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SAMe

SAMe

Uses

What Are Star Ratings?

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.

2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

This supplement has been used in connection with the following health conditions:

Used for Why
3 Stars
Liver Cirrhosis
1,200 mg daily
Taking SAMe may improve liver function, bile flow, and survival.

Large amounts of SAMe (S-adenosylmethionine) may improve survival and liver function in alcoholic liver cirrhosis. A double-blind trial found that 1,200 mg of SAMe per day for two years significantly decreased the overall death rate and the need for liver transplantation in people with alcoholic liver cirrhosis, particularly in those with less advanced liver disease.1 Preliminary trials suggest that lower amounts of SAMe (180 mg per day in one trial2 and 800 mg per day in another3) may improve liver function in people with liver cirrhosis. SAMe supplementation has been shown to reverse the depletion of glutathione , an important antioxidant required for liver function.4It has also been shown to aid in the resolution of blocked bile flow (cholestasis), a common complication of liver cirrhosis.5 , 6

3 Stars
Osteoarthritis
1200 mg daily
SAMe has anti-inflammatory, pain-relieving, and tissue-healing properties that may help protect the health of joints and reduce OA symptoms.

SAMe (S-adenosyl methionine) possesses anti-inflammatory, pain -relieving, and tissue-healing properties that may help protect the health of joints,7 , 8 though the primary way in which SAMe reduces OA symptoms is not known. A very large, though uncontrolled, trial (meaning that there was no comparison with placebo) demonstrated “very good” or “good” clinical effect of SAMe in 71% of over 20,000 OA sufferers.9 In addition to this preliminary research, many double-blind trials have shown that SAMe reduces pain, stiffness, and swelling better than placebo and equal to drugs such as ibuprofen and naproxen in people with OA.10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 These double-blind trials all used 1,200 mg of SAMe per day.

Lower amounts of oral SAMe have also produced reductions in the severity of OA symptoms in preliminary clinical trials. A two-year, uncontrolled trial showed significant improvement of symptoms after two weeks at 600 mg SAMe daily, followed by 400 mg daily thereafter.18 This amount was also used in a double-blind trial, but participants first received five days of intravenous SAMe.19 A review of the clinical trials on SAMe concluded that its efficacy against OA was similar to that of conventional drugs but that patients tolerated it better.20

2 Stars
Depression
1,600 mg daily
SAMe appears to raise levels of dopamine, an important neurotransmitter in mood regulation.

SAMe (S-adenosyl methionine) is a substance synthesized in the body that has recently been made available as a supplement. SAMe appears to raise levels of dopamine, an important neurotransmitter in mood regulation. Higher SAMe levels in the brain are associated with successful drug treatment of depression, and oral SAMe has been demonstrated to be an effective treatment for depression in most,21 , 22 , 23 but not all,24 clinical trials. SAMe has been found to be effective both when used by itself and when used as add-on treatment to antidepressant medication.25 Most trials used 1,600 mg of SAMe per day. While it does not seem to be as powerful as full applications of antidepressant medications26 or St. John’s wort , SAMe’s effects are felt more rapidly, often within one week.27

2 Stars
Fibromyalgia
800 mg daily
Supplementing with SAMe may increase serotonin levels in the blood and help relieve symptoms.

Intravenous SAMe (S-adenosylmethionine) given to people with fibromyalgia reduced pain and depression in two double-blind trials;28 , 29 but no benefit was seen in a short (ten-day) trial.30 Oral SAMe (800 mg per day for six weeks) was tested in one double-blind trial and significant beneficial effects were seen, such as reduced pain , fatigue, and stiffness, and improved mood.31

2 Stars
Hepatitis and Cholestasis
1,600 mg daily
Supplementing with SAMe may help resolve blocked bile flow.

SAMe (S-adenosylmethionine) (1,600 mg/day orally or 800 mg/day intravenously) has been shown to aid in the resolution of blocked bile flow (cholestasis), a common complication of chronic hepatitis.32 , 33

2 Stars
Pregnancy and Postpartum Support and Cholestasis
Refer to label instructions
 
1 Star
Bipolar Disorder
Refer to label instructions
SAMe is an amino acid that has an impact on serotonin levels, it has shown significant antidepressant effects in clinical trials.

