Laboratory-made SAMe is used for mood, joints, and liver function. Mood and joint signals are real but contested; liver tests improve more consistently than survival. Gastrointestinal upset is common and usually mild. The distinctive harm is a mania switch in bipolar-spectrum illness. It is not used with antidepressant drugs that block monoamine oxidase. Not a general longevity drug. (Full Review)
| Marker | Target | Why |
|---|---|---|
| Homocysteine | <8 µmol/L | Tracks whether donated methyl groups are being recycled |
| Vitamin B12 | 500–1,000 pg/mL | Cofactor for methionine synthase |
| Folate (red-cell) | Upper half of the laboratory range | Substrate for remethylation to methionine |
| ALT / AST | Low-normal (often <25–30 U/L) | Liver response and safety |
| Total bilirubin | Within the laboratory range, falling if cholestatic | Bile-flow response |
| Mood score (PHQ-9 or equivalent) | No established target; track improvement from the person's own baseline | Detects benefit and activation |
Cadence: Baseline bipolar-spectrum history plus B12, folate, homocysteine, ALT, AST, and bilirubin; 2 weeks mood and sleep only; 4–8 weeks symptoms plus labs if liver use; then every 3 months in year 1 and every 6–12 months thereafter