Role of S-adenosyl-L-methionine in the treatment of depression:: a review of the evidence
Role of S-adenosyl-L-methionine in the treatment of depression:: a review of the evidence
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DOI：
10.1093/ajcn/76.5.1158s
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发表时间：
2002-11-01
影响因子：
7.1
通讯作者：
Fava, M
中科院分区：
文献类型：
--
作者：
Mischoulon, D;Fava, M
尽管有各种注册的抗抑郁药，但重度抑郁症仍然难以治疗。近年来，天然药物或替代药物的流行激增。尽管越来越受欢迎，但许多自然疗法的有效性证据有限。S-腺苷-L-甲硫氨酸（SAMe）是研究得比较好的自然疗法之一。SAMe是甲基供体，参与大脑中各种神经递质的合成。从氨基酸L-甲硫氨酸通过称为一碳循环的代谢途径衍生而来，SAMe被认为具有抗抑郁特性。少量胃肠外或口服SAMe的临床试验表明，在200-1600 mg/d的剂量下，SAMe上级安慰剂，并且在缓解抑郁症方面与三环类抗抑郁药一样有效，尽管有些人可能需要更高的剂量。SAMe可能比传统抗抑郁药起效更快，并且可能增强三环类抗抑郁药的效果。SAMe还可以防止阿尔茨海默病的有害影响。SAMe耐受性良好，相对无不良反应，尽管在双相情感障碍患者中报告了一些躁狂病例。总体而言，SAMe似乎在治疗抑郁症方面安全有效，但需要更多研究来确定最佳剂量。与较新的抗抑郁药进行头对头的比较应该有助于澄清SAMe在精神药理学设备中的位置。
Major depression remains difficult to treat, despite the wide array of registered antidepressants available. In recent years there has been a surge in the popularity of natural or alternative medications. Despite this growing popularity, there is limited evidence for the effectiveness of many of these natural treatments. S-adenosyl-L-methionine (SAMe) is one of the better studied of the natural remedies. SAMe is a methyl donor and is involved in the synthesis of various neurotransmitters in the brain. Derived from the amino acid L-methionine through a metabolic pathway called the one-carbon cycle, SAMe has been postulated to have antidepressant properties. A small number of clinical trials with parenteral or oral SAMe have shown that, at doses of 200-1600 mg/d, SAMe is superior to placebo and is as effective as tricyclic antidepressants in alleviating depression, although some individuals may require higher doses. SAMe may have a faster onset of action than do conventional antidepressants and may potentiate the effect of tricyclic antidepressants. SAMe may also protect against the deleterious effects of Alzheimer disease. SAMe is well tolerated and relatively free of adverse effects, although some cases of mania have been reported in bipolar patients. Overall, SAMe appears to be safe and effective in the treatment of depression, but more research is needed to determine optimal doses. Head-to-head comparisons with newer antidepressants should help to clarify SAMe's place in the psychopharmacologic armamentarium.