Dec. 2, 2004 -- There is growing interest in the use of nutritional supplements for the treatment of depression. Some people swear by St. John's wort or fish oil capsules containing omega-3, and now early studies suggest that the dietary supplement SAMe can help patients who do not respond to single-drug treatment with prescription antidepressants.
The investigation included 30 people who continued to struggle with depression while taking antidepressants like Prozac, Paxil, or Effexor. Half the patients in the study reported significant improvement in symptoms when they took SAMe along with their prescription antidepressant for six weeks. Forty-three percent reported having no depression symptoms at all six weeks after adding the dietary supplement to their treatment.
The patients in the study knew they were taking SAMe, but lead researcher Jonathan Alpert, MD, PhD, has received funding from the National Institutes of Health to do a larger trial in which participants will not know if they are getting the supplement or a placebo.
Alpert stresses the importance of discussing the use of SAMe or any nutritional supplement with a doctor. The study was published in the December issue of the Journal of Clinical Psychopharmacology and was paid for by SAMe supplement manufacturer Pharmavite LCC.
"Anyone who has depression that is serious enough to require treatment, and especially someone who is not responding to an initial course of antidepressants, really needs to be evaluated by a physician," he tells WebMD.
The Big 3
SAMe is a naturally occurring molecule within cells that, among other things, is believed to influence chemicals involved in depression. It is widely used to treat a number of seemingly unrelated disorders, including depression, osteoarthritis, and chronic liver conditions, but few studies have evaluated its usefulness in the treatment of these conditions.
In addition to SAMe, Alpert and colleagues from Massachusetts General Hospital's Depression and Clinical Research Program are studying other nutritional supplements, including St. John's wort and omega-3 fatty acids.
Harvard psychiatry professor David Mischoulon, MD, PhD, who is also a staff psychiatrist at Massachusetts General Hospital, says SAMe, St. John's wort, and fish oil capsules containing omega-3 are the most promising supplements for the treatment of depression.
"I would say they are the big three," he tells WebMD. "We are at the point where we have maybe four or five well-designed studies on St. John's wort, but the results have been contradictory."
Though the SAMe and fish oil research appear promising, not enough studies have been done to prove their effectiveness, he says.
"What we need is a larger body of studies so that we can look at all of these supplements as a whole and come up with an overall trend," he says. "We just aren't there yet."
The Dangers of Self-Medicating
Like Alpert, Mischoulon warns that self-medicating with any supplement can be dangerous and even deadly. St. John's wort has been shown to decrease the effectiveness of some lifesaving drugs -- including chemotherapy, HIV drugs, and drugs used to prevent organ rejection.
Kava, which is derived from the kava root and is widely used as a depression treatment, has been associated with liver failure. Its sale has been banned in many European countries, and the FDA is considering a similar ban in the United States.
Although most early reports suggest that SAMe is generally safe, there was one report of a potentially fatal drug interaction in an elderly patient taking the supplement along with a tricyclic antidepressant. The most commonly reported side effects in Alpert's study were constipation and upset stomach.
"One of the main things I emphasize to patients is that they should not self-medicate with any of these supplements, especially if they are already taking other medications," Mischoulon says.