Down with Depression

Depression is the most common psychiatric ailment in Western society. Depression affects around 1.4 million people in Canada at any given time and is the second leading cause of long-term disability among workers.

There are many known causes of depression environmental (exposure to chemicals that disrupt brain chemistry), nutritional (deficiency of certain vitamins), situational (stress), and physiological (imbalance of neurotransmitters). It is important that the underlying cause is determined so that an appropriate treatment can be initiated. For example, cases of depression have been linked to chemical exposure, such as inhalation of fumes given off by new carpet or paint, or ingestion of chemicals in food (dyes, preservatives, and pesticides).

Conventional treatment of depression focuses on prescription drugs and psychiatric counselling. Antidepressant drugs are divided into two major categories: tricyclic antidepressant drugs (TCAs) and newer selective serotonin re-uptake inhibitors (SSRIs). TCAs include amitriptyline, clomipramine, imipramine, nortriptyline, desipramine, and doxepin. The SSRIs include fluoxetine, fluvoxamine, citalopram, paroxetine, and sertraline. While these drugs have helped many people, some professionals believe they are being prescribed too frequently and safer alternatives should be explored.

The main concern with antidepressant drugs is their high incidence of side effects, drug interactions, and variable response. Some estimates indicate one-third of people will not be helped or are unable to tolerate the side effects that include nausea, loss of appetite, headaches, anxiety and nervousness, insomnia or drowsiness, diarrhea, sweating, tremor, and reduced sex drive.

On average, a prescription for antidepressants in Canada costs between $50 and $60 a month. Perhaps this is why natural substances, such as SAMe - a dietary supplement otherwise known as S-adenosyl-L-Methionine Tosylate - are receiving so much attention.

A Natural Alternative

SAMe is a compound that is naturally produced in the body when methionine (an amino acid found in fish, meat, and dairy products) combines with ATP (a key energy source for cells). SAMe is involved in over 40 critically important biochemical reactions in the body, having effects on the brain, liver, and joints.

SAMe was discovered in Italy almost 50 years ago and is commonly prescribed in many European countries for depression and osteoarthritis. In Canada, SAMe was available without a prescription as a dietary supplement until 2002 when the government decided to suspend over-the-counter sales until further research was conducted. When Health Canada introduced the new regulations for dietary supplements in 2004, SAMe became available again.

Fighting Depression

SAMe has been found to increase the action of several neurotransmitters (chemical messengers in the brain), such as dopamine, serotonin, and norepinephrine. Low levels of these neurotransmitters have been linked to depression and emotional disorders.

SAMe enhances cell membrane fluidity and improves cellular communication between neurons. It is also involved in energy production in the brain by supporting the function of the mitochondria (powerhouse of the cell). Additionally, SAMe has antioxidant properties, which protect brain tissues against damage from free radicals.

The Argument for SAMe

Numerous clinical studies have shown SAMe to not only be effective against depression, but also free of serious side effects. The US Department of Health and Human Services recently released a report that reviewed 47 separate studies into the supplement. While some of these studies compared SAMe to placebo (sugar pill), many compared it to conventional, prescribed antidepressants. The report concluded, "SAMe is more effective than placebo for relief of symptoms of depression" and "equivalent to standard therapy for depression."

Side Effects

Unlike prescription antidepressants, the side effects of SAMe are rare and minor and can include nausea, an upset stomach, and insomnia. While some antidepressants cause liver damage, SAMe has been shown in some studies to be liver protective.

One further advantage of SAMe is its rapid onset of action. Effects are often noticeable within one or two weeks compared with four weeks or longer for prescription antidepressants.

As with conventional antidepressants, SAMe should not be used to treat bipolar disorder (manic depression) as it can worsen the manic symptoms. Those who are taking antidepressant medications, are pregnant, or breastfeeding should consult their doctor before using SAMe.

How Much is Enough?

SAMe is available without a prescription at most pharmacies and health food stores and costs approximately $40 for a 30-day supply. The recommended daily dose is 400 mg to 1600 mg - start low and increase if needed.

There are various forms of SAMe available, but only natural SAMe has been clinically tested with proven health benefits. Look for "Iso-Active High Isomer SAMe" also known as S-adenosyl-L-Methionine Tosylate. SAMe should be taken on an empty stomach.

While SAMe is not a magic pill, it does represent some significant advantages over conventional therapies.

Signs of Depression

According to the American Psychiatric Association's Diagnostic Manual of Mental Disorders, serious clinical depression can be diagnosed if someone exhibits four or more of the following symptoms nearly every day for at least two weeks:

• poor appetite and significant weight loss, or increased appetite and significant weight gain
• insomnia or increased sleep
• agitation or sluggishness in movement and thought
• loss of interest or pleasure in usual activities, or decrease in sexual drive
• fatigue or loss of energy
• feelings of worthlessness, self-reproach, or excessive or inappropriate guilt
• diminished ability to think or concentrate, or indecisiveness
• recurrent thoughts of death or suicide, or suicide attempts