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Depressed? Get Some Folate, Not SAMe
What is SAMe?
SAMe (pronounced like "Sammy") is short for S-adenosylmethionine. It is made up two amino acids (the building blocks of protein). It is used a nutritional supplement that claims to treat a number of diseases, most notably depression.
SAMe can be obtained over the counter as a dietary supplement in the United States. As a dietary supplement, the makers of SAMe only need to tell the FDA what diseases they claim it treats. This is very different from prescription drugs, which must submit rigorous scientific studies proving their claims. As a result, it is difficult to know if the claims made about SAMe are true.
SAMe and Depression
SAMe does seem to have a correlation with depression. Depression is much more common in women than in men, so SAMe is of special appeal to women who wish to treat their depression without going on Prozac. So, it sounds great. It seems to be a dietary supplement that will cure depression just like Prozac, but without the side effects or a prescription. It isn't quite as simple as that.
Several scientific studies have found a link with blood levels of S-adenosylmethionine and brain chemistry and neurology, even depression. The higher the percentage of SAMe that is present in a person's blood, the less likely they are to be depressed. SAMe is involved in the formation of neurotransmitters such as dopamine and serotonin, both known to combat depression. Folate and Vitamin B12 are vitamins farther upstream in the neuro-chemical pathway. They can create SAMe and may be the true key to treating depression through diet.
SAMe in the Mouth Does NOT Lead to SAMe in the Mind
It sounds like taking SAMe may, indeed solve depression problems. This isn't exactly true. Lower levels of depression were seen in people with higher levels of SAMe in their bloodstream. How do you get more SAMe in your blood? Not always by taking an oral supplement. An oral supplement first has to go through the stomach, the liver, and the rest of the digestive tract. In the process, the body may degrade a substance before it ever reaches the blood. From the blood it has to find its way into the body part in question. There is a tissue barrier between the bloodstream and the brain, to make matters more difficult.
The Media Hype about Clinical Studies
Many major media outlets have reported that clinical research supports the effectiveness of SAMe in lifting depression. However, Estronaut found only four studies. This is a small number, usually proof of the effectiveness of treatment involves dozens of studies. Worse yet, these few had problems such that their conclusions cannot be accepted. These studies' conclusions matched those reported on TV and in magazines.
- One study had no control group. That means they reported that a certain percentage got better with SAMe. They forget to tell that a surprisingly high number of patients will report improvement in any disease, even if it is sugar pill. This is known as the Placebo Effect.
- The much touted "head to head" comparison study that concluded that SAMe was better than sugar pills and as good as the older tricyclic anti-depressants never quite happened. It was a meta-analysis. What that means is that they take the data from different studies, with different researchers, with different measures of depression, on different types of patients, with different ...you get the idea. The only thing that was compared was the jumble of "apples to oranges" data at the end.
- The study oft misreported as saying that SAMe bested desimpramine (also an older tricyclic antidepressant) did not say that. It said that regardless of what they took, if a patient's blood levels of SAMe were higher, they were less depressed. It also had fewer subjects than generally accepted for a study.
- A study showing a SAMe in an injected form (bypassing all the problems in the stomach) helped imipramine work faster. But, its conclusions' believability also suffered from small numbers and other procedural problems.
What an Estronaut (woman) should do? Folate
In short, the SAMe pill has very little scientific evidence to suggest that it increases blood levels of SAMe. There is no credible evidence that it treats depressions successfully.
The supplement folate has a much stronger and more associations with depression and mental disorders. Numerous studies have found a correlation between low folate levels and higher rates of depression (although most data is from European/caucasion populations). There are even studies tying folate deficiency treatment to the lifting of depression, increasing serotonin levels, and the effectiveness of drugs like Prozac.
The cause and effect relationship between SAMe, Folate, B-12 and depression is there, but not clear, yet. SAMe pills haven't shown any proof of working. Folate has shown quite a bit of proof. And unlike SAMe, and at least we know when a woman swallows it, it gets where it is supposed to go, taking it is at least correlated with less depression, and it leads to increased SAMe anyway. This is not to suggest that any supplement has proven effectiveness or that it is a substitute for standard ways of dealing with depression. But, if a woman wants to experiment with natural ways to ward off depression or complement standard treatment, this one shows the best promise.
The smart estronaut woman would skip this over-priced, trendy supplement and get a woman's multivitamin that provides her minimum daily requirement for folate.
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