SAM-e supplement for depression - Benefits and risks and how to combine it with other natural antidepressants to reduce or avoid the use of prescription SSRI drugs

SAM-e is a supplement used for depression. In high doses it has side effects of anxiety, restlessness and insomnia. Rapid heart beat could occur. Supplements in high dosage may potentially be of danger if combined with prescription anti-depressants or prescription heart medications.
   Additional supplements used for mood enhancement include 5HTP supplement and St. John's wort herb.

Biochemical properties and benefits
Unlike other methyl donors where the research is scarce, there have been a number of studies with SAM-e. These studies have shown that it influences brain chemicals by helping to convert norepinephrine to epinephrine and serotonin to melatonin.
Sam-e is also involved in the production of creatine, which in turn is phosphorylated to phosphocreatine using adenosine triphosphate. Creatine is an important energy reservoir in muscle tissue
It helps the preservation of glutathione, an important antioxidant.
Furthermore, SAM-e is involved in the formation of myelin, the white sheath that surrounds nerve cells and it can improve brain cell membrane fluidity, thus potentially enhancing the function of receptors.

Timing of use and dosage
I purchased these mood enhancement pills and it says on the box instructions to take two 200mg SAM-e pills a day. Is it best to take them both at once or one in the morning and one at night?
   SAM-e is a potent mood enhancer and has side effects if the dosage is too high. Although initially some people may tolerate high dosages, the effects soon build up and side effects can occur such as anxiety, restlessness and insomnia. Although at first many people may tolerate 200 mg or 400 mg, after a few days this could be too much. We suggest using as low a dosage as possible, even if it means using a half or a quarter of a tablet.

Tremor
I have been taking SAM-e in a reasonable dosage (200 mg every 3 days) during two weeks against my depression and I obtained very good results so far. I am feeling a sort of stiffness and tremor in my hand when I am writing and my handwriting is becoming somehow awkward and hasty. Is it just a little bit of excitation, or could it be a Parkinson-style “extra-pyramidal” tremor which is also a side-effect in some prescription antidepressants?
   It is possible that high doses could cause slight tremor.

Withdrawal symptoms
I was wondering if rapid withdraw from Sam-e pills can cause lightheadedness, tinnitus and dizziness as the SSRI's do in general.
   We have not heard of this, but it could be hypothetically possible to have withdrawal symptoms.

Questions
Can you point me to any information regarding the safety of using SAM-e (as a "pure" product) on a patient with Stage 4 Kidney Disease?
   We have not seen such studies regarding its influence on kidney disease.

Q. I am currently taking 200 mg of Nature Made Sam-e. Seems to be ok and I noticed that the first week seemed to be the best. I am in my fourth week and because it does not seem that it's doing as good as the first week I have been taking it with another natural supplement called Amoryn. One of the ingredients is 5-htp and also B vitamins. Do you think it is ok to take these two supplements at the same time?
   A. Sometimes tolerance can develop to certain supplements such as SAM-e or it is possible mixing it with other supplements such as 5-HTP could dampen the effect. Taking a break can be helpful. We did an internet search for Amoryn and it appears the main ingredient in Amoryn is hyperforin, from St. John's wort, and Amoryn also has 5-HTP and rhodiola. 
      Q.  I stopped the Sam-e on Monday and Tuesday was a tough day. Today I'm doing better. Any clue as to withdrawal symptoms when you go off Sam-e? Yes if you could look into the Amoryn along with Sam-e that would be great. I looked into some of your testimonials and saw that if you have Anxiety issues that Sam-e may not be good. That would be the major part of my issues. Depression would be the minor part. But definitely have both.
         A. We don't have enough feedback yet from users of SAM-e who have abruptly stopped to determine what kind of withdrawal effects there are, but they should be temporary. SAM-e can increase anxiety and those who are prone to anxiety may do better just using 5-HTP by itself. See anxiety for additional options.

Q. I have just started on Sam-e to treat depression and am starting out very slow. Perhaps 100mg every other day? I’m looking for some suggestions. I am using this to treat depression and anxiety. Anyway, I want to make sure that this doesn’t raise my homocysteine levels or cause any other physical problems. Some suggest using a good B6 or B12 vitamin but I would rather control by dosage. So the question is in general how much should I be taking to avoid this situation? I was formally on Lexapro for anxiety primarily but I really don’t like the side effects (weight gain and tiredness). I really want to get on something safer and less toxic. I noticed that I did have depression when I got off of it as well. I was using St John’s Wart but really don’t like the fact that it slowed me down too much.
   A. Each person needs to find the dosage that works for them best. For some it is 100 mg every other day or every third day, for others it is 200 mg a day. The only way to tell is by trial and error.

Q. My doctor said that as SAM e is produced naturally in the body - if we take external quantities our body may be resistant thereafter to producing it's own quantity of SAM e - it'll get "lazy" - would you kindly comment.
   A. We have not seen any research that would support this claim.

