Imagine a nonprescription pill that promised to quickly lift the darkness of depression, ease the pain of arthritis and even help the liver function better.
Now picture 300 psychiatrists jammed into a Washington, D.C., ballroom to learn more about this natural remedy.
And consider the hype--the books, media coverage and advertising--that could accompany the arrival of a pill that promised so much and had a cute name that sounded like "sammy."
While this would have been an unlikely scenario a decade ago, before alternative medicine went mainstream, a new pill called SAM-e (for S-adenosylmethionine) has been creating a stir since it became available for sale in this country a few months ago.
Unlike other popular, natural remedies--such as St. John's wort for depression and glucosamine for arthritis--which became hits without strong science behind them, SAM-e has debuted in this country with support from some top U.S. scientists.
What's not known is whether consumers and medical doctors will embrace SAM-e or whether it will be viewed as another overly hyped natural product with a very high price (about $75 a month).
"I would tend to the side of caution on this," advises Jerry Cott, chief of adult psychopharmacology research at the National Institute of Mental Health in Washington. "It's very expensive. Clearly, if something is very expensive, it requires a higher level of scientific proof before I would give it a try. I'm concerned there is too much motivation for profit on the part of companies selling the product."
Other experts--and many consumers, based on early sales--are intrigued.
"I'm getting a lot of calls from doctors who are interested in this," says Dr. Richard Brown, a psychiatry professor at Columbia University College of Physicians and Surgeons in New York, who gave a lecture on SAM-e last month at the annual meeting of the American Psychiatric Assn. and wrote a new book on SAM-e called "Stop Depression Now." "It's a little awesome to have the responsibility of saying that SAM-e is really good."
Moreover, part of its appeal is the possibility that it may have wide applications. While there are studies demonstrating SAM-e's effectiveness for depression and arthritis, some researchers also believe that SAM-e may minimize the pain of fibromyalgia (a mysterious disorder characterized by achiness in muscles and soft tissue), improve liver function and ameliorate some of the symptoms of Alzheimer's disease. This link to Alzheimer's is far from established.
And, if that isn't enough, SAM-e is said to be a fast-acting treatment for depression, sometimes easing symptoms in one to two weeks. It also has few side effects and does not appear to interact with other medications.
"Doctors say nothing can do so much. But there is a reason it can do so much," says Brown.
SAM-e is produced naturally in the body from a substance called adenosine triphosphate, or ATP, and the amino acid methionine, which is found in protein-rich foods and is long thought to have properties that affect mood and mental functions. SAM-e's major role in the body is to release an essential substance, called a methyl group, which fuels dozens of biochemical reactions and accounts for SAM-e's purported vast array of benefits.
Discovered in 1952, there is an extensive body of scientific study on SAM-e, and very few researchers dismiss its therapeutic potential. But there are several reasons why doctors may be wary of advising patients to try SAM-e.
For one, most studies on SAM-e are from Europe, where it is an approved and popular treatment in several countries for various disorders, such as depression and arthritis. And there are few of the large, long-term, randomized clinical trials that U.S. doctors favor.
"It may have some potential benefits, but I'm not very impressed," says Dr. Shri K. Mishra, director of the Complementary Health Program at USC, who says larger studies that meet strict research standards are needed.
Long-Term Effects Are Not Known
Others say the substance is of value, but little is known about dosage, long-term effects and how it compares with other medications.
"Nobody has proven definitely that this substance has antidepressant properties, but there is a lot of evidence that it works," says Dr. Maurizio Fava, director of the Depression Clinic and Research Program at Massachusetts General Hospital in Boston.
Fava was the co-author of a study of 163 patients in Italy who were given SAM-e injections for 15 days. That study, published in the journal Psychiatry Research in 1995, found that depressive symptoms were significantly reduced in more than half the patients after seven days. Other studies have found it is as effective as the older, tricyclic antidepressants. Tricyclic antidepressants, such as desipramine, are effective medications that tend to cause annoying side effects.