nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
See here for more discussion.

Wednesday, September 1, 2010

STUDY: Supplement Can Improve Treatment Of Depression...We Hope

There's some media interest in a study that shows S-adenosyl methionine may be useful in the treatment of major depression.

But notice the sentence in the NY Times Well Blog (Aug 31):
A popular dietary supplement called SAMe may help depressed patients who don’t respond to prescription antidepressant treatment, a new study shows.
Actually that's not what the study shows.  Let's look at the real study. in the American Journal of Psychiatry, July 2010.

But first some background.  S-adenosyl methionine (SAM-e for short) is a compound found normally in our bodies.  It's involved in regulating the synthesis of some brain chemicals, among other things.  If you measure the amount of the compund in the spinal fluid of severely depressed patients, it's very low.  If you treat depressed patients with other medicines, it raises the level of SAM-e.

These and other studies show that something's going on with this compound that involves depression.  What, we're not sure.  However, a beginning hypothesis could be that limited amounts of SAM-e can either be the cause of, or result of, depression.

So, why not try giving it to people and see if they improve?  There have been a number of studies to look at this, but they all suffer from some limitations:  either the compound had to be given by shot, or the study period was not long enough, or too few patients, or investigations couldn't document that different commercial formulations had the same amount of the compound in them, yada yada yada.....  And finally, the benefit could not be distinguished from that of least convincingly.  If you follow Nostrums, you know these are common occurrences and they make for caution in claiming great things for new treatments.

So, what was wrong with the NY Times statement?  Here's what they didn't say:
1.  The study had only 73 people in it altogether, and the study period was only 6 weeks.  If I was despressed, 6 weeks of improvement would be great, but what about the next 30 years?
2.  The SAM-e was used as an "adjunct."  For those not used to the term, this means it was an "add-on" drug.  The patients were still getting their SRI (Prozac or whatever) along with the supplement.
3.  The study participants were people with "major depressioin."  This is different as night and day from garden variety being down, depressed, and havin' the Blues.  Major depression is "characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation."   So nothing has been shown about other depression categories.
4.  Different commercial preparations make it not possible to know whether the dose used in this study is the good, bad, or indifferent.

All of the above sounds like I'm down on the idea that this supplement can work.  I'm not.   This was a double blind controlled trial.  But there is more work to be done, and NYT didn't get the story straight.

For Onion Peelers, here's what I know (The abstract didn't give p-values, CI's, etc.):
The Hamilton Depression Rating Scale response [a tool to measure level of depression] and remission rates were higher for patients treated with adjunctive SAMe (36.1% and 25.8%, respectively) than adjunctive placebo (17.6% versus 11.7%, respectively). The number needed to treat for response and remission was approximately one in six and one in seven, respectively.

Recommendation:  Not ready for primetime, yet...but some promise shown.

If you still want to run out and buy this, there's a leeeetle problem:  expense.  $140 a month is in the range.

And it ain't covered by insurance.

Doc D

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