Q. I read your Sam-e article. If you have a quick minute, I am wondering about are typical reactions if someone takes SAM-e and is not depressed. Reason I ask, I do not fit into a clinical depression "box," maybe I am mildly depressed, but I'm not sure. So, after reading your article and doing other research, I started taking sam-e 50 mgs each day. I feel more sluggish and feel maybe a little worse. So, I am curious as to your thoughts about how a hypothetical "non-depressed" person would react to taking Sam-e so I can better diagnose myself.
   A. Most people who are not depressed and take a small amount of SAM-e actually feel a better mood for that day. It could be dose related, you could try lower or a higher dose to see if it makes a difference.
      Q.  it just seems counterintuitive that taking something that boosts serotonin can make me feel depressed rather than the other way around. I have not felt "typically depressed" but decided to try a low dose of sam-e to improve sleep (which I am thinking is from a very mild depression from being in law school). However, 3 weeks later at only 50mgs per day I started to feel drained of all energy. Setting aside coincidences I guess my real question is whether it is possible to feel "depressed" from sam-e?
         A. it is possible that sam-e can accumulate in the system and cause untoward side effects. It is impossible to predict whether a person will respond to 5-HTP which increases serotonin, St. John's wort, SAM-e which influences many brain chemicals not just serotonin, Mind Power Rx, or at times using on supplement that works then later switching to another. It takes time and trial and error to find the one (s) that work and to find the right dosage. It is often a good idea to err on the side of taking less. Taking days off often makes them work better.

Q. I have been taking Sam-e for about 7 weeks, 200 mg per day. I started to up my dose to 300 mg per day for about 4 days at week 5, but started to feel anxious, so I went back to 200 mg per day. However, the anxiety hasn't gone away and has slowly gotten worse. I am also having very bad stomach cramping and pain for about 30-45 minutes after taking the SAM-e pill. I suffer from anxiety and thought taking Sam-e would help, which it did for about a month, then once I increased the dosage it came back. I am going 4 days now without taking Sam-e at all, while the stomach problems stopped immediately, I feel like I am even more anxious and shakey. Sort of like I am withdrawing from the medication. Have you ever had anyone experience this when stopping sam-e? How long can I expect this to last?
   A. We have had few reports of anxiety continuing more than a day or two after stopping SAM-e. It should become less each day that passes. SAM-e is very potent and many people take a higher dose than necessary.

Q. I have begun taking SAM-e after meals and this gets rid of the stomach upset. Does SAM-e have an effect on serotonin levels, or is its activity restricted to dopamine and norepinephrine? If the latter is the case, is it safe to try Zoloft at low dosage while taking SAM-e, or do these interact?
   A. Unexpected reactions can occur when Zoloft or Prozac or another SSRI is combined with SAM-e. Some people may tolerate the combination of low doses of SAM-e and Zoloft, whereas others may have unpleasant side effects.

Q. I have been taking SAM-e, for only 3 days, 800mg per day, and every time I take it I get so tired. Is this normal? I also have been on your web site and you suggest to take less than 200mg a day. Am I feeling miserable because I am
taking to much?. If the SAM-e does not work after a couple of weeks, would you please recommend something for me to take. I'm getting desperate.
   A. High doses of SAM-e can have the side effect of fatigue, we prefer lower amounts such as 100 mg which would require breaking a tablet in half. Please see the page on depression for suggestions you can discuss with your doctor.

Q. The affects of SAM-e (800 mg per day) treating my depression have shown great results, however I also suffer from anxiety and panic disorder. I've read that high doses of SAM-e can actually cause anxiety in some individuals. Since I already suffer from anxiety and panic disorder in addition to depression, do you have any suggestions as to an additional supplement to take in addition to SAM-e that can help with anxiety? I recently found a supplement called Inositol, which says is for anxiety and panic attacks. Do you feel this is ok to take along with my daily intake of SAM-e? Do you know of anything else that could be taken in addition to SAM-e for anxiety, since I suffer from both depression and anxiety. Please advise because I really like the effects of SAM-e helping my depression.
   A. We cannot make specific suggestions as to what a person should take or not take. However, as a general rule, if a supplement or medicine is causing a particular side effect, a better option is to reduce the dosage rather than adding another medicine or supplement.

Q. Greetings from the Sonoran Desert! I am a guest reporter on health issues for a couple of magazine and newspaper publications here in Arizona. Recently, the supplement, SAM-e has been brought to my attention as a product to be possibly used as an anti-depressant and I do have one question regarding it. First of all, as SAM-e is described as an anti-depressant, what if anything, can SAM-e do for panic disorders or attacks?
   A. High doses of SAM-e taken daily, sometimes even 200 mg or half a 200 mg tablet, can lead to some patients who are depressed into a manic phase. Those with bipolar disorder should be carefully monitored when place on SAM-e. SAM-e is not recommended for panic disorders since it can speed metabolism and heart rate and overall alertness and restlessness and that is not helpful in a panic attack.