SAMe (S-adenosylmethionine) is another amino acid that has an impact on serotonin levels, and it has demonstrated significant antidepressant effects in clinical trials.36 , 37 , 38 In both controlled and preliminary studies, SAMe has been shown to be helpful for the depressive symptoms of bipolar disorder. However, some patients have switched from depression to mania while using SAMe at 500 to 1,600 mg daily.39 , 40 This is a known side effect of other antidepressant medications.41 The mania induced by SAMe resolved when the supplement was discontinued, and in one case resolved spontaneously while the patient continued taking SAMe.42 Therefore, people with bipolar disorder should supplement with SAMe only under the supervision of a qualified healthcare practitioner.
1 Star
Male Infertility
Refer to label instructions
Preliminary research suggests that oral SAMe may also increase sperm activity in infertile men.

Preliminary research suggests that oral SAMe (S-adenosyl-L-methionine), in amounts of 800 mg per day, may also increase sperm activity in infertile men.43

1 Star
Migraine Headache
Refer to label instructions
Preliminary research suggests that supplementing with SAMe may reduce symptoms for some migraine sufferers.

Preliminary research also suggests that oral supplements of SAMe (S-adenosyl-L-methionine) may reduce symptoms for some migraine sufferers.44

How It Works

How to Use It

Healthy people do not need to take this supplement. Researchers working with people suffering from a variety of conditions have been using these amounts of SAMe: depression , 1,600 mg per day; osteoarthritis , 800–1,200 mg per day; fibromyalgia , 800 mg per day; liver disorders, 1,200 mg per day; and migraine , 800 mg per day.

Where to Find It

SAMe is not abundant in the diet, though its precursor, the amino acid methionine is plentiful in many protein foods. It is not known whether increasing one’s intake of methionine will increase the body’s production of SAMe. Supplements of SAMe have been available in the U.S. since 1997.

Possible Deficiencies

SAMe is normally produced in the liver from the amino acid methionine which is abundant in most diets. Folic acid and vitamin B12 are necessary for the synthesis of SAMe, and deficiencies of these vitamins results in low concentrations of SAMe in the central nervous system.45 Low blood or central nervous system levels of SAMe have been detected in people with cirrhosis of the liver ,46 coronary heart disease ,47 Alzheimer’s disease , and depression .48

Interactions

Interactions with Supplements, Foods, & Other Compounds

At the time of writing, there were no well-known supplement or food interactions with this supplement.

Interactions with Medicines

Certain medicines interact with this supplement.

What Are Drug Interactions
Types of interactions: Beneficial Adverse Check

Replenish Depleted Nutrients

  • none

Reduce Side Effects

  • none

Support Medicine

  • Amitriptyline

    SAMe may improve the clinical response to imipramine (Tofranil®). In a double-blind trial, depressive symptoms decreased earlier in the people who received SAMe injections (200 mg per day) in combination with imipramine than in those who received imipramine with placebo injections.49 Oral supplementation with SAMe has demonstrated antidepressant activity, independent of its combination with imipramine.50

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Amoxapine

    SAMe may improve the clinical response to imipramine (Tofranil®). In a double-blind trial, depressive symptoms decreased earlier in the people who received SAMe injections (200 mg per day) in combination with imipramine than in those who received imipramine with placebo injections.51 Oral supplementation with SAMe has demonstrated antidepressant activity, independent of its combination with imipramine.52

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Clomipramine

    SAMe may improve the clinical response to imipramine (Tofranil®). In a double-blind trial, depressive symptoms decreased earlier in the people who received SAMe injections (200 mg per day) in combination with imipramine than in those who received imipramine with placebo injections.53 Oral supplementation with SAMe has demonstrated antidepressant activity, independent of its combination with imipramine.54

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Desipramine

    SAMe may improve the clinical response to imipramine (Tofranil®). In a double-blind trial, depressive symptoms decreased earlier in the people who received SAMe injections (200 mg per day) in combination with imipramine than in those who received imipramine with placebo injections.55 Oral supplementation with SAMe has demonstrated antidepressant activity, independent of its combination with imipramine.56

