Veterinary Medicine - July 2008 - (Page V7)

A roundtable discussion clinically meaningful at 57.1%. By contrast, the average improvement recorded for signs such as confusion (33.3%) or increased total amount of sleep over 24 hours (26.7%) was moderate. More than half of the owners of dogs assigned to the Novi t treatment group (58%) were overall satis ed or very satis ed with the product as opposed to 21.1% of owners of dogs who received the placebo tablet. They found Novi t easy to give to their dogs (77.8%) and thought that their dogs tolerated Novi t well (94.1%). We saw during this trial that the e ect was progressive over time. Improvement was seen at one month and again at two months. We don’t know what would happen during a longer treatment period because the trial was conducted for two months only.13 Landsberg: What is the minimal amount of time you would expect to see e ectiveness of SAMe and the longest time you would wait to see e ectiveness? Dramard: It depends on the case. My protocol is that I begin with SAMe and propose a recheck in two weeks. If they notice at least a little improvement, we continue. If there is no progress, I add another drug. I wouldn’t start with this protocol if the dog appears to have underlying disease that needs to be addressed. Bottiglieri: SAMe has a good safety pro le. Diarrhea has been reported in people, though it’s transient and resolves itself. Other complaints in people have been headaches and some nausea. Mischoulon: We are currently running two SAMe studies in people, and stomach upset and diarrhea are the most common side e ects. The side e ects in dogs seem very similar to what we see with people. Landsberg: If you are seeing gastrointestinal side e ects with SAMe, would you suggest continuing treatment, stopping use of the drug, or lowering the dose of the drug? Dramard: I suggest stopping the drug, waiting for two or three days, and starting again at a lower dose than the rst time. Figure 1. Study results: Overall response to treatment as measured on Day 60 80 70 60 Placebo group Noviﬁt group Mischoulon: 40 Typically, antidepressants 30 require six to 20 eight weeks to work. So a good 10 clinical trial should run for at 0 Good response Fair response No or poor least eight weeks. (>50% clinical (30-50% clinical response There are some improvement) improvement) (<30% clinical studies in which improvement) people who were taking SAMe, placebo-controlled trial to compare particularly in combination with another the e cacy of SAMe when given antidepressant, improved fairly quickly, before clinical signs of dementia have usually within two weeks. This parallels appeared. My prediction is that the Dr. Dramard’s ndings that animals group on SAMe would bene t the most. improve within a couple of weeks. Landsberg: Does administering SAMe early on in the disease process— rather than later—make it more e ective at resolving or controlling clinical signs? Bottiglieri: Management of dementia is dependent on early detection and intervention. We know that the damage caused by the deposition of betaamyloid in the brain is irreversible. I think early pharmacotherapy gives you the best chance for success. It would be interesting to know the e ect of SAMe when given as a prophylactic treatment for dementia in dogs. That would let us see the e ect of SAMe treatment before clinical signs of dementia appear. Landsberg: Studies to date have been about improving the clinical signs instead of catching the disease early and slowing the progress. Is there enough evidence to say that if older animals were just developing early signs of cognitive decline, SAMe could slow progression of the disease? Bottiglieri: From a biochemical standpoint it makes sense. It would be interesting to perform a double-blind, Mischoulon: One area I would like to see explored is the role of neurotropic agents in the prevention of disease, particularly in high-risk individuals. For example, in a family with many cases of Alzheimer’s, a family member might bene t from starting an agent like SAMe or ginkgo biloba earlier, even before symptoms exist. We all agree that the earlier we treat Alzheimer’s, the better the outcome. Landsberg: Are there any contraindications for SAMe? Dramard: There are no label contraindications. Landsberg: Are there any contraindications in human medicine? Mischoulon: Some people with bipolar disorder who are depressed and treat themselves with SAMe may cycle into mania. I don’t know if there is an analogous disorder in dogs, but I would watch for agitation in an animal that has just started receiving SAMe. Landsberg: You hear about the range in quality of nutraceuticals. Is there a % of Dogs 50 7

Table of Contents Feed for the Digital Edition of Veterinary Medicine - July 2008

Veterinary Medicine - July 2008 Contents Leading Off Practical Matters Idea Exchange Clarification Dental Corner The Diagnostic Approach to Hematuria Guidelines for Evaluating Hypercalcemic Cats CE Form Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - July 2008

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