Q. I have been taking Sam-E instead of the overpriced prescription anti-depressant that I used to take. Sam-E has worked just as well if not better that the prescription anti-depressant. I would like to try Passion Rx, but I read that Dr S. doesn't advise taking it with Sam-E. Do you have a product that is safe to take Passion Rx with or on alternating days? Can I take Mind Power Rx and Passion Rx? I did not see that question answered in the online information. I would also like to try Eyesight Rx. Is there any problem with taking all three?
   A. All three products are potent and are strong enough by themselves to increase energy, mental clarity, and their appropriate benefits, including slight mood lift. There is no need to combine them, they can be taken on alternate days.

Q. I am trying to wean myself off of tramadol which I have been taken for pain from a broken tail bone for 1 1/2 years. I thought everything was fine but I started wanting higher doses and I recently was taking quite a bit so I scaled back to only 2 50mgs a day and now I am SICK! I am achy, cant sleep, depressed and so tired. Could Sam-E alleviate my problems or should I just deal with it? Do you know how long these side effects will bother me. It has been 3 days with no relief. I feel like taking more of the tramadol but now I am afraid. Can someone please direct me somewhere.   
   A. SAM-e is an antidepressant and not a pain pill. Sometimes when mood is elevated people don't feel pain as much, but SAM-e is not a pain pill.

Q. My question in regard to SAM-e e involves the fact that I suffer from HEP C, I am currently only a level 1, the Hepatitis virus is in my system but it is not active (I received the disease from a contaminated blood transfusion in 1988). I have mild depression, I currently only take 37.5 mg of Effexor - but would love to get off of this, and WOULD if I am able to take SAM-e. I have bad asthma, I take Spiriva, Advair and Ventolin and I have allergies, I take a no-name brand antihistamine (non-drowsey). Once I get myself OFF of the Effexor, would it be advisable to take the SAM-e even if I have HEP C? Could I still take the SAM-e if I was to go on Interferon to try and cure my HEP C? Would the SAMe be advisable to take given the above complications in my system? Also, degenerative heart disease runs in my family, as well as arthritis. THANK YOU soooo very much if you can help me out with this info, I am extremely appreciative for any help you may be able to provide. I really like what I have read about SAM-e, and would MUCH rather take a NATURAL suppliment rather than the Effexor.
   A. We have not seen any studies regarding SAM-e and its influence on the liver in those who have hepatitis C. SAM-e is a potent mood lifter and it can have side effects when used in high dosages. Please make sure you read all the benefits and side effects of SAM-e and ask your doctor to read them, too. If your doctor decides to use it, he or she may recommend taking half of a 200 mg tablet. The benefits of SAM-e, and the side effects, can accrue over time, it builds up in the system so if 200 mg a day was fine initially, it may quickly turn out to be too much as the dose from one day adds up on the some of the leftover effects from the day before. We don't have any experience or seen research using SAM-e in combination with interferon or other drugs, so caution is advised. Much of the SAM-e effects, or other medicines, is dose dependent.

Q. Is there any reason not to take 200 or 400 mg a day SAM-e with Coumadin?
   A. The whole person has to be evaluated in making such decisions, not just two variables such as the supplement and the medication.

Q. I am currently taking SAM-e -800 mg/day for seasonal affective disorder and osteoarthritis. I have taken it with great results for the last 6 yrs. My knees are pain-free and I can "live through the winter". My Doctor has prescribed Wellbutrin xl for seasonal depression- it has been particularly bad this year. (150 mg and then after 2 wks up the dose to 300mg). Do I need to get off the SAM-e or will they act independently of each other? I'm afraid to get off of the SAM-e b/c it takes weeks for the Wellbutrin to take effect and I am severely affected by the winter depression without it- I also have nightmares when I abruptly change dosage of the SAM-e.
   A. We suggest your doctor read the page on SAM-e. There could be potential danger combining the two, particularly in high dosages.