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Doxepin

    SAMe may improve the clinical response to imipramine (Tofranil®). In a double-blind trial, depressive symptoms decreased earlier in the people who received SAMe injections (200 mg per day) in combination with imipramine than in those who received imipramine with placebo injections.57 Oral supplementation with SAMe has demonstrated antidepressant activity, independent of its combination with imipramine.58

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Imipramine

    SAMe may improve the clinical response to imipramine (Tofranil®). In a double-blind trial, depressive symptoms decreased earlier in the people who received SAMe injections (200 mg per day) in combination with imipramine than in those who received imipramine with placebo injections.59 Oral supplementation with SAMe has demonstrated antidepressant activity, independent of its combination with imipramine.60

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Nortriptyline

    SAMe may improve the clinical response to imipramine (Tofranil®). In a double-blind trial, depressive symptoms decreased earlier in the people who received SAMe injections (200 mg per day) in combination with imipramine than in those who received imipramine with placebo injections.61 Oral supplementation with SAMe has demonstrated antidepressant activity, independent of its combination with imipramine.62

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Protriptyline

    SAMe may improve the clinical response to imipramine (Tofranil®). In a double-blind trial, depressive symptoms decreased earlier in the people who received SAMe injections (200 mg per day) in combination with imipramine than in those who received imipramine with placebo injections.63 Oral supplementation with SAMe has demonstrated antidepressant activity, independent of its combination with imipramine.64

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Trimipramine

    SAMe may improve the clinical response to imipramine (Tofranil®). In a double-blind trial, depressive symptoms decreased earlier in the people who received SAMe injections (200 mg per day) in combination with imipramine than in those who received imipramine with placebo injections.65 Oral supplementation with SAMe has demonstrated antidepressant activity, independent of its combination with imipramine.66

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Reduces Effectiveness

  • none

Potential Negative Interaction

  • none

Explanation Required

  • none

The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers’ package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a supplement with your doctor or pharmacist.

Side Effects

Side Effects

Clinical trials in thousands of people for up to two years have demonstrated that SAMe is very well tolerated, much better than the medications with which it has often been compared.67 , 68 Occasional gastrointestinal upset may be experienced by some people. Researchers treating people with bipolar disorder (manic depression) have reported that SAMe could cause them to switch from depression to a manic episode.69 , 70

References

1. Mato JM, Camara J, Fernandez de Paz J, et al. S-adenosylmethionine in alcoholic liver cirrhosis: a randomized, placebo-controlled, double-blind, multicenter clinical trial. J Hepatol 1999;30:1081–9.

2. Miglio F, Stefanini GF, Corazza GR, et al. Double-blind studies of the therapeutic action of S-Adenosylmethionine (SAMe) in oral administration, in liver cirrhosis and other chronic hepatitides. Minerva Med 1975;66:1595–9 [In Italian].

3. Gorbakov VV, Galik VP, Kirillov SM. Experience in heptral treatment of diffuse liver diseases. Ter Arkh 1998;70:82–6 [in Russian].

4. Loguercio C, Nardi G, Argenzio F, et al. Effect of S-adenosyl-L-methionine administration on red blood cell cysteine and glutathione levels in alcoholic patients with and without liver disease. Alcohol Alcohol 1994;29:597–604.

5. Frezza M, Centini G, Cammareri G, et al. S-adenosylmethionine for the treatment of intrahepatic cholestasis of pregnancy. Results of a controlled clinical trial. Hepatogastroenterology 1990;37 Suppl 2:122–5.

6. Frezza M, Surrenti C, Manzillo G, et al. Oral S-adenosylmethionine in the symptomatic treatment of intrahepatic cholestasis. A double-blind, placebo-controlled study. Gastroenterology 1990;99:211–5.

7. Schumacher HR. Osteoarthritis: the clinical picture, pathogenesis, and management with studies on a new therapeutic agent, S-adenosylmethionine. Am J Med 1987;83(Suppl 5A):1–4 [review].

8. Harmand MF, Vilamitjana J, Maloche E, et al. Effects of S-adenosylmethionine on human articular chondrocyte differentiation: an in vitro study. Am J Med 1987;83(Suppl 5A):48–54.

9. Berger R, Nowak H. A new medical approach to the treatment of osteoarthritis. Report of an open phase IV study with ademetionine (Gumbaral). Am J Med 1987;83:84–8.

