Night Sky: How do I taper SAM-e?

[NightSky]

My pdoc said I should get off of SAM-e because he thinks I may have bipolar and SAM-e can induce mania. I am currently taking 400mg SAM-e daily as two doses of 200mg, morning and bedtime. Should I worry about tapering this or just drop 200mg at a time as he suggested? I ask because the pills are enteric coated so I don't know how to even try to make smaller doses than 200mg. (If I cut the pills it will render the enteric coating useless, I would think. Then the drug would be destroyed in the stomach.)

 

I have had a bad time in the past when I stopped taking Effexor suddenly so I am worried about going too fast now with SAM-e. Should I be worried? What should I do?

[Jemima]

Other than the usual 10% reduction of the present dose, I don't think we have any specific guidelines on tapering SAM-e.  You might find this introductory topic worth reading, written by someone else who got hooked on SAM-e:

 

http://survivingantidepressants.org/index.php?/topic/1822-romido-sam-e-gave-me-withdrawals/?hl=romido

 

And here's the topic on the 10% taper:

 

http://survivingantidepressants.org/index.php?/topic/1024-why-taper-by-10-of-my-dosage/

 

When you have some time, please add your drug history to your signature, like so: 

 

http://survivingantidepressants.org/index.php?/topic/893-please-put-your-withdrawal-history-in-your-signature/

 

Welcome to the forum, NightSky.  You'll find lots of solid information and friendly support here.

[tezza]

Welcome, NightSky!

[NightSky]

Jemima, that 10% taper sounds good, but I don't know how to do it because I can't cut or crush the pills.

[Jemima]

You may be able to make a liquid from the tablets:

 

http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/

 

Does this seem feasible?

[NightSky]

You may be able to make a liquid from the tablets:

 

http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/

 

Does this seem feasible?

 

I don't think it is feasible, but I'm not 100% sure. The problem as I see it is that the medicine has to reach the intestines in order to be absorbed and not destroyed in the stomach. So that is what the "enteric" coating does, it keeps the SAM-e protected from the stomach but then dissolves in the intestine. So it would appear impossible to taper by cutting it up, crushing it, or liquifying it because the enteric coating then gets broken and then the SAM-e doesn't reach the intestine in usable form.

 

Now it might be, I have no idea really, that a little bit of the SAM-e would make it into the intestine, but I don't know this and I wouldn't know how to control the dose.

[NightSky]

My dose is 200mg so I did a web search for smaller doses. I can't seem to find any smaller than 200mg. Except that I did see 50mg doses meant for pets (cat or dog). But I don't know if that is a good idea to take those, and it probably is against the law as well.

[Jemima]

You might try asking a pharmacist what to do.  SAM-e may come in different forms from what you're taking now.

[NightSky]

You might try asking a pharmacist what to do.  SAM-e may come in different forms from what you're taking now.

 

OK, good idea. As long as I'm not getting manic or hypomanic, (and my pdoc and family don't think I am right now), I'm not going to rush into this without knowing more.

 

I would be curious to hear from anyone who has gone off SAM-e, I guess I am wondering how often trouble like Romido had ends up happening. Is it possible Romido's difficulty was a rarer exception?

[Jemima]

I'm not sure.  I think I took SAM-e some years back and dropped it cold when it didn't seem to be doing anything for me (no after-effects that I remember), and I haven't seen much of anything about it in the media.  On the other hand, some other countries only allow it to be sold on a prescription basis, which says something about the negative side effects.

 

Please don't buy into the idea that you might be bipolar.  That's a very common and ignorant interpretation of side effects from taking antidepressants by doctors who should know better.  Many antidepressants are overstimulating and give the appearance of mania, but it's all from the drug. A too abrupt withdrawal from antidepressants can also cause mania-like symptoms. This is how people get started down the not-so-merry road to taking multi-drug cocktails and ruining their lives.  I advise you to be very wary of anyone who attempts to diagnose or treat you for bipolar.

 

And speaking of antidepressants, please put your drug history in your signature (link in my post, above).  Your history with Effexor and any other psychiatric drugs has a lot to do with your present state of mind and sensitivity to drugs and supplements.  We can likely be of more help with more accurate information.