Q. I am 74 years old, male living in Istanbul Turkey. I am in depression now, it is 4th one in 6 years. Antidepressants never helped me to shorten each period of depression; each depression took 8-10 months at least. During my search in the web I discovered the product SAM-e and purchased it from the US, in order to to try it in addition to my antidepressant. It has not arrived yet. Later I discovered an article of Winston Wicomb, Ph.D http://www.stoneclinic.com/sam_e.htm
saying: “But the most important potential problem: SAM-e is converted into homocysteine in the body. High levels of homocysteine may raise the risk of heart disease. SAM-e is likely to promote higher levels, though no one knows how high. Interestingly, SAM-e breaks down into the potentially harmful homocysteine, which has recently made press as a substance strongly correlated with heart disease if it is left to build up within your cells. The good news is that SAM-e, which is so good for you does NOT have to turn into a toxic build-up of homocysteine. With the proper complement of B-complex vitamins (especially B-6, B-12 and folic acid, which are all methyl-donors), homocysteine is re-methylated into good old methionine (used to produce S-Adenosyl Methionine) or convert to the antioxidant glutathione. People taking SAM e should be well advised to supplement with B vitamins. This will ensure adverse reactions and prevent homocysteine build-up. Thus one health problem is combated only to introduce a different problem? ”
   However my other finding looks like saying the opposite of it: “More of the SAM e - the body's best anti-ageing agent If the body then adds a different methyl group it produces a chemical called S-adenosyl methionine (SAM-e), which is a useful natural antidepressant, fights against arthritis and is excellent at lowering homocysteine levels. As levels of SAM-e increase, another vital chemical is produced from homocysteine called glutathione. This is the body's best anti-ageing agent and also works as a detoxifier. A low glutathione level has been linked to an increased risk of death from all common causes. The key to a long healthy life - keep the homocysteine level down and the glutathione level up.” Because of the above apparent discrepancy, could you kindly give me your reply to the following question: when I take SAM-e is it going to be first converted into homocysteine in the body so that it will increase the homocysteine level?
   A. It is yet not clear what happens in the human body when a SAM-e supplement is taken, whether it has beneficial or harmful effects in the long term. However, a more immediate concern with SAM-e is the side effects as listed on this web page. Older individuals, or those taking other medications, should not exceed 100 mg of SAM-e initially and then reduce the dose if there are symptoms of insomnia or being too stimulated. SAM-e is potent. One should not be concerned about the effect on homocysteine since this is not a pill to take for prolonged periods. If you take B vitamins, we suggest not to exceed one or two times the RDA.

Q. is SAM-e ok to take as a supplement if one is on cholesterol lowering drugs like Zocor or Vytorin? Is there any potential side effects to the heart taking SAM-e while on these drugs or would it be better to get off them entirely to use SAM-e.
   A. High dosages of SAM-e could stimulate the heart to beat faster and it can cause insomnia. We are not aware of direct interactions of SAM-e with statin drugs such as Zocor or Vytorin.

Q. I was taking 400 mg Sam-E and i didn't feel right; so I read the article by Dr. Ray Sahelian where he recommended lower dosages. I reduced my Sam-E dose to 100 mg and I now am fine.

Q. SAM-e worked well for mood enhancement for me, but I stopped it because of loose bowels. I tried different doses from 1/2 tablet to 2 and didn't notice much difference in this side effect. St. John's wort seemed to work the first three or four days and then didn't have much effect. It also gives me loose bowels. Does this mean that my neurotransmitters are normal, or I'm just sensitive to herbs. I have been very sensitive to prescriptions, so I wanted to try something natural rather than ask for antidepressants. I am 64, work out three times a week, and use a low-dose estrogen patch (estrogen has helped me a great deal until lately).
   A. It is not possible for us to know without a full history and medical evaluation. Some people may be very sensitive to herbs and supplements and may need even smaller dosages.

Q. Can you tell me if it is safe to take SAM e with taking thyroid medication (medication taken b/c I have no thyroid)?
Also, for a friend of mine, does SAM e interact with other herbs? Is it OK to take a herbal suppliment that contains the following: Black Cohosh, Red Clover, and Kudzu Passionflower, Chasteberry and Wild Yam, Ashwagandh. Would you recommend taking 5HTP with SAM e - if so, in what dosage?
   A. SAM-e is a potent supplement and should be used with caution in those taking thyroid medications since anxiety, restlessness and insomnia could easily occur unless the dosage of the SAM-e is a fraction of the 200 mg pills commonly sold. There are many factors that influence combinations of herbs and supplements and there are no easy answers on combinations since different people react differently.

Q. I have been taking SAM-e for about 5 days now and I have noticed my muscles tighten up very easily when I exercise. I am a runner and I usually run 3-4 times a week several miles. I have been taking SAM-e 400mg every morning and I am wondering if I would benefit from decreasing my dosage and trying only to take SAM-e on the days that I do not exercise? What if any is the link between SAM-e and exercise?
   A. SAM-e does influence several neurotransmitters that could affect muscle tissue but we have not seen any studies specifically addressing the role of SAM-e and exercise or muscle tissue. SAM-e 400 mg is a very high dose.

Q. My 16 year old daughter is on Minocycline, 100 mg. twice a day for severe acne. Is it safe for her to take Sam E for mild depression at the same time?
   A. This is a decision her doctor has to make. We have not seen studies that have combined the use of SAM-e supplements with antibiotics.

