S-Adenosylmethionine (SAMe) in major depressive disorder (MDD): a clinician-oriented systematic review

Abstract

Background: Major depressive disorder (MDD) is a recurrent illness with high rates of chronicity, treatmentresistance, and significant economic impact. S-Adenosylmethionine (SAMe), a molecule that is formed naturally in the human body, has shown antidepressant effects and may expand the available options for treating MDD. This systematic review examines the evidence concerning the efficacy of SAMe as monotherapy or in combination with antidepressants. Methods: A systematic search in Medline, Psychinfo, AMED, and Cochrane Controlled Trials Register was conducted for any reference recorded up to March 2020. Double-blind, randomised controlled trials, comparing the antidepressant efficacy of SAMe to placebo or/and to other antidepressants, were selected. Two authors evaluated each study independently and then, reconciled findings. Results: Eight trials, with a total of 11 arms and 1011 subjects, evaluating the efficacy of SAMe used as monotherapy or as adjunctive therapy (512 individuals), were included in this review. The study duration ranged between 2 and 12 weeks and the daily dose of SAMe varied from 200 to 3200 mg. Five comparisons evaluated the differences between SAMe and placebo and SAMe resulted significantly better than placebo in three of these studies. Four comparisons evaluated the differences between SAMe and other antidepressants (imipramine or escitalopram) and showed no significant difference. One study showed that SAMe was significantly better than placebo in accelerating the response to imipramine from day 4 to day 12, but the mean scores were not statistically different at the day 14 endpoint. One study showed that SAMe combined with serotonin reuptake inhibitors (SSRI) was better than PBO combined with SSRI. The studies reported only mild, transient or non-clinically relevant side effects. Conclusions: The existing trials of SAMe, used as monotherapy or add on to another antidepressants, have shown encouraging and generally positive results. However, more evidence is necessary before definitive conclusions can be drawn. Larger, double-blind randomised controlled studies are warranted to confirm the antidepressant effectiveness of SAMe.

Improvement of Depression in a Patient with Hypothyroidism and Deiodinase Polymorphism with LT3 Therapy

“…Patient had no signs/symptoms of hyperthyroidism and a normal cardiac screening. He was able to discontinue all prescribed antidepressant drugs, and was treated with 2 over-the-counter drugs namely S-adenosylmethionine (SAMe) (13) and Rhodiola Rosea supplements (14). Additionally, our patient required psychotherapy sessions less frequently.…”

Disturbances in branched-chain amino acid profile and poor daily functioning in mildly depressed chronic obstructive pulmonary disease patients

“…SAMe has been assessed in numerous trials over the years as a potential antidepressant [ 105 ], with some trials identifying SAMe as a potentially beneficial add-on in antidepressant therapy that enhances the effectiveness of the drug it is paired with [ 106 ]. If methionine levels are decreased in a particular patient population, it may create a predisposition for the development of depression.…”

SAMe, Choline, and Valproic Acid as Possible Epigenetic Drugs: Their Effects in Pregnancy with a Special Emphasis on Animal Studies

“…SAMe has been proposed as a potential treatment for many medical conditions, particularly major depressive disorder (MDD) [56][57][58], primary and secondary fibromyalgia [56,59], attention-deficit hyperactivity disorder [60], Parkinson's disease [61], and Alzheimer disease [62]. In addition, SAMe demonstrated good clinical effectiveness and was well tolerated in patients affected by osteoarthritis [63].…”