Tuesday, May 06, 2008

Methylfolate and depression

...or how to B undepressed.

Folate is a B vitamin that occurs naturally in green leafy vegetables. It plays a host of important roles in the human body, and is so essential to the proper construction of the nervous system of a developing human that the FDA mandated in 1