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{"project":"2_test","denotations":[{"id":"23700366-12418493-76000590","span":{"begin":747,"end":749},"obj":"12418493"},{"id":"23700366-21438644-76000591","span":{"begin":1085,"end":1087},"obj":"21438644"},{"id":"23700366-21438644-76000592","span":{"begin":1260,"end":1262},"obj":"21438644"},{"id":"23700366-22762295-76000593","span":{"begin":1430,"end":1432},"obj":"22762295"},{"id":"23700366-20573327-76000593","span":{"begin":1430,"end":1432},"obj":"20573327"},{"id":"23700366-15538131-76000593","span":{"begin":1430,"end":1432},"obj":"15538131"},{"id":"23700366-20595412-76000594","span":{"begin":1826,"end":1828},"obj":"20595412"},{"id":"23700366-12598804-76000595","span":{"begin":1970,"end":1972},"obj":"12598804"},{"id":"23700366-12711653-76000596","span":{"begin":1993,"end":1995},"obj":"12711653"},{"id":"23700366-11104210-76000597","span":{"begin":2016,"end":2018},"obj":"11104210"},{"id":"23700366-15538952-76000598","span":{"begin":2088,"end":2090},"obj":"15538952"},{"id":"23700366-22762295-76000599","span":{"begin":2189,"end":2191},"obj":"22762295"},{"id":"23700366-21911258-76000600","span":{"begin":2979,"end":2981},"obj":"21911258"}],"text":"Dietary supplements as CAM therapies\nOver-the-counter dietary supplements (nutraceuticals) are used extensively by patients with depression, and are categorized as nutrients, herbal and dietary supplements, and traditional and nontraditional methods.40 Nutraceuticals have also been used to promote mental and physical health, to prevent illness, and to treat diseases, with substantial benefits.40 Nutraceuticals, in particular S-adenosylmethionine, have benefited patients with major depression and other mood disorders. This compound provides methyl and sulfate groups used in the synthesis of deoxyribonucleic acid, proteins, phospholipids, neurotransmitters, and the antioxidant, glutathione, that are disturbed in people with mood disorders.41 In a critical review of the literature, Brown et al reported the results of 48 studies and found S-adenosylmethionine to be safe and effective for the treatment of depression.42 A recent review further supports the use of this compound in mild-to-moderate depression, reporting that eight of 14 studies (57%) produced positive results.43 Interestingly, like selective serotonin reuptake inhibitors (SSRIs), neither S-adenosylmethionine nor St John’s wort have been associated with an increased risk of suicide.43 Several researchers have appraised the clinical and pharmacological benefits of S-adenosylmethionine in depression and as an adjunct in treatment-resistant depression.44–46 In a double-blind randomized study of patients with depression who were nonresponders to SSRIs, Papakostas et al reported preliminary beneficial effects from S-adenosylmethionine augmentation with good tolerability. S-adenosylmethionine appears to be a safe adjunctive treatment for patients with major depression who do not respond to SSRIs, but this needs confirmation in clinical trials.47 S-adenosylmethionine alone or combined with other supplements has been shown to alleviate depression associated with musculoskeletal disease,48,49 liver disease,50,51 Parkinson’s disease,52 and human immunodeficiency virus/acquired immune deficiency syndrome.53 S-adenosylmethionine acts similarly to noradrenergic antidepressants, but with fewer side effects.44\nIn a randomized clinical study of 30 women with postpartum depression, 1600 mg/day of S-adenosylmethionine resulted in a 70% reduction in symptoms of depression and anxiety compared with a 50% reduction in the placebo group by day 30.54 S-adenosylmethionine is safe to use during pregnancy and breast-feeding. Infants naturally have 3–7 times higher S-adenosylmethionine levels than adults.55 This is because they need more S-adenosylmethionine for methylation of the developing brain, especially the myelin sheaths critical for conduction of electrical impulses. A secondary analysis of clinical trial data for S-adenosylmethionine administered to patients with major depression nonresponsive to SSRIs found a positive impact on symptoms of depression and related cognitive dysfunction.56 In summary, the primary and adjunctive role of S-adenosylmethionine in patients with major and treatment-resistant depression is gaining solid ground."}

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