Safety and Effectiveness of S-adenosyl-l-methionine (SAMe) for the Treatment of Major Depression

Inclusion Criteria: * Diagnosis of major depression * Score of 25 or higher on the Inventory of Depressive Symptomatology (IDS-C) scale * Score of higher than 2 on the Clinical Global Impression Improvement (CGI) scale * Willing to use acceptable methods of contraception Exclusion Criteria: * Suicidal or homicidal * Unstable illness, including cardiovascular, hepatic, renal, respiratory, endocrine, neurological, or hematological disease. * Any of the following mental conditions: organic mental disorders; schizophrenia; delusional disorder; psychotic disorders; bipolar disorder; recent bereavement; severe borderline or antisocial personality disorder; panic disorder; or obsessive compulsive disorder * Substance abuse, including alcohol abuse, within 6 months prior to study entry * Uncontrolled seizure disorder, or a seizure disorder controlled with psychotropic anticonvulsants * Psychotic features * Current use of other psychotropic drugs * Hypothyroidism * Have taken 6 weeks or more of either escitalopram or SAMe during the current depressive episode * Previous intolerance of SAMe or escitalopram * Investigational psychotropic drugs within 1 year prior to study entry * Have received two or more antidepressant therapies of adequate doses and duration and failed to respond * Have received depression-focused psychotherapy * Bleeding tissue disorder, low platelet counts, a history of GI bleeding, or use of medications that alter bleeding risk * Long-term aspirin use * Pregnancy