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S-adenosylmethionine
(SAM-e) for the Treatment of Depression in People Living with HIV/AIDS
Depression, sometimes severe, is common among
both treatment-naïve and treatment-experienced individuals with
HIV infection. It is not clear which of the many available antidepressant
therapies would be most beneficial to these patients. There are
concerns that regular use of antidepressants would add another
level of side effects management to the existing management complexities
of HAART.
The current study offers information on the clinical outcome from
a short, open-label study of 20 HIV patients with Major Depressive
Disorder who underwent therapy with S-Adenosylmethionine (SAM-e).
The study investigators evaluated SAM-e as a potential alternative
to other, more commonly used anti-depressant s.
Study
participants took 200 mg SAM-e twice daily along with a daily supplement
of vitamin B12 (1,000 mg) and 800 mcg Folic Acid.
Over
the course of the study, the dose of SAM-e was individually adjusted
up to 800 mg, twice daily.
Patients
reporting nausea or insomnia were not increased above 800 mg daily,
while patients with no reported side effects could be increased
to a total daily dose of 1600 mg. Dosing was adjusted according
to the severity of symptoms and clinical treatment response.
The
researchers defined clinical treatment response as an improvement
in depressive symptomatology of greater than 50% reduction on patient
scores on the BDI and HAM-D as our treatment endpoint. A statistical
data codebook was created and secondary statistical analyses were
performed. The Hamilton Rating Scale for Depression (HAM-D) and
the Beck Depression Inventory (BDI) were used to assess depressive
symptomatology from 1,2,4,6 and 8 weeks after initiation of treatment
with SAM-e.
According
to the investigators, the study data show a significant acute reduction
in depressive symptomatology, as measured by both the HAM-D and
the BDI instruments.
In
conclusion, the authors write, “SAM-e has a rapid effect evident
as soon as week 1 (p < .001), with progressive decreases in depression
symptom rating scores throughout the 8 week study.”
Discussion
Depression
remains under-reported and under-treated in the HIV population.
Patient factors include stigma, fear of more medication, and perhaps
the assumption that depression is a normal part of HIV disease,
or due to HAART. Physicians tend to focus more on physical symptoms,
and may be unaware of how to screen for depression in this population.
Both
physicians and patients are disadvantaged in accessing gay-affirmative,
well-trained HIV mental health specialists who can disentangle HIV
medical problems from substance abuse and mental illness. Risk factors
for depression (e.g., history of substance use/abuse, lack of social
support, stigma, etc.) are prevalent in those populations who are
disproportionately affected by HIV.
Many
patients are reluctant to add more medication to their complex treatment
regimens. The need for effective and safe treatments for depression
is clear.
Results
of this study demonstrate that SAM-e significantly reduces depression
in people living with HIV. This finding supports previous research
demonstrating the efficacy of SAM-e for use in treating depression.
More importantly, the therapeutic effect of SAM-e had an acute onset.
There
were significant reductions in the severity of depression among
study patients within the first week of treatment. Unlike most antidepressants
that require several weeks to reach maximum therapeutic efficacy,
previous research has shown that serum levels of SAM-e peak within
24 hours of treatment. This may account for the rapid, effects of
SAM-e seen on the HAM-D and BDI scores.
ACRIA
(AIDS Community Research Initiative of America), New York, NY, USA.
02/11/05
Reference
R
A Shippy and others. BMC Psychiatry 4(1): 38. November 11, 2004.
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