Dear Dr. Roach • I have been taking sertraline (100 mg) and bupropion for depression. Due to the number of medications I am on for physical ailments, I would like to be weaned off the antidepressants. In a recent column, you suggested that SAM-e might be a safe and effective alternative to antidepressants. Do you feel that it might be worthwhile to go off the antidepressants and start on the SAM-e? In addition to SAM-e being helpful with depression, your recent column suggested that the SAM-e might help with joint problems. I have arthritis in my hip, but due to a history of stomach ulcers, I am reluctant to treat the arthritis with NSAIDs. — R.S.
Answer • You should never stop any medication without discussing this with the clinician who prescribed it. This is particularly true with medicines for psychiatric conditions that have the potential to cloud judgment.
I recommended SAM-e as an alternative to prescription antidepressants but did not mean to suggest that it is as effective as those prescription drugs. The combination of bupropion and sertraline is a common and often effective one, and I would again urge you to discuss whether your situation supports a trial of SAM-e or other alternative medication or non-medication treatment.
SAM-e for arthritis may be helpful, and it is possible, but not certain, that your need for prescription antidepression medicine will decrease due to the antidepressant effect of SAM-e.
Dear Dr. Roach • Several times you have mentioned herpesviruses. How many are there? — K.C.H.
Answer • In the herpes family, there are eight viruses that primarily infect humans, as well as a few animal herpesviruses that rarely do so.
The herpes simplex viruses are the best known. HSV-1 is the usual cause of oral cold sores, while HSV-2 is the usual cause of genital disease. In a few people, those can be reversed, but HSV-2 is generally more severe than HSV-1. Very recent studies have shown that HSV-1 and HSV-2 can share genetic material in people who are infected with both strains.
Varicella zoster virus is the cause of chickenpox. Like all herpesviruses, it can remain dormant in the body for decades, and when it reactivates, it causes a localized reinfection called shingles.
Epstein-Barr virus is the classic cause of infectious mononucleosis, a disease familiar to most, which causes tremendous fatigue and may affect the liver and spleen. Cytomegalovirus causes similar monolike symptoms, and is a severe danger to people with immunosuppression, such as organ transplant recipients or those with HIV. The unimaginatively named human herpesvirus 6 is similar, in that it can cause a mild monolike illness in healthy children. HHV-6 is also the most common cause of roseola. HHV-7 rarely causes symptoms, but is also an occasional cause of roseola in children.
HHV-8 is the cause of Kaposi sarcoma, a cancer found in older men, especially in Israel and around the Mediterranean, but is much more common now in people with advanced HIV disease (AIDS). Kaposi sarcoma was one of the first cancers to clearly show an infectious link.
Of the animal herpesviruses that can possibly infect humans, the one that is most frightening is called B virus. It is fatal in about 75% of the reported cases. It is a concern mostly in laboratory staff working around primates, especially macaques.
Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.