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Full Title: S-Adenosyl-L-Methionine (SAMe) for Depression, Osteoarthritis, and Liver Disease
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Objectives: We conducted a comprehensive literature review and synthesis of evidence on the use of S-adenosyl-L-methionine (SAMe) for the treatment of depression, osteoarthritis, and liver disease.
Search Strategy: We searched 25 databases using the MesH term SAMe and its many pharmacological synonyms. Additional articles were identified from bibliographies and by experts.
Selection Criteria: The synthesis of SAMe focused on clinical trials of human subjects. Approximately 25 percent of the selected reports were in non-english languages, mainly Italian.
Data Collection and Analysis: Selected titles, abstracts, and articles were reviewed. Patient demographics, disease state, intervention, study design, and outcomes were collected. Meta-analyses were performed where appropriate.
- Compared to placebo, treatment with SAMe was associated with an improvement of approximately 6 points in the score of the Hamilton Rating Scale for Depression. (This degree of improvement is clinically significant and is equivalent to a partial response to treatment.)
- Compared to treatment with conventional therapy, SAMe was not associated with a statistically significant difference in outcomes.
- Compared to placebo for osteoarthritis, one large randomized clinical trial showed a small to moderate effect in favor of SAMe.
- Compared to nonsteroidal anti-inflammatory agents, treatment with SAMe was not associated with a statistically significant difference in outcomes.
- Compared to placebo, treatment with SAMe for cholestasis of pregnancy was associated with a large effect in decreasing pruritus and in decreasing bilirubin levels.
- In two clinical trials for cholestasis of pregnancy, conventional therapy (ursodeoxycholic acid) was favored over SAMe for the treatment of pruritus.
- Compared to placebo for intrahepatic cholestasis, treatment with SAMe for pruritus was associated with a risk ratio of 0.45, meaning that patients treated with SAMe were twice as likely as placebo-treated patients to have a reduction in pruritus (95% CI [0.37, 0.58]).
- Too few studies compared SAMe to active therapy for intrahepatic cholestasis to conduct a pooled analysis.
- Twenty remaining studies were too heterogeneous with respect to diagnosis (a wide variety of liver conditions) and outcomes to permit pooled analysis.
Conclusions: These data indicate that SAMe is more effective than placebo for relief of symptoms of depression, pain of osteoarthritis, and pruritus in cholestasis of pregnancy, and in intrahepatic cholestasis. SAMe is more effective than placebo in reducing bilirubin for cholestasis of pregnancy and serum bilirubin for intrahepatic cholestasis. Treatment with SAMe was equivalent to standard therapy for depression and osteoarthritis but not for liver disease.
These results justify additional randomized controlled trials to evaluate the efficacy and tolerability of SAMe for treatment of depression, osteoarthritis, and cholestasis (related to pregnancy and associated with other liver diseases).
S-Adenosyl-L-Methionine (SAMe) for Depression, Osteoarthritis, and Liver Disease
Evidence-based Practice Center: Southern California
Topic Nominator: National Center for Complementary and Alternative Medicine (NCCAM)
Current as of August 2002