Similar
efficacy of S-adenosyl-L-methionine (SAMe) and
imipramine in major depression
S-adenosyl-L-methionine
(SAMe) has been shown to be the most important
methyl donor in transmethylation reactions in
the central nervous system and several clinical
trials have suggested that SAMe is efficacious
in depression. The aim of a recent study was to
confirm the efficacy and safety of SAMe in the
treatment of major depression.
In a four-week, multi-centre, double-blind trial
293 participants were enrolled to receive SAMe
(146 patients) at the dose of 400 mg per day
i.m., or 150 mg per day oral imipramine (IMI)
(147 patients). The subjects were diagnosed with
a major depressive episode, with baseline scores
equal to or greater than 18 on the 21-item
Hamilton Depression Rating Scale (HAM-D).
Endpoint HAM-D score and the percentage of
responders to the Clinical Global Impression at
week 4 were the main measures used to evaluate
efficacy. The final Montgomery-Asberg Depression
Rating Scale (MADRS) scores and the response
rate measured as a decrease in HAM-D scores of
at least 50% from baseline were the secondary
efficacy measures. Safety and tolerability were
also analysed in all the patients.
The results showed no significant difference on
any main or secondary efficacy measures between
SAMe and IMI groups. The patients treated with
SAMe, however, complained less of adverse events
than those treated with IMI.
SAMe thus appears to be comparable to IMI for
the treatment of major depression, at least in
this short-term trial, but with a better
tolerance. However, the in the absence of a
placebo arm, a type 2 error (not detecting a
difference when one exists) cannot be ruled out.
Nevertheless, the use of SAMe appears to
represent an interesting alternative treatment
in depression. Int
J Neuropsychopharmacol 5: 287-294,
2002