Before you exceed 1,600 mg/day the maximum Yoga poses low back pain dose that has been used in clinical trials, consider augmenting SAMe with other CAM treatments and Yoga poses low back pain prescription antidepressants or obtaining a CAM consultation. Inform the patient that SAMe has been used safely in high doses, but that clinical trials have not exceeded 1,600 mg, and record this discussion in the patient's chart see Chapter 1.
SAMe Augmentation With B Vitamins The pathways by which SAMe donates methyl groups methylation for the production of the major neurotransmitters involved in mood regulation require the cofactors B12 methylcobalamine and folate see Figure 2.1. Low levels of these cofactors have been found in association with severe depression.
Adding 1,000 mcg/day B12, 800 mcg folate, and 50-100 mg/day B6 will often enhance the antidepressant effects of SAMe as well as other antidepressant medications see below.
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B vitamins and folate should not be given to men with cardiac stents because they can accelerate restenosis in those whose baseline homocysteine is less than 15 pmol/liter. Clinical Applications and Practical Considerations SAMe is as effective as prescription antidepressants for mild to severe depression.