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Vitamin B boosts effectiveness of antidepressants

Robin Wulffson MD's picture
depression, antidepressants, folate, folic acid, B vitamin, Deplin, serotonin

Almost 20 million individuals in the United States suffer from depression. Many of them are prescribed antidepressants to help them cope. Not uncommonly, a variety of medications are tried before results are seen; furthermore, the effect of some regimens decreases over time. In recent months, Deplin, a prescription form of folate, is being increasingly recommended for depressed patients. Folate and folic acid are forms of a water-soluble B vitamin. Folate occurs naturally in food; folic acid is the synthetic form of this vitamin. People with low folate levels are six times as likely to respond poorly to antidepressants as those with normal levels.

Although Deplin has been on the market since 2006, it has recently been found to be beneficial to individuals who do not improve after being placed on an antidepressant. Folate, which is present in green, leafy vegetables, legumes, nuts, and some fruits, is necessary for cell growth and brain function. Recent research has found that the body converts folate (the synthetic version, and folic acid) into an active form, known as L-methylfolate. This substance is necessary for the production of serotonin, dopamine and norepinephrine, which are neurotransmitters that are essential for mood regulation.

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Many factors can reduce L-methylfolate levels; these included aging, genetics, illness, poor nutrition, excess alcohol consumption, and some medications. Many antidepressants slow the "reuptake" of serotonin or norepinephrine; thus, making them available longer to the brain; however, these antidepressants may be less effective or ineffective if the brain is not producing adequate quantities of the neurotransmitters in the first place.

The Food and Drug Administration (FDA) categorizes Deplin as a "medical food," which is held to less-rigid standards by the agency. Medical foods are intended to provide dietary management for a disease or condition; all ingredients must be "generally recognized as safe" (GRAS) and physician supervision is required. Two recent randomized, placebo-controlled trials have evaluated Deplin, with a total of 223 subjects. Both studies were subsidized by the product’s manufacturer: Pamlab LLC (Covington, LA). One study, which was presented at the American Psychiatric Association's meeting last May, 75 depressed patients were randomly assigned to take either 15 milligrams of Deplin or a placebo along with an antidepressant. After 30 days, 32% of subjects on Deplin had responded, compared with 15% on the placebo. However, an earlier study using a lower dose of Deplin found no difference with a placebo. In both trials, the subjects reported no more side effects with Deplin than with the placebo.

Facts about depression:

  • 11% of Americans over age 12 take antidepressants.
  • Nearly 20 million individuals in the U.S. suffer depression during their lifetime.
  • Only 30% improve well on the first antidepressant alone.
  • Almost 50% of depressed patients never improve significantly.
  • Individuals with low folate levels are six times as likely to fail to respond to antidepressants as those with normal levels.

Take Home Message: Folate is present in cereals, baked goods, leafy vegetables (i.e., spinach, broccoli, and lettuce), okra, asparagus, fruits (i.e., bananas, melons, and lemons), legumes, yeast, mushrooms, organ meat (i.e., liver and kidney), orange juice, and tomato juice. These substances are components of a healthy diet; thus, including them in one’s diet is sensible. Pregnant women are advised to ingest folate or folic acid to reduce the risk of neural tube defects in their developing fetus. Although Devlin is likely to be effective as an adjunct medication for patients on depression, fresh food sources of the folate could not only add nutrition but also save the cost of a prescription medication. In fact, some individuals suffering from depression might find that that they can discontinue their antidepressants; thus, avoiding their cost and potential side-effects. An activity that can reduce depression is an exercise program. When one exercises, endorphins are produced in the brain. These substances improve one’s mood in a natural manner.