While fewer and milder side effects are typically reported with SAM-e
(S-adenosylmethionine) than with other antidepressants, I have found
several reports of insomnia and anxiety in connection with the use of
SAM-e. These symptoms may be worse in the first few weeks of
treatment, and taper off thereafter. Some of these references involve
the triggering of the manic phase of bipolar disorder. There are also
occasional mentions of "serotonin syndrome" in connection with SAM-e
(particularly if it is used concurrently with other psychoactive
drugs.) I have found no evidence of SSRI withdrawal syndrome or other
adverse effects associated with withdrawal from SAM-e.
"To prevent insomnia, don't take SAMe late in the day. Most people
report a mild energy boost with the supplement... If you suffer from
severe depression, don't take SAMe without consulting your doctor
first. This precaution is particularly important if you have a bipolar
disorder because SAMe could trigger or exacerbate mania (the 'up'
phase) in such cases."
Whole Health MD
http://www.wholehealthmd.com/refshelf/substances_view/1,1525,818,00.html
"At present, the safety of SAM-e has not been proven. The U.S. Food
and Drug Administration (FDA) does not approve or regulate the
distribution of supplements in the United States. Not all formulations
of SAM-e are the same. Some brands are more potent than others,
depending upon the quality of the ingredients used.
SAM-e can have numerous adverse side effects, including:
Nausea.
Diarrhea.
Headache.
Anxiety.
Flatulence (gas).
Causing a change from bouts of depression to intense periods
of energy (mania)."
Yale New Haven Health
http://yalenewhavenhealth.org/library/healthguide/IllnessConditions/topic.asp?hwid=ty1564
"Yes, there are side effects (occasional triggering of mania or
hypomania - especially in people with bipolar disorder - is the most
significant)."
Aquarian Online
http://www.aquarianonline.com/Reviews/books/Stopdepression.html
"SAM-e does not cause sexual dysfunction or weight gain and gives
people a sense of energy and wellbeing very quickly. Side effects from
SAM-e can include heartburn, queasiness, diarrhoea, headaches and
jitteriness."
Good Medicine
http://goodmedicine.ninemsn.com.au/goodmedicine/Factsheets/db/mental/depression/1085.asp
"The mechanism of action of S-adenosylmethionine may also be due to
enhanced brain dopamine activity. Side effects of S-adenosylmethionine
may include anxiety and insomnia."
Nutraceuticals World
http://www.nutraceuticalsworld.com/Sept011.htm
"SAMe's antidepressant activity may lead to the manic phase in
individuals with bipolar (manic) depression. Though not reported in
the literature, higher doses may lead to anxiety even in non-bipolar
individuals, and if such should be lowered and/or discontinued."
iHerb
http://www.iherb.com/same3.html
"Though this effect is not reported in the literature, higher doses
can cause irritability, anxiety, or insomnia in some people. In this
case, lower the dose, but if the effect continues, stop taking it. By
the same token, SAMe’s antidepressant activity may trigger a manic
phase in individuals with bipolar disorder, so they should not take
SAMe unless under medical supervision."
iHerb
http://www.iherb.com/same4.html
"The safety of SAMe has not been fully assessed in children or women
who are pregnant or nursing. For this reason, these groups of people
should avoid SAMe. Side effects may include dry mouth, nausea,
flatulence, diarrhea, headache, anxiety, a feeling of elation,
restlessness, and insomnia. For this reason, SAMe should not be taken
at night. People with bipolar disorder (manic-depression) should not
take SAMe since it may worsen manic episodes."
iVillage Health
http://www.ivillagehealth.com/library/onemed/content/0,7064,241012_248638,00.html
"High doses can lead to anxiety and restlessness, and even insomnia.
Long term side effects are currently not known. The effects seem to be
additive over several days of use, hence dosage may need to be reduced
with time... SAM-e may induce a manic swing in those with bipolar
disorder."
Website of Ray Sahelian, M.D.
http://www.raysahelian.com/sam-e.html
"[Dr. Richard P.] Brown noted that American companies only sell SAM-e
in 50 mg, 100 mg and 200 mg tablets. He recommended a daily dose of
400 mg for mild depression.
'Keep in mind that absorption is better on an empty stomach,' he said.
'Starting patients with 200 mg 30 minutes before breakfast and 30
minutes before lunch minimizes the overstimulation and insomnia which
some patients report in the first few weeks [Berger and Nowak, 1987].
This can be switched to 400 mg before breakfast after a few weeks."
Geriatric Times
http://www.geriatrictimes.com/g010923.html
"SAMe is well tolerated and relatively free of adverse effects,
although some cases of mania have been reported in bipolar patients."
National Library of Medicine: PubMed
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12420702&dopt=Abstract
"SAMe is a physiologic substance that is non-toxic and relatively free
of severe side effects (with the exception of mania, which may be a
manifestation of the basic mood disorder."
National Library of Medicine: PubMed
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3318437&dopt=Abstract
"We report a pilot study of S-adenosyl-methionine (SAM) in 13
depressed patients with Parkinson's disease. All patients had been
previously treated with other antidepressant agents and had no
significant benefit or had intolerable side effects. SAM was
administered in doses of 800 to 3600 mg per day for a period of 10
weeks. Eleven patients completed the study, and 10 had at least a 50%
improvement on the 17-point Hamilton Depression Scale (HDS). One
patient did not improve. Two patients prematurely terminated
participation in the study because of increased anxiety."
National Library of Medicine: PubMed
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11104210&dopt=Abstract
"The serotonin syndrome occurs following the use of serotomimetic
agents (serotonin reuptake inhibitors, tricyclic and tetracyclic
antidepressants, tryptophan, 3,4-methylenedioxy-methamphetamine,
dextromethorphan, meperidine, S-adenosylmethionine) alone or in
combination with monoamine oxidase inhibitors. It is characterized by
various combinations of myoclonus, rigidity, hyperreflexia, shivering,
confusion, agitation, restlessness, coma, autonomic instability,
low-grade fever, nausea, diarrhea, diaphoresis, flushing, and rarely,
rhabdomyolysis and death."
National Library of Medicine: PubMed
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7854515&dopt=Abstract
Search terms used:
"sam-e" + "side effects"
"s-adenosylmethionine" + "side effects"
"sam-e" + "adverse effects"
"s-adenosylmethionine" + "adverse effects"
"sam-e" + "insomnia"
"s-adenosylmethionine" + "insomnia"
"sam-e" + "bipolar"
"s-adenosylmethionine" + "bipolar"
"sam-e" + "serotonin syndrome"
"s-adenosylmethionine" + "serotonin syndrome"
I hope this is useful. Please keep in mind that Google Answers is not
an authoritative source of medical advice. The material that I've
posted is intended for informational purposes, and should not be
viewed as a diagnosis nor a substitute for the services of a medical
professional.
If anything is unclear, or if a link does not function, please request
clarification; I'll be glad to offer further assistance before you
rate my answer.
Best regards,
pinkfreud |
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