10. Domljan Z, Vrhovac B, Durrigl T, Pucar I. A double-blind trial of ademetionine vs naproxen in activated gonarthrosis. Int J Clin Pharmacol Ther Toxicol 1989;27:329–33.

11. Müller-Fassbender H. Double-blind clinical trial of S-adenosylmethionine in versus ibuprofen in the treatment of osteoarthritis. Am J Med 1987;83(Suppl 5A):81–3.

12. Vetter G. Double-blind comparative clinical trial with S-adenosylmethionine and indomethacin in the treatment of osteoarthritis. Am J Med 1987;83(Suppl 5A):78–80.

13. Maccagno A. Double-blind controlled clinical trial of oral S-adenosylmethionine versus piroxicam in knee osteoarthritis. Am J Med 1987;83(Suppl 5A):72–7.

14. Caruso I, Pietrogrande V. Italian double-blind multicenter study comparing S-adenosylmethionine, naproxen, and placebo in the treatment of degenerative joint disease. Am J Med 1987;83(Suppl 5A):66–71.

15. Marcolongo R, Giordano N, Colombo B, et al. Double-blind multicentre study of the activity of s-adenosyl-methionine in hip and knee osteoarthritis. Curr Ther Res 1985;37:82–94.

16. Glorioso S, Todesco S, Mazzi A, et al. Double-blind multicentre study of the activity of S-adenosylmethionine in hip and knee osteoarthritis. Int J Clin Pharmacol Res 1985;5:39–49.

17. Montrone F, Fumagalli M, Sarzi-Puttini P, et al. Double-blind study of S-adenosyl-methionine versus placebo in hip and knee arthrosis. Clin Rheumatol 1985;4:484–5.

18. Konig B. A long-term (two years) clinical trial with S-adenosylmethionine for the treatment of osteoarthritis. Am J Med 1987;83:89–94.

19. Bradley JD, Flusser D, Katz BP, et al. A randomized, double blind, placebo controlled trial of intravenous loading with S-adenosylmethionine (SAM) followed by or SAM therapy in patients with knee osteoarthritis. J Rheumatol 1994;21:905–11.

20. Di Padova C. S-adenosylmethionine in the treatment of osteoarthritis. Review of the clinical studies. Am J Med 1987;83:60–5 [review].

21. Bell KM, Potkin SG, Carreon D, Plon L. S-adenosylmethionine blood levels in major depression: changes with drug treatment. Acta Neurol Scand 1994;154(suppl):15–8.

22. Bressa GM. S-adenosyl-l-methionine (SAMe) as antidepressant: Meta-analysis of clinical studies. Acta Neurol Scand 1994;154(suppl):7–14.

23. Salmaggi P, Bressa GM, Nicchia G, et al. Double-blind, placebo-controlled study of s-adenosyl-methionine in depressed postmenopausal women. Psychother Psychosom 1993;59:34–40.

24. Kagan BL, Sultzer DL, Rosenlicht N, et al. Oral S-adenosyl-methionine in depression: A randomized, double-blind, placebo-controlled trial. Am J Psychiatry 1990;147:591–5.

25. Papakostas GI, Mischoulon D, Shyu I, et al. S-Adenosyl methionine (SAMe) augmentation of serotonin reuptake inhibitors for antidepressant nonresponders with major depressive disorder: a double-blind, randomized clinical trial. Am J Psychiatry 2010;167:942–948.

26. Fava M, Rosenbaum JF, Birnbaum R, et al. The thyrotropin-releasing hormone as a predictor of response to treatment in depressed outpatients. Acta Psychiatr Scand 1992;86:42–5.

27. De Vanna M, Rigamonti R. Oral S-adenosyl-L-methionine in depression. Curr Ther Res 1992;52:478–85.

28. Tavoni A, Jeracitano G, Cirigliano G. Evaluation of S-adenosylmethionine in secondary fibromyalgia: A double-blind study. Clin Exp Rheumatol 1998;16:106–7 [letter].

29. Tavoni A, Vitali C, Bombardieri S, et al. Evaluation of S-adenosylmethionine in primary fibromyalgia: A double-blind crossover study. Am J Med 1987;83(suppl 5A):107–10.