Q. I am a 60 year old man who started taking 400 mg of SAM-e pill in the morning before breakfast and another 400 mg SAM-e pill before bed to improve my mood. I took this dose for around 4 months without side effects but discontinued because I felt the effects to be subtle to marginal at best. I have been plagued with untreatable Radial Brachial Pruritus for nearly 20 years and itch free interludes have become increasingly rare and shorter in duration. I experienced almost nonstop excruciating nocturnal itching for the 4 months after I discontinued SAM-e pills. I had become used to this cycle of itching and interlude and never expected that the SAM-e might be effecting the RBP. My wife noticed that my most recent interlude ended when I discontinued SAM-e. I resumed my original dose and the itch abated in 2 days. In the 2 months that I have resumed the SAM-e I have been itch free. Since I have enjoyed itch free intervals for nearly this long I'll be waiting to see what happens.

Q.  I have a very important question about Sam-e and I'm hoping you can help. I have been taking Sam-e for about two years now and I cannot remember ever feeling so great. I take two 400mg tablets every night. However, I am having surgery in two weeks. My doctor advised me to stop taking any herbal supplements. However, without Sam-e or with a lower dosage my depression immediately returns. Is it absolutely necessary to stop Sam-e before surgery? My doctor is not very familiar with the supplement and I'm afraid he is just being overly careful.
   A. Your doctor has to balance the risk from stopping the supplement in terms of depression versus untoward reactions from the use of SAM-e whose role in the body during or after surgery is not fully known.

Q. I was taking Cymbalta and Provigil for depression and it caused me to have a seizure. I am off all medication now but am feeling the depression returning. Is there any research association with Sam-e lowering a person's seizure threshold that you are aware of?
   A. SAM-e influences several neurotransmitters in the brain and, although we have not come across specific research regarding the influence of SAM-e on seizure risk, there is a theoretical possibility that SAM-e supplement use could influence seizure activity.

Q. I work a in a very stressful job and when the stress is at its highest, usually for 6 weeks at a time, I even get muscle twitches around the eyes. The stress causes me too wake up at night and I'm unable to get back to sleep because my brain is racing about work. This lack of restful sleep further compounds the problem. I'm wondering if SAM-e pill would be a good OTC supplement as a natural stress remedy to help manage the stress and help me get a better nights sleep?
   A. It is possible that low dosages of SAM-e pill, at 50 mg taken in the morning, may be helpful, but higher dosages of SAM-e supplement can cause anxiety and alertness late into the night that can cause insomnia.

Q.  I've been searching all over the Internet for information on a possible interaction between SAM-e 400mg daily and spironolactone 200mg daily and haven't found any information. I've been taking 200mg of Spironolactone since 2004 for acne, very pleased. I only had menstrual irregularities the first 2 months and afterwards everything went back to normal with a cycle every 4 weeks. However in 2006 I started taking SAM-e pills in addition to Spironolactone, on a daily basis, for depression. Dosage would be from 400mg to 1200mg, however currently at 400mg daily. I have found that when combining these two - my menstrual cycle occurs every other week. It's terrible because I need both of these, as both are very beneficial, however the side-effects are incredibly frustrating. When SAM-e pill is removed my cycle goes back to normal with taking only Spironolactone. Birth Control does not agree with my system so it's not an option. Have you heard of anyone else taking this combination? I am 28 years old; normal weight (slim), no other health issues aside from ADD, in which I take 20mg of Dextroamphetamine (since 2003).
   A. We have not seen any research regarding the combination of SAM-e pills and spironolactone or had any feedback from anyone taking this combination. The interaction between different medications and supplements is difficult to predict and as much as possible dosages and frequency of use should be minimized.

Q. I have been wondering about sam-e, read on the Univ. of Maryland Medical Center website that sam-e levels may be low in people w/ Parkinson's and heart disease. However, experiments in rats have indicated that sam-e supplements may actually cause Parkinson's disease in these animals." Have you heard anything about a connection between sam-e and Parkinson's? Another thing I'm wondering about is which neurotransmitter systems does sam-e seem to target, do we have a clue at this point? My uneducated guess about pharmaceutical antidepressants like the various SSRI's, tricyclics, and MAO inhibitors is there is some knowledge of which neurotransmitters each one tends to affect more strongly; how would sam-e be categorized among these in terms of its effects?
   A. The interpretation of the effects of supplements or medications on rodents is helpful but can sometimes be unreliable since researchers often give the animals dosages that are several fold what humans would ingest per weight ratio. SAM-e is a methyl donor and can influence a number of neurotransmitters. SSRIs mostly influence serotonin levels, MAO inhibitors mostly influence dopamine levels. SAM-e is not easy to categorize since it influences several neurotransmitters.

