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      S-Adenosyl-L-Methionine Results Similar to Imipramine in Major Depression

      A DGReview of :"A double-blind, randomized parallel-group, efficacy and safety study of intramuscular S -adenosyl- L -methionine 1,4-butanedisulphonate (SAMe) versus imipramine in patients with major depressive disorder"
      International Journal of Neuropsychopharmacology

      12/30/2002
      By Elda Hauschildt


      Intramuscular S-adenosyl-l-methionine (SAMe) appears to be comparable to oral imipramine for the treatment of major depression, Italian researchers have found in a short-term trial. They add that patients tolerate SAMe significantly better, however.

      Investigators the Universita La Sapienza, Fondazione Italiana per lo studio della Schizofrenia and Societa Italiana di Psichiatria in Rome, explain that SAMe constitutes the most important methyl donor in transmethylation reactions in the central nervous system. Clinical trials had indicated SAMe possesses antidepressant activity.

      They enrolled 293 patients in a four-week, multi-centre, double-blind trial of SAMe and imipramine. A total of 146 patients received 400 milligrams per day of intramuscular SAMe and 147 received 150 mg/d of oral imipramine.

      Participants had been diagnosed with a major depressive episode. They had baseline scores equal to or greater than 18 on the 21-item Hamilton Depression Rating Scale (HAM-D).

      Endpoint HAM-D scores and the percentage of responders to the Clinical Global Impression measure were used to measure efficacy. Secondary efficacy measures included final Montgomery-Asberg Depression Rating Scale scores and response as a fall in HAM-D scores of at least 50 percent from baseline.

      The researchers report that "SAMe and imipramine did not differ significantly on any efficacy measure, either main or secondary." In addition, "Adverse events were significantly less in patients treated with SAMe compared to those treated with imipramine." However, intramuscular administration may make SAMe use more complex than an oral medication.
      International Journal of Neuropsychopharmacology, 2002; 5: 287-294. "A double-blind, randomized parallel-group, efficacy and safety study of intramuscular S -adenosyl- L -methionine 1,4-butanedisulphonate (SAMe) versus imipramine in patients with major depressive disorder"

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