30. Volkmann H, Norregaard J, Jacobsen S, et al. Double-blind, placebo-controlled cross-over study of intravenous S-adenosyl-L-methionine in patients with fibromyalgia. Scand J Rheumatol 1997;26:206–11.

31. Jacobsen S, Danneskiold-Samsoe B, Andersen RB. Oral S-adenosylmethionine in primary fibromyalgia: Double-blind clinical evaluation. Scand J Rheumatol 1991;20:294–302.

32. Frezza M, Centini G, Cammareri G, et al. S-adenosylmethionine for the treatment of intrahepatic cholestasis of pregnancy. Results of a controlled clinical trial. Hepatogastroenterology 1990;37 Suppl 2:122–5.

33. Frezza M, Surrenti C, Manzillo G, et al. Oral S-adenosylmethionine in the symptomatic treatment of intrahepatic cholestasis. A double-blind, placebo-controlled study. Gastroenterology 1990;99:211–5.

34. Frezza M, Surrenti C, Manzillo G, et al. Oral S-adenosylmethionine in the symptomatic treatment of intrahepatic cholestasis. A double-blind, placebo-controlled study. Gastroenterology 1990;99:211–5.

35. Frezza M, Centini G, Cammareri G, et al. S-adenosylmethionine for the treatment of intrahepatic cholestasis of pregnancy. Results of a controlled clinical trial. Hepatogastroenterology 1990;37 Suppl 2:122–5.

36. Rosenbaum JF, Fava M, Faulk WE, et al. The antidepressant potential of oral S-adenosyl-l-methionine. Acta Psychiatr Scand 1990;81:432–6.

37. Friedel HA, Goa KL, Benfield P. S-Adenosyl-l-methionine: A review of its pharmacological properties and therapeutic potential in liver dysfunction and affective disorders in relation to its physiological role in cell metabolism. Drugs 1989;38:389–417 [review].

38. Carney MWP, Chary TKN, Bottiglieri T. The switch mechanism in affective illness and oral S-adenosylmethionine (SAM). Br J Psychiatry 1987;150:724–5.

39. Carney MWP, Chary TKN, Bottiglieri T. The switch mechanism in affective illness and oral S-adenosylmethionine (SAM). Br J Psychiatry 1987;150:724–5.

40. Carney MWP, Chary TKN, Bottiglieri T, Reynolds EH. The switch mechanism and bipolar/unipolar dichotomy. Br J Psychiatry 1989;154:48–51.

41. Wehr TA, Goodwin FK. Can antidepressants cause mania and worsen the course of affective illness? Am J Psychiatry 1987;144:1403–11.

42. Rosenbaum JF, Fava M, Faulk WE, et al. The antidepressant potential of oral S-adenosyl-l-methionine. Acta Psychiatr Scand 1990;81:432–6.

43. Piacentino R, Malara D, Zaccheo F, et al. Preliminary study of the use of s. adenosyl methionine in the management of male sterility. Minerva Ginecologica 1991;43:191–3 [in Italian].

44. Gatto G, Caleri D, Michelacci S, Sicuteri F. Analgesizing effect of a methyl donor (S-adenosylmethionine) in migraine: an open clinical trial. Int J Clin Pharmacol Res 1986;6:15–7.

45. Bottiglieri T, Hyland K, Reynolds EH. The clinical potential of ademetionine (S-adenosylmethionine) in neurological disorders. Drugs 1994;48:137–52 [review].

46. Osman E, Owen JS, Burroughs AK. S-adenosyl-L-methionine–a new therapeutic agent in liver disease? Aliment Pharmacol Ther 1993;7:21–8 [review].

47. Loehrer FM, Angst CP, Haefeli WE, et al. Low whole-blood S-adenosylmethionine and correlation between 5-methyltetrahydrofolate and homocysteine in coronary artery disease. Arterioscler Thromb Vasc Biol 1996;16:727–33.

48. Bottiglieri T, Godfrey P, Flynn T, et al. Cerebrospinal fluid S-adenosylmethionine in depression and dementia: effects of treatment with parenteral and oral S-adenosylmethionine. J Neurol Neurosurg Psychiatry 1990;53:1096–8.