Q. SAM-E has worked miracles; it lifted me out of a very depressed mood that I'd been in for over four months, and which was worsening still. (It was triggered by two deaths, and the loss of my dream job.) Thank god SAM-E exists! When no other coping tactic or remedy worked, research led me to try "SAM-E". (An injury prevented me from working out, or else I would have resumed intense aerobic activity as a solution first.) It wasn't a smooth road in the beginning, but like many others I began to feel better within four days of taking 100 mg of SAM-E a day, at which time I increased the dose to 200 mg. (During the first two days on 100 mg I experienced mild to moderate headaches, which then went away completely.) When I increased the dose to 200 mg, I again experienced a headache, but just one for a few hours. Feeling much better, but not yet feeling like myself -- I'm generally a happy (and very healthy) person with a great deal of energy -- I increased the dose to 400 mg the fourth week. After less than a week on this higher dosage, when lying on the couch in the evening I noticed that my limbs were restless; they'd move, rest, and move again -- involuntarily. This was startling, and scary enough for me to go back to 200 mg for three days. But hoping the muscular symptoms would go away like the headaches did, and feeling my mood dropping again, I tried 300 mg and over the course of another week I felt better and this time with no side effects; the next week I upped to 400 mg/day, where I stayed for about a month and felt very good, but still not quite my old chipper self. Less than a week into taking 600 mg/day, heart palpitations (which I had never before experienced) steadily grew in frequency and intensity until one afternoon I thought my heart would leap out of my chest and I went straight to the emergency room. I've never before had any heart issue, and feared that this side effect would mean that I wouldn't be able to continue using SAM-E. Instead of going off it completely, the next day I returned to the 400 mg dosage, where I stayed for two weeks, and then dropped to 300 mg/day. Within a month after the emergency room visit, my heart palpitations had gone away completely. (I was required to see a cardiologist after the emergency room visit, went through extensive tests, and learned I have one very healthy, strong heart.) I started taking SAM-E in the beginning of August 2008, and for the past three and a half months have been on the 300 mg/day dosage, and feel fine. However, insomnia, which I had never before experienced, has taken hold and not gone away now for nearly a month. This side effect doesn't seem to be diminishing with time as did the other ones, and I'm desperate to sleep again. I have tried twice to withdraw from SAM-E, but fear I am not doing so correctly as I can feel my mood drop the second day after not taking SAM-E, which scares me into taking it again immediately, but the insomnia persists. Should I ween myself off slowly, going down to 200 mg, then 100 mg? Over how long a period of time? Or, since my mood has now been lifted for nearly six months on SAM-E, can I/should I stop taking it cold turkey? Will the dip in mood I've experienced when I don't take it rise again after a few days off of it?
   A. Each person is different on the severity of their depression and how they respond to sam-e dosage reduction or elimination. A general guideline is to withdraw gradually over several days or weeks but this is a rough guideline and there are great individual variations.

Q. I read Dr. Sahelian's recommendation to only take 100mg SAM-e, so being extremely efficient, I cut all my 200 mg tablets in half at once and put them in the bottle. Then I read today that if you cut a tablet in half, you should use it the very next day because exposure to air is harmful to the tablets. AGH! Now what do I do?This is one month's supply of tablets we're talking about here. Will they be okay in the bottle, or should I wrap them in plastic?
   A. You may wish to wrap them in tight plastic, but even if the edges of the cut tablets are destroyed, it is still okay to scrape these off and end up ingesting 80 or 90 mg which may be a better option anyway.

Q. I have been taking Sam E pills for over 4 years. 200mg tabs once a day. My Alpha Fetoprotein levels have been high but not high enough to be cancer related. My M.D. wonders why my liver would be producing these new liver cells normally found pregnant women and in people with cancer with very high levels. Any studies of a relationship between SAM e pills and elevated Alpha Fetoprotein levels?
   A. We have not seen any studies regarding the long term use of SAM-e supplements and their relationship to alpha fetoprotein levels.

Q. What is the difference between Source Naturals SAM-e supplements and Naturemade SAM-e supplements?
   A. We don't have any specific laboratory analysis on how each are made to know if there is any difference.

I have pernicious anemia- is it safe to take SAM-e?
    That is a decision you and your doctor would need to make. Small amounts are probably safe.

Q. I have been taking SAM-e for only four days, 200mg in the morning. It helped rather quickly with mood and energy. On the night of the third day, however, which was yesterday, I became pretty seriously ill. I felt as though I was going to throw up several times during the night, and would sweat a lot as though with fever when this happened. Before this happened, I had also became uncommonly tired when the sun went down in the evening, which is not usual for me. This happened again this evening, even though i cut my dose to about 75mg, and I think I feel the upset stomach coming back. All day today my stomach was unsettled and I was very fatigued, which is the opposite of what the SAM-e did for the first two days. So I don't know whether this is from a virus or whether it could be from the SAM-e. My general questions are: whether sickness from SAM-e usually occurs, if it does occur, shortly after having taken the medication, or whether nighttime nausea may also occur. Second, may unusual fatigue in the evening, following stimulation, be a side effect? Another factor is that I take pseudoephedrine as an alternative to amphetamine for attention issues during the day. This does not, however, lead to any anxiety with the SAM-e, as I realize it might, but could it be the cause of sickness? I am a 26 year old healthy male who exercises every day.
   A. Yes, it is possible that nausea and fatigue could be due to too much SAM-e. This nutrient is very potent and smaller amounts work better. Taking SAM-e with pseudoephedrine or another stimulant can make the side effects worse.

