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The switch mechanism and the bipolar/unipolar dichotomy
M W Carney1, T K Chary, T Bottiglieri
1Northwick Park Hospital, Harrow, Middlesex.
Summary
S-adenosyl methionine (SAM) treatment shows potential for bipolar depression, with many patients experiencing mood elevation. Further research into the dopaminergic system is suggested for understanding treatment mechanisms.
Area of Science:
- Neuroscience
- Psychiatry
- Biochemistry
Background:
- S-adenosyl methionine (SAM) is a naturally occurring compound involved in various biochemical processes.
- SAM has been investigated for its potential role in mood regulation and treatment of depressive disorders.
Purpose of the Study:
- To evaluate the efficacy and effects of S-adenosyl methionine (SAM) in patients with bipolar and unipolar depression.
- To explore the potential mood-altering effects of SAM, including switches to elevated mood states.
Main Methods:
- Open trials of intravenous and oral S-adenosyl methionine (SAM) were conducted.
- A placebo-controlled trial of intravenous SAM was administered to 29 patients.
- Patient responses, including mood state changes and improvement, were monitored.
Main Results:
- Nine of eleven bipolar patients (all SAM-treated) switched to an elevated mood state (hypomania, mania, euphoria).
- Six of eleven endogenous unipolar patients showed improvement, while five did not respond.
- No non-endogenous or placebo patients responded significantly beyond 14 days.
- A switch from depression to elation occurred in 38% of trials and 33% of patients.
Conclusions:
- S-adenosyl methionine (SAM) demonstrates a capacity to induce mood elevation in bipolar depression patients.
- The findings suggest a potential role for SAM in treating certain forms of depression, particularly bipolar depression.
- Further investigation into the dopaminergic system is warranted based on cerebrospinal fluid biochemical data.