Complementary & Alternative Medicine for Mental Health

 Compared to treatment with conventional therapy, SAM-e was not associated
with a statistically significant difference in outcomes.”^4
 Mischoulon and Rosenbaum cite the history of over 40 small clinical studies confirming
the efficacy of IV and IM administration of SAM-e monotherapy, beginning in 1973,
concluding that “parenteral [used by injection, bypassing the stomach and entrails]
SAM-e appears to be an effective anti-depressant.” In the absence of comparative
studies, they question the efficacy of oral dosing and the appropriate dose. However,
they note that in the 2010 adjunctive use trial cited below, in which Dr. Mischoulon
participated, oral SAM-e was used, with a coating to avoid loss of potency when taken
by mouth.
 Mischoulon and Rosenbaum cite four double-blind studies using oral dosages of 1,600
mg per day that found improvement in depressive symptoms over placebo. The only
study that found no greater effect than placebo was flawed by exposure to air of an
older form of SAM-e that oxidized and became ineffective (Fava, et al. (1992).^5
Mischoulon and Rosenbaum suggest that Fava et al.’s older preparation of the drug
(later found to degrade substantially in the gut) and the low (400 mg per day) dosage
may have contributed to the lack of effect in the 1992 study.
 Mischoulon and Rosenbaum recommend oral SAM-e monotherapy for mild to
moderate depression, for persons who are intolerant of standard anti-depressants,
and for those whose depression has proven unresponsive to a series of anti-
depressant trials. They also caution that use of a mood stabilizer is essential if there is
any indication of mania or bipolar disorder. They are silent on adjunctive use,
although the subsequent 2010 article co-authored by Mischoulon (below) supports
adjunctive use.
 Lake and Spiegel (through Settle, J.E.) conclude that SAM-e is one of the most
thoroughly studied dietary supplements,” and that recent studies have “la[id] to rest
charges of inconclusive data.”^6 They affirm SAM-s’s efficacy for mild to severe
depression.