Q. I recently had a bad anxious reaction to even the lowest possible dose of 5 HTP so i washed it out for 4 weeks and am now trying, SAM-e at just 1/2 of a 200 mg pill every other day for my depression and anxiety combined with regular walks, fruit, fresh water, Hypnotherapy for relaxation etc (Trying to avoid heavy SSRIs as they are bad for me and many others with side effects). I experienced some mild short anxiety even at this dose of SAMe that seems to pass ok, will this 100mg SAMe dose every other day be ok for me and help with my symptoms in time? any idea how long it takes to build up? i don't really want to try and increase to 400mg a day and risk further anxiety but do i need to do that to kick my depression? OR will the 100mg accumulate gently in time and work just as well? (i like the fact that it addresses all the neurotransmitters and forms Myelin and is an antioxidant).
   A. SAM-e does accumulate over days of use, and hence it is best to use the lowest dose that works.

Q. I have been taking 200mg a day of L-Theanine for quite a while and have found it very effective. Now fighting depression I'm thinking of trying SAM-e. Is it a safe mix to take 100mg SAM-e in the morning and 200mg in the evening? I would rather not give up the L-Theanine because of how well it has worked but would you recommend higher doses of Vitamin B instead, if so what dose?
   A. We can't make specific individual recommendations. We suggest reading the information on the SAM-e page for the benefits and side effects. Different people respond differently to individual supplements and combinations. One option is to begin using very low dosages.

Q. When I read your information about Sam-E, I became curious about how it affects dopamine in the brain. I have an extra pyramidal side-effect to Compazine and like anti-nausea drugs and the reason is due to how they affect dopamine in the brain. Can you explain for me how Sam-E works?
   A. SAM-e works by the process of methylation, it can transfer a methyl group to other substances in the body and thus help increase levels of several brain chemicals including dopamine. The full process is very complicated and we are not biochemists so we don't know. We focus on the clinical aspects of treatment.

I took SAM-e 400mg a day for 2 years and have had acute anxiety attacks. Since I didn't have any side effects for the two years, I still didn't attribute the anxiety attack to the SAM-e and thought I was developing generalized anxiety disorder. After several small attacks over the months, I had a huge panic attack 10 months after the first one. I finally figured from reading your info on SAM-e that it might be the culprit. I stopped and have been getting better ever since. My symptoms were dizziness and vertigo, tingling numbness in extremities followed by panic, racing heart and high blood pressure, lasting three or more hours. The first attack I was extremely nauseas. Thank you.

Although I haven't yet tried using SAM-e, I am wondering if taking theanine or another anxiolytic supplement may help control anxiety for those taking SAM-e, or if you have any other knowledge of their interactions. It appears the two supplements affect different pathways, at least directly.
    We prefer using a lesser dosage of a supplement rather than taking another one to counteract the side effects of the first supplement. However, adding theanine in the evening is an interesting option and worth a try if your doctor approves.

I've decided recently to start taking natural herbs instead of the prescription for my anti-depressent but I was wondering if SAM-e is known to interfere with other prescription medications (non anti-depressents)? I'm worried about it interfearing with my Birth Control, Metforin, and Topomax.
    Metformin is used for diabetes, Topamax is used for migraine headache. SAM-e pills are potent and should be used in low dosages.

A question regarding SAM-e: 2 days after initiating a 200mg dose I experienced a number of flu like symptoms, except for respiratory: chills, fever, head and body ache, mild nausea, extreme lethargy - all of which cleared up after a day of bed rest. I am continuing SAM-e but at lower dose. Am wondering as there was no other change in my habits if the introduction of SAM-e and its metabolism could have set off that cascade of reactions? I take allopurinol (gout), Lipitor, and low dose aspirin (preventative, no diagnosed heart condition).
    Some people do experience some of these symptoms as a reaction to SAM-e pills, and it is possible that interactions with medications could also be a factor.

Great site! I had a question about Sam-E. Sam-E is an amazing product for my depression, but my stomach can not metabolize the mannitol (an artificial sweetner) in it. Do you know of any Sam-E brands that do NOT have mannitol or other similar artificial sweeteners?
    There are probably some that don't have mannitol, a google search should reveal a few. This supplement, itself, can cause some gastrointestinal symptoms, so it may not necessarily be the sweetener that is causing the GI symptoms.

