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However, long-term and extensive pharmacotherapy are almost always associated with the extent of undesirable effects on the patient like the risk of major adverse cardiovascular events, decline in cognitive functioning over time, behavioral changes including but not limited to sexual problems, and feeling of "emotional numbness." The B vitamins are crucial particulates of the 1-carbon metabolism wherein 5-methyltetrahydrofolate and methylcobalamin help convert homocysteine to methionine, which in turn forms S-adenosylmethionine (SAM), which is the essential methyl donor required for the production of monoamine neurotransmitters, phospholipids, and nucleotides [21]
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