SAM-e for Fibromyalgia and Chronic Fatigue Syndrome

Energy, Pain, and Neurotransmitter Balance

SAM-e is one of the more popular supplements for fibromyalgia (FMS) and chronic fatigue syndrome (CFS or ME/CFS). Its full name is s-adenosyl methionine and it's a substance that's made naturally in your body. Its job is to regulate key functions in your cells.

It's also important in the production of the neurotransmitters serotonin and dopamine, and research suggests that activity of these neurotransmitters is sluggish in FMS and ME/CFS.

SAM-e has been studied extensively for depression, osteoarthritis, and liver disease, with mixed results. It's also been investigated for migraine, Alzheimer's disease, ADHD, and schizophrenia. However, so far we don't know enough about it to draw conclusions about whether it works.

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What the Research Says

Some studies suggest that SAM-e is effective at relieving some FMS symptoms, including pain, morning stiffness and tender-point count, as well as mood disorders and depression symptoms. It's not as well researched in connection with ME/CFS, but many experts say the research we do have supports its use.

A 2006 review of complementary and alternative FMS treatments named SAM-e as one of the supplements with some of the best evidence behind it.

A 2010 review noted improvements in pain, fatigue, quality of sleep, and clinical disease activity in a placebo-controlled study involving 44 people with FMS. That same year, another review said it had a lot of potential for future research, both for FMS and ME/CFS.

It should be noted, though, that not a lot of research has been done, and even less of it has been done in the past decade. It's common enough that there's a lot of anecdotal evidence behind it, but that's far less valuable than research when it comes to deciding whether this treatment is right for you.


Many healthcare providers recommend starting with 400 mg a day of SAM-e and increasing the dosage if you tolerate it well, possibly to as high as 800 mg a day.

SAM-e should be taken on an empty stomach. It can be stimulating, so it's best to take it early in the day so it doesn't disrupt your sleep.

In Your Diet

You can't get SAM-e through your diet. Supplements are typically the recommended way to increase the amount that's available in your body. It can also be injected.

Side Effects

Just like medications, supplements can cause negative side effects. Possible side effects of SAM-e include:

  • Digestive problems, especially nausea
  • Skin rash
  • Lowered blood sugar
  • Dry mouth
  • Bloody stool
  • Thirst
  • Increased urination
  • Headache
  • Hyperactivity
  • Anxiety
  • Insomnia

People who take L-dopa, a common drug for Parkinson's disease and a few other conditions, shouldn't take SAM-e as it could lead to dangerous increases in dopamine. It may also lead to a potentially deadly condition called serotonin syndrome when combined with other drugs or supplements that increase levels or function of serotonin.

SAM-e is also not recommended for anyone with HIV/AIDS.

Because of an association with mania and hypomania, those with bipolar disorder, anxiety disorders, or other psychiatric conditions should be under the close supervision of a healthcare provider when taking SAM-e.

We don't have safety data on SAM-e use during pregnancy or breastfeeding.

Is SAM-e Right for You?

The best way to decide whether you should try SAM-e supplements is to do your research and talk to your healthcare provider about it. Be sure to weigh the risks versus the potential benefits.

It's also a good idea to ask your pharmacist about SAM-e or any other supplement you plan to add to your regimen, as well. Pharmacists are experts on how different things may interact in your body, so they can be a great resource as you look for things that make you feel better.

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4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Sarac AJ, Gur A. Complementary and alternative medical therapies in fibromyalgia. Curr Pharm Des. 2006;12(1):47-57.

  2. De silva V, El-metwally A, Ernst E, Lewith G, Macfarlane GJ. Evidence for the efficacy of complementary and alternative medicines in the management of fibromyalgia: a systematic review. Rheumatology (Oxford). 2010;49(6):1063-8. doi:10.1093/rheumatology/keq025

  3. Porter NS, Jason LA, Boulton A, Bothne N, Coleman B. Alternative medical interventions used in the treatment and management of myalgic encephalomyelitis/chronic fatigue syndrome and fibromyalgia. J Altern Complement Med. 2010;16(3):235-49. doi:10.1089/acm.2008.0376

  4. Sharma A, Gerbarg P, Bottiglieri T, et al. S-Adenosylmethionine (SAMe) for Neuropsychiatric Disorders: A Clinician-Oriented Review of Research. J Clin Psychiatry. 2017;78(6):e656-e667. doi:10.4088/JCP.16r11113

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