), so perhaps SAMe will give medical researchers a better understanding of the treatment of depression.

For depression in bipolar disorder, SAMe has not been shown to be effective.

Of course there are side effects such as dry mouth and nausea. Restlessness has been reported as well. A potentially bad side effect is bleeding, because SAMe might block platelet clumping (that means platelets can't join together to stop a bleed). Ergo, it's not recommended in folks with history of bleeding ulcers, strokes from hemorrhage, or other bleeding problems. 

It also should be used with caution when combined with Coumadin (warfarin), aspirin, Plavix, and any other blood thinner. So a person doesn't end up like a volunteer for a vampire feast, doses should be withdrawn two weeks before procedures that can cause bleeding like dental work, colonoscopy, and surgery.

As a person who been successfully treated for clinical depression (though some would argue about that!), I hope we find a cure for the disease. It would be awful to go through life not being able to enjoy Dr. Seuss and all the other wonderful things about normal daily living.


Dr. Hook cracks a joke or two, but he's a renowned physician with an interesting website, drjohnhong.com. Email him with your questions.