[NightSky]

OK I edited my signature box but I don't remember details back more than a couple years ago...

 

I found out recently I have sleep apnea so that may actually be related to some of my attention / depression / memory / brain issues. I am doing CPAP therapy for that for about 5 weeks now and I think I might be getting a bit better.

 

Since you suggested making a liquid, I also searched for liquid SAM-e and found one liquid product called "Cellfood SAM-e" from NuScience Corp. (http://www.cellfood.com/same.htm) but I'm not sure if they are legit or full of it because I don't know how they supposedly stabilize it from stomach acids. I will ask the pharmacist...

[NightSky]

I guess even if I'm not bipolar, I'd like to get off of the SAM-e and then the 5-HTP because they are expensive for me.

[Jemima]

Good enough, thank you.

 

BTW, taking 5-HTP at the same time as an SSRI is a bad idea.  It can cause serotonin syndrome, a very serious medical condition.  Here's topic about that:

 

http://survivingantidepressants.org/index.php?/topic/656-5-htp-5-hydroxytryptophan-and-tryptophan/?hl=tryptophan

 

Forty milligrams of Prozac is a very large dose (twice the usual) and I wonder if this is making you appear to be bipolar.  Zyprexa is an atypical antipsychotic, so you are apparently already being treated for bipolar, which may or may not be an accurate diagnosis.  The 2.5 mg. may not seem like a high dose, but that is because this is an extremely strong drug.

 

The Cellfood SAM-e is a possibility, although it seems awfully pricey.  I checked on the Drugstore.com site and it looks like GNC has a version of SAM-e that isn't coated.  Rather than take a chance and mail order it, I'd go find a GNC store and read the labels carefully.

 

Since the SAM-e and 5-HTPare both mood-altering substances, you might want to go ahead and start tapering off the 5-HTP while you figure out what to do about the SAM-e.

[NightSky]

Since the SAM-e and 5-HTPare both mood-altering substances, you might want to go ahead and start tapering off the 5-HTP while you figure out what to do about the SAM-e.

OK that sounds reasonable, I will try the liquid suspension method and see how that goes with the 5-HTP.

[Romido]

Hi Nightsky,

Just wanted to say hi. I am the Sam-e withdrawal person. I also took and stopped Sam-e years before my withdrawal experience with it so I think it can depend on the individual. I was taking less the first time I stopped, and I don't think I took it as long. I think it was said by a poster on here that some people can bathe their nervous system in offending agents for years and stop cold turkey with zero problems, and others are neuro adapters that have problems quickly. You just can't predict which you are until you are in it.

 

How are you doing with the Sam-e? Are you having any problems from it other than wanting to get off due to the expense? I was having heart palps really bad, and it was giving me anxiety (but nothing like the horrific withdrawal anxiety). How long have you been taking it? from your signature, it looks like maybe two years? I only took it 3 months. I had never had a withdrawal experience from any other medication before so I really thought I was going to die! If you have been through withdrawal from Effexor and Klonipin I probably wouldn't risk it.

 

Either way even if you do experience some symptoms, you will live through it, I promise! It may not feel like it for a long while, but you will make it. If you have a way to taper, I would do it. There are a few of us on here dealing with Sam-e. I think other names are Horty and Moonbow too.

 

Good luck, and if I can help in any way let me know!

[Altostrata]

Welcome, NightSky.

 

You should also taper off 5-HTP. SAM-e and 5-HTP can both exacerbate the serotonergic effects of Prozac.

 

In my humble opinion, your regimen of Prozac and Zyprexa for supposed bipolar disorder is odd, one being an accelerator and the other a brake. You  might seek a second and third opinion from other psychiatrists. You might find one who knows what she or he is doing.

 

But by no means take SAM-e and 5-HTP with a serotonergic drug.

[Sarahjayne5792]

I weaned off 200mg of Sam-e. The eccentric coating is so the medicine won't degrade in storage. It doesn't have to do with absorption by your body so you can cut the tablets. I used a Gemini scale to help me with weight.