49. Berlanga C, Ortega-Soto HA, Ontiveros M, Senties H. Efficacy of S-adenosyl-L-methionine in speeding the onset of action of imipramine. Psychiatry Res 1992;44:257–62.

50. Bressa GM. S-adenosyl-l-methionine (SAMe) as antidepressant: Meta-analysis of clinical studies. Acta Neurol Scand 1994;154(suppl):7–14.

51. Berlanga C, Ortega-Soto HA, Ontiveros M, Senties H. Efficacy of S-adenosyl-L-methionine in speeding the onset of action of imipramine. Psychiatry Res 1992;44:257–62.

52. Bressa GM. S-adenosyl-l-methionine (SAMe) as antidepressant: Meta-analysis of clinical studies. Acta Neurol Scand 1994;154(suppl):7–14.

53. Berlanga C, Ortega-Soto HA, Ontiveros M, Senties H. Efficacy of S-adenosyl-L-methionine in speeding the onset of action of imipramine. Psychiatry Res 1992;44:257–62.

54. Bressa GM. S-adenosyl-l-methionine (SAMe) as antidepressant: Meta-analysis of clinical studies. Acta Neurol Scand 1994;154(suppl):7–14.

55. Berlanga C, Ortega-Soto HA, Ontiveros M, Senties H. Efficacy of S-adenosyl-L-methionine in speeding the onset of action of imipramine. Psychiatry Res 1992;44:257–62.

56. Bressa GM. S-adenosyl-l-methionine (SAMe) as antidepressant: Meta-analysis of clinical studies. Acta Neurol Scand 1994;154(suppl):7–14.

57. Berlanga C, Ortega-Soto HA, Ontiveros M, Senties H. Efficacy of S-adenosyl-L-methionine in speeding the onset of action of imipramine. Psychiatry Res 1992;44:257–62.

58. Bressa GM. S-adenosyl-l-methionine (SAMe) as antidepressant: Meta-analysis of clinical studies. Acta Neurol Scand 1994;154(suppl):7–14.

59. Berlanga C, Ortega-Soto HA, Ontiveros M, Senties H. Efficacy of S-adenosyl-L-methionine in speeding the onset of action of imipramine. Psychiatry Res 1992;44:257–62.

60. Bressa GM. S-adenosyl-l-methionine (SAMe) as antidepressant: Meta-analysis of clinical studies. Acta Neurol Scand 1994;154(suppl):7–14.

61. Berlanga C, Ortega-Soto HA, Ontiveros M, Senties H. Efficacy of S-adenosyl-L-methionine in speeding the onset of action of imipramine. Psychiatry Res 1992;44:257–62.

62. Bressa GM. S-adenosyl-l-methionine (SAMe) as antidepressant: Meta-analysis of clinical studies. Acta Neurol Scand 1994;154(suppl):7–14.

63. Berlanga C, Ortega-Soto HA, Ontiveros M, Senties H. Efficacy of S-adenosyl-L-methionine in speeding the onset of action of imipramine. Psychiatry Res 1992;44:257–62.

64. Bressa GM. S-adenosyl-l-methionine (SAMe) as antidepressant: Meta-analysis of clinical studies. Acta Neurol Scand 1994;154(suppl):7–14.

65. Berlanga C, Ortega-Soto HA, Ontiveros M, Senties H. Efficacy of S-adenosyl-L-methionine in speeding the onset of action of imipramine. Psychiatry Res 1992;44:257–62.

66. Bressa GM. S-adenosyl-l-methionine (SAMe) as antidepressant: Meta-analysis of clinical studies. Acta Neurol Scand 1994;154(suppl):7–14.

67. Bressa GM. S-adenosyl-l-methionine (SAMe) as antidepressant: meta-analysis of clinical studies. Acta Neurol Scand 1994;154(suppl):7–14.

68. Di Padova C. S-adenosyl-methionine in the treatment of osteoarthritis: review of the clinical studies. Am J Med 1987;83(suppl 5A):60–4.

69. Carney MWP, Chary TK, Bottiglieri T, et al. The switch mechanism and the bipolar/unipolar dichotomy. Br J Psychiatry 1989;154:48–51.

70. Carney MWP, Chary TK, Bottiglieri T, et al. Switch and S-adenosyl-methionine. Alabama J Med Sci 1988;25:316–9.

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