Department of Pharmacy, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
Department of Pharmacy, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
Gen Hosp Psychiatry. 2024 Jan-Feb;86:118-126. doi: 10.1016/j.genhosppsych.2024.01.001. Epub 2024 Jan 4.
Major depressive disorder (MDD) is an intractable disease requiring long-term treatment. S-adenosyl-L-methionine (SAMe), a natural substance, has antidepressant effects, but the exact effect remains unclear. This study examines the evidence concerning the efficacy of SAMe as a monotherapy or in combination with antidepressants.
The PubMed, EMBASE, and Cochrane electronic databases were searched for meta-analyses of randomized controlled clinical trials (RCTs) until June 30, 2023. We performed a systematic review and meta-analysis of the enrolled trials that met the inclusion criteria, with the aim to compare the effects of SAMe to those of a placebo or active agents, or SAMe combined with other antidepressants in the treatment of MDD.
Fourteen trials, with a total of 1522 subjects, were included in this review. The daily dose of SAMe varied from 200 to 3200 mg and the study duration ranged between 2 and 12 weeks. The results of SAMe versus placebo as a monotherapy, SAMe versus imipramine or escitalopram as a monotherapy, and SAMe versus placebo as an adjunctive therapy, showed no significant difference in depression with SAMe compared to the comparison treatment.
SAMe may provide relief of depression symptoms similar to imipramine or escitalopram. However, the results of the comparisons should be interpreted with caution due to the small number of studies and the large range of SAMe doses that were used in the included trials. Therefore, we recommend that patients discuss treatment options with their doctor before taking SAMe.
重度抑郁症（MDD）是一种需要长期治疗的顽疾。S-腺苷-L-蛋氨酸（SAMe）是一种天然物质，具有抗抑郁作用，但确切的作用尚不清楚。本研究考察了 SAMe 作为单一疗法或与抗抑郁药联合使用的疗效证据。
检索了 PubMed、EMBASE 和 Cochrane 电子数据库中截至 2023 年 6 月 30 日的随机对照临床试验（RCT）的荟萃分析。我们对符合纳入标准的试验进行了系统评价和荟萃分析，旨在比较 SAMe 与安慰剂或活性药物的疗效，或 SAMe 联合其他抗抑郁药治疗 MDD 的疗效。
本综述共纳入了 14 项试验，共 1522 名受试者。SAMe 的日剂量从 200 到 3200mg 不等，研究持续时间为 2 到 12 周。SAMe 作为单一疗法与安慰剂相比、SAMe 作为单一疗法与丙咪嗪或依地普仑相比、SAMe 作为辅助疗法与安慰剂相比，SAMe 与对照治疗相比，在改善抑郁症状方面没有显著差异。
SAMe 可能提供与丙咪嗪或依地普仑相似的抑郁缓解。然而，由于纳入研究数量较少，以及试验中使用的 SAMe 剂量范围较大，因此对比较结果的解释应谨慎。因此，我们建议患者在服用 SAMe 之前与医生讨论治疗选择。