I just started taking Sam-e 100 mg after reading your articles. I am concerned that I drink wine and an occasional cocktail is this OK? I also use Levitra for ED.
    We can't know in any one person what the interaction between alcohol, medications and SAM-e or any other supplement would do. As a general rule it is best to learn how each supplement works by itself before combining with other supplements, alcohol, or medication and to have medical guidance.

I have been taking the supplement SAM-E for close to a year now. I started taking it to help my mood after I started taking birth control pills. I have been buying it from my local Wal-Mart. I have been happy with the results, but I am finding that I have to take a minimum of 400 MG to achieve the desired results (which is any result at all). After doing some google searches, I found your website with information regarding SAM-E. I am going to order some of your SAM-E when what I have now is about to run out, and give it a try to see if there is a difference in products. My question relates to Passion Rx product. I read that you recommend not taking it on the same day that SAM-E is taken, but I take SAM-E daily. I am interested in trying it, and was wondering if it might be OK to take in a low dose - say, maybe, 1/2 a capsule every other day to every 3rd day?
    We suggest not to take them the same day since they both can cause alertness, stimulation, and increase energy. The combination may be too stimulating.

I am intrigued by this supplement after reading about its safety profile. The only real negative came from Wikipedia that references a 1982 study that indicates "Long-term effects are unknown. SAM-e is a weak DNA-alkylating agent, and may thus act as a weak carcinogen." I have not seen this anywhere else. Is it possibly a weak carcinogen?
    We have not seen any such studies in humans or animals that indicate a higher risk for cancer in those who take this supplement. However, as with many medications and potent supplements, it is a good idea to take the least amount and to take breaks from use.

I am a 21 year old female, who is currently taking suboxone, for long term use. I was a heroin user, and i am currently in treatment with a "dual diagnosis" doctor. she is urging me to get on an anti depressant, but i am very sensitive to most medications. I have tried countless different medications, when i stumbled upon SAM-e. I wanted to know if the two are safe to use together, the SAM-e and the suboxone. My doctor doesnt know anything about SAM-e and wants me to bring in some print outs about it. so shes not too much help for me. I also wanted to know if i have anxiety, will the SAM-e increase this, or help it? I have started taking 200 mg SAM-e along with 6mg of suboxone (on for a year or so). is this dosage too high for someone of my weight? thank you for your time. i just dont know who to turn to, when my own doctor cant help me. i cant thank you enough!
    There have not been studies with the combination of this medication and the supplement so it is difficult to know their interactions. High dosages of the supplement can cause anxiety and some people take less than a full tablet and skip some days if side effects occur.

I'm a 58 year old female who ism still doing so well on the Sam-e with improvements in energy, clarity of thinking, organizing, getting less sleep, getting tired earlier and sleeping deeper. But after about 5 weeks of taking 200 mg./day, I started getting bad stomach cramps and sometimes sweating that would last about an hour. My doc said to take it along with St. John's wort. Have you heard of this? I never got any because finally I realized why I had this reaction - it only happened if I had a meal within 1-3 hours of taking tit (even if I took it with food). But if I take it on an empty stomach in the a.m., have some juice and light fruit and/or smoothies, then wait 4 hours before a meal, then I'm fine. If I'm going to lunch with someone, I just won't take it that morning. If that's the only sacrifice, then it's worth the benefits!

Suppliers, press release March 2010
Fenchem Enterprises - SAM-e (S-adenosyl-L-methionine) has gained worldwide recognition for its efficacy. As the SAM-e market becomes more mature and booming, the company has optimized the technology and saved cost, looking to expand production capability to 30t in the next two years. Our SAMe has a high purity of 98%min, with a high ratio of s,s isomer which is the active substance. The main problem associated with the use of S-adenosyl-L-methionine is its structural instability. Salt forms of SAM-e are more stable for use as a supplement. Our SAM-e is available in two salt forms: Ademetionine 1,4-Butanedisulfonate and Ademetionine Disulfate Tosylate. The main final form that is sold in the market as a supplement is enteric-coated tablet containing SAM-e salt. Now the company is making both SAM-e raw material as well as tablets for the US market. As a contract manufacturer of dietary supplements, we have recently developed new SAM-e tablets using our SAM-e raw material. The SAM-e tablets are enterically coated in order to prevent breakdown by stomach acidity and promote intact absorption in the small intestine. Compression is the critical processing for SAM-e tablet manufacturing. We have carried out intense investigation on a variety of systems in order to improve the stability of SAM-e tablets. Stability studies are conducted on the SAMe tablets. On finished tablets, the result so far show reason for optimism. We intend to apply for a patent for this new tablet production technology. Fenchem is specialized in developing, manufacturing and marketing active ingredients for dietary supplement and functional foods, and has officially stepped into contract manufacturing of dietary supplements recently. The products are manufactured adherence to premium quality that is guaranteed by practices of GMP, HACCP and ISO certification.