Folic acid. A vitamin that was prescribed (yes, you can get it as part of a multi-vitamin, but not in the dosage desired- and not without other items that are not needed) and then removed from regimens, when we found folate did not help against heart disease. But, it is still prescribed for some pregnant women (please, no more than 400 ug a day), who could use the extra help and it also may help (as part of a vitamin B cocktail) with/against Alzheimer’s disease.
And, now, there may be a new, adjuvant, use for folic acid. It seems that antidepression medication works better when Deplin (prescription form of folic acid) is administered. Which should not be totally surprising, since folate (the ionic form of folic acid) is critical for cell growth and brain function. (You can add this naturally to your diet by eating green, leafy vegetables, legumes, nuts, and even some fruits. You can also cut back on alcohol consumption.) Folate is converted into L-methylfolate, which promotes the formation of three mood regulating neurotransmitters (norepinephrine, serotonin, and dopamine).
Treating depression is critical. Over the course of our lives in America, we have a 5% chance of being subject to it. (As of now, 20 million folks in the US have experienced depression; the remission rate is nearly 50%.). Which is different than being treated for depression- since 11% of us over the age of 12 are taking antidepressants- with only 30% of us getting relief from the first antidepressant medication taken. And, here is the kicker- if one has low folic acid levels, one is 5 to 6 times more likely to be non-responsive to antidepressant therapy.
Many antidepressants [selective serotonin reuptake inhibitors (SSRI) and serotonin norepinephrine reuptake inhibitors (SNRI]) try to insure that the neurotransmitters stick around longer in our bodies. But, if the brain is not producing these neurotransmitters, having them stick around longer is an exercise in futility. So, that’s the drive behind adding Deplin as an adjuvant to these antidepressants; since Deplin already is L-methylfolate, there is no conversion from folic acid necessary. (Deplin is a prescription medical food sold by Pamlab; it was originally developed by Merck.)
The problem is that clinical evidence to support these beliefs is somewhat limited. Two trials, with a total of 223 subjects, have been effected. The more recent one involved 75 subjects, randomly assigned 15 mg of Deplin or a placebo (along with an antidepressant). After 30 days, twice as many (32%) had positive results, compared to the 15% with the placebo (both had the antidepressant.) The previous study, using a lower dosage, did not prove Deplin more useful. However, side effects in both studies were not prevalent.
The issue is to find out who would most benefit from the inclusion of the adjuvant. The prime target would be those with the diminished ability to produce L-methylfolate. (30% of us have one abnormal copy of MTHFR 677, while 12% have two abnormal copies; those with two only produce 30% of the normal levels of L-methylfolate.) But, that may not be the real issue- since folks who have no abnormal copies of the gene have responded well to the medical food adjuvant.
In the meantime, only a small number of folks are using Deplin. Only something on the order 0.2% of the 20 million antidepressant prescriptions written monthly are accompanied by a prescription for the adjuvant.
I know this is anecdotal, my personal experience, but let me say a hearty amen to this post. I have a strange reaction to anti-depressants (which is well documented by my doctor) they do what they are supposed to do after the customary week or so build up, and they maintain that for about a month, and then they do to me what benzodiazepines (did I spell that correctly) do to most people, it makes me a total stoner, with black out episodes (I have an amusing, albeit scary tale of buying 300 dollars worth of junk food at the grocery and showing up on my mum’s doors with flowers and no recollection how I got there). Now, having struggled with depression my whole life, and not reacting well to standard treatment I did my research (which made my doc nervous) and adjusted my diet to include folic acid packed foods daily. (which is much easier now that due to stomach issues I’ve had to become a fish eating veggie eater) The change in my diet has reduced depression episodes, and their severity, and when I am having a problem I include a non-prescription multi-b vitamin and some quasi b’s like choline. NOW that said, I don’t advocate that kind of effort unsupervised by a doctor…depression can kill so you can’t just willy nilly unsupervised, and without making yourself accountable to someone. It is wonderful to see this kind of study in progress! And as usual, I rambled all over your post. lol Cheers!
So, let me see if I can ferret out the facts you bring up.
1. Antidepressants don’t always work. (Agreed- you may want to check out my post as to the “clinical trials” performed to demonstrate effectiveness.)
2. Antidepressants seem to have a threshold affect. Both in that they are dose dependent (and the dosage required is pretty much hit or miss) AND we become inured to them after a while.
3. Some of the dosages employed for antidepressants have side-effects that folks find discomforting.
4. Diet can have tremendous affects on our neural chemistry.
5. Physician mediated treatment is probably a good thing.
Did that summarize your points, Lisa?
If so, they are all very valid and very important.
Roy
That is exactly my points, put much better than my pre-coffee blabber…<3
Very interesting. Who knew the mutli-benefits of folic acid across therapeutic areas. Your site is always an education!
Tor Constantino recently posted..Fastest U.S. Marathon Sellout Ever
I have been following folic acid for a while. And, keep wondering why folks are advocating it, when the data is so lacking.
Thanks for the visit AND the comment, Tor!
Roy
There are people that actually get over being depressed? I though Mike Wallace was just making that up. Do people get over being bipolar, too? Very interesting blog, Roy. My sister has pernicious anemia and takes a folic acid and B12 shot every week. I can tell when she forgets, too.
