Dr. James Schaller, MD
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Title: Is SAMe Ever Useful in Bipolar Patients or Those Who Might Have Bipolar Disorder?

If you read the labels on the SAMe bottles found in most pharmacies you will notice the warning not to take if you are manic, manic-depressive illness or bipolar disorder--different names for approximately the same disorder.

Why the fuss?

We have found in experience that the dosing for people prone to mania or milder functional hypo-mania are much lower than people who merely have different types of depression.

Mania is often missed. People with depression forget a period of mild hypomania, they are prone to mania but it has not occurred yet. Also, mania can make you incredibly irritable, but it can also make you feel very good, "high or energized" and go unnoticed because insight is low in the person feeling it. You can feel unusually high, but think nothing of the fact you are suddenly doing tons of projects, sleeping 5 hours a night, and talking a bit too fast.

And in people under 20, it is simply possible they may have only had depression and never had a manic or hypo-manic experience. Meaning, you are bipolar but your first episode of hypomania or mania is in the future. (I do not mean to make anyone afraid--there are reasonable ways of determining if a youth is at risk).

I suggest discussing your experiences with a solid psychiatrist or psychologist and reading a little. Bipolar is both over diagnosed and under diagnosed. Some books find it everywhere and some minimize it. One reason you need someone who knows you and works closely with you.

With this background, what is my point about SAMe and mania?

We have found that 500 mg will almost always induce mania in someone prone to them. We do not say this is the magic cut off point for safety. And it might be that some people, especially youth, tolerate higher doses and then evolve into becoming manic. In other words, they would have had mania in the next two years anyway, but SAMe brings it out early.

We have found that very low doses might be of use in select bipolar people, and would advise that you discuss dosing with a physician who:

  1. You see regularly
  2. Understands both SAMe and bipolar disorder
  3. You have emergency access to call if you or a trusted loved one thinks you might be manic

Any physician or "all knowing" relative or friend that suggests starting with those large 400 mg tablets is clueless on this issue. They may be far brilliant than me and be a caring and concerned person, but that is a wildly high and inappropriate starting dose in an out patient setting for someone with bipolar disorder.

Best wishes for your balanced health!

Dr. James Schaller

See Article: SAMe Use in Children and Adolescents

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