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New Dietary Supplement for the Treatment of Arthritis and Depression

Healthfacts, August, 1999 by Maryann Napoli

A new dietary supplement, available since March, has been shown in studies to have advantages over the standard painkillers for people with osteoarthritis. It also appears to be as effective as drug therapy for the treatment of depression. This over-the-counter supplement may be new to the U.S., but it has been studied and used in some European countries for over 20 years.

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S-Adenosylmethionine is a metabolite of methionine, an amino acid found in high-protein foods. SAM-e, as it is called, has already generated its first book, Stop Depression Now by Richard Brown, MD, Teodoro Bottiglieri, PhD, and Carol Colman. The authors answer the question of why Americans, including doctors, haven't heard about SAM-e (pronounced Sammy) by citing the pharmaceutical industry's power to control information. SAM-e, according to the authors, "is a substance normally produced by every living organism on the planet, including human beings." They say there is no incentive for the pharmaceutical industry to spend the millions of dollars on clinical trials for a natural substance that cannot be patented. Dr. Brown, the lead author and an associate professor of clinical psychiatry at Columbia University College of Physicians and Surgeons in New York City, writes that he has been using SAM-e in his private practice for over five years.

Virtually all the research supporting the efficacy of SAM-e for the treatment of osteoarthritis was published years ago. The best of the studies appeared in a 1987 issue of the American Journal of Medicine (11/20), though most were conducted in other countries. In four trials, SAM-e was compared with ibuprofen (Advil), indomethocin (Indocin), or piroxicam (Feldene) for people with osteoarthritis of the hip, knee, or spine. In all studies, participants taking SAM-e were averaging 1,200 mg a day for up to 2.5 months. The supplement consistently demonstrated equivalent efficacy to the drugs and in one study, a more lasting improvement than piroxicam.

Among the best-designed trials is one conducted in Milan, Italy. Most of the 734 participants had either hip or knee arthritis. Participants were given daily doses of 1,200 mg of SAM-e, 750 mg of naproxen (Aleve), or a placebo. After four weeks, SAM-e was as effective as naproxen, and both were better than a placebo. The SAM-e users, however, had significantly fewer side effects. SAM-e also met with a higher rate of tolerance than naproxen.

Drug intolerance is a major issue for people with arthritis, most of whom rely on continuous doses of non-steroidal, anti-inflammatory drugs (NSAIDs) like ibuprofen, aspirin, and naproxen. NSAIDs are notorious for causing potentially fatal gastrointestinal bleeding. In an animal study reported in the same 1987 issue of the American Journal of Medicine, Argentine researchers found that SAM-e had a protective effect on the stomach. SAM-e was compared with misoprostol, a drug sold under the brand name, Cytotec, and frequently prescribed to reduce the risk of stomach ulceration in people taking NSAIDs. Rats were subjected to gastric distress with ethanol, aspirin, and stress, after being treated with either SAM-e or misoprostol. SAM-e was as effective as misoprostol in reducing injury to the stomach. The investigator, Dr. O.M. Laudanno, concluded, "SAM-e seems to provide a therapeutic advantage, in contrast to currently available NSAIDs."

SAM-e might have another advantage over NSAIDs where it concerns arthritic joints. Some experts believe that the chronic use of NSAIDs may exacerbate the loss of cartilage and thus contribute to the degenerative effect of arthritis. There are some preliminary studies suggesting that SAM-e and another popular supplement, glucosamine, may actually have a protective effect on joints and even repair cartilage.

Forty studies have explored the effect of SAM-e on people with depression. They are reviewed in a 1994 supplement to Acta Neurologica Scandinavica (No. 154, Vol. 89). SAM-e was compared with a placebo and/or one of the older tricyclic antidepressant drugs like imipramine (some brand names: Tofranil, Impril). The supplement consistently demonstrated an efficacy that matches the drug and exceeds the placebo. What's more, SAM-e works faster than antidepressant drugs, seven days vs. four weeks, with relatively few side effects.

Contrary to conventional medical wisdom, Dr. Brown, co-author of Stop Depression Now, sees nothing wrong with self-treatment for depression that is either mild or moderately severe, which represents the overwhelming majority of cases. Those who are severely depressed, suicidal or have a history of drug or alcohol abuse, should seek help from a professional. The major drawback of SAM-e seems to be cost, which ranges from $2.50 to $4.50 a pill. Given the usual quality assurance and standardization problems associated with all dietary supplements and herbs (see HealthFacts, 4/98) Dr. Brown was asked in a telephone interview to identify a trustworthy brand. "In Germany and for a time in Italy, the supplement was available only by prescription and therefore studied like any other prescription drug," he answered. "The best brand is also the least expensive brand, an Italian product marketed in this country under the name, Nature Made, a 200 mg pill sold at many different stores. The best prices are at Costco, a buyers' club, it is also marketed under the name of GNC, General Nutrition Center, but they only have a decent price on the first Tuesday of the month." Dr. Brown says he has been a paid lecturer for antidepressant manufacturers but has never taken money from a SAM-e manufacturer.

New Dietary Supplement for the Treatment of Arthritis and Depression

Healthfacts, August, 1999 by Maryann Napoli

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