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From what I have learned, the recovery from depression is lightyears ahead of the recovery from bipolar disorders.
And, in your sister’s case, the folic/cyanocobalamin combination is aimed at clotting factors more than at brain chemistry. But, it does affect both.
Thanks for the comment, Ann.
Two questions Roy
1. Folic acid is from green vegetables so a diet high in green vegetables may fight off depression?
2 that 5% suffer is only those diagnosed? I wonder if the number is not a great deal larger but as they are self medicating with drugs and alcohol and other anti-social behaviors we have not diagnosed them as depressed?
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Ah- the key point is that folate is an adjuvant. That means it helps all the components in the mixture to perform well. By itself, it can promote the production- but, in depression, it seems that the chemicals are reabsorbed quickly- so they don’t yield the normal effects. By increasing the levels of the neurochemicals AND decreasing their reabsorption, the desired affects are manifested.
And, I am fairly certain that the 5% includes those that self-medicate.
Roy
I know you don’t need me to tell you how impressed I am with your writing or even how wonderful I find it that you actually do the research but, I will anyway. *Applauds and whistles* Very good job.
Folic acid is something that is very easy to get in foods, at least that is what we are told nowadays. My family eats a lot of beans and dark green leafy veggies. I’m raising an army of farting Popeye’s for the zombiepocalypse. lol
For my own personal reasons and those close to me I am against anti-depressants and those who administer them. I am anti- pharmaceutical medicines for the most part. Ok, let me clarify what I’ve said. Many people in the USA do at times experience depression, it’s natural to have moments of sadness or even extreme moments of sadness… hello, it’s called life. When my sister was 13 they diagnosed her with Manic Depression (otherwise known as Bi-Polar) They gave her medication. Despite the fact that she enjoyed cutting herself for attention, she was fairly upbeat and lived good. Her biggest problem was she wanted the spotlight at the cost of everyone else including her children. I don’t know if medication helped her because she never stayed on it long enough for it to work properly. As soon, as they go back to their “high” they drop the medication because they no longer “need” it. That is what society has told us. Feeling low is bad, feeling high with extreme energy is fine.
When I had an issue and was given anti-depressants I never noticed a change. I took many kinds, many dosages, on and so forth. The problem wasn’t that I had depression it was that I was extremely unhappy. I was unhappy with everything. I was unhappy being a young mom, home alone all the time, never leaving the house, no friends or family, raising toddlers alone, etc… I also was still trying to deal with the fact I had been abused from age 3 until I got married at age 19. I saw a school therapist for “my issues” from grade 3 until I graduated, no meds given, no real help given, all I learned was people say it’s wrong but the adults won’t help remove you from harm’s way. Some even found it necessary to call my stepmom and tell her everything so I could be punished more severely for opening my mouth. None of this was actual depression it was all stressful, it may have even been Post traumatic Stress Disorder. I may still be dealing with that now after losing my sister last year. The point is the reason those anti-depressants don’t work is because most of the people who are taking them don’t need them. They need to learn that life has ups and downs and it’s not the end of the world. They need counseling for life not for how their mind reacts to bad times. No therapist ever tells them it’s normal to feel that way and that they too feel that way. Obviously there are extreme cases, like when suicide is brought up. But, most people who want to hurt themselves don’t tell anyone that anyway.
I hope that this discovery of taking folic acid with anti-depressants works. I just have a hard time thinking that it will when most of those people who are taking them are taking them for a “chemical imbalance” that they do not have.
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Jenni:
I wish I had words of wisdom to offer. You voiced the issue well- medication is not always the answer; it’s used because many of us just want a solution- NOW. And, then get frustrated when that prescription is improper or incorrect. (Improper- not the right titer. Incorrect- the wrong medication.)
When we are dealing with issues of the brain, our knowledge is limiting our ability to choose the proper drug and dose. We don’t know enough about the interactions of all those chemicals in our brains to truly discern which- if any- are the proper choice.
Roy
Hi Jenni,
I am sorry you have witnessed and experienced the bad side of anti-depressants.
As a flipside to your comment, I’d like to show the other side of the story – which is me. I’m from a family with a history of depression and anxiety disorders. For 18 years I’ve struggled on and off with depression. I’ve tried everything from eating well, exercising, mediation, yoga, changing jobs, following my passions, working part time, travelling, councelling, vitamins, talking, forcing myself to go out with friends, locking myself away, being in a relationship, not being in a relationship, trying anti-depressants, not trying anti-depressants, etc.
For me, anti-depressants have allowed me to live my life – to function, to achieve, to love, to smile. I resisted so hard the thought of going on them again, but once I found the right type, they certainly helped. For some people, it’s just like taking a pill for high blood pressure, or diabetes.
I do not knock peoples choices not to try them, but for some – like myself and my Nan – they have certainly made a huge difference. I don’t think I would be here if I hadn’t gone back on them. And who knows, one day I may come off of them…but until that day, I am happy with my little daily pill.
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Great post, this subject will only get more attention as science discovers the connection between nutrients and the brain.
Thanks so much for your comment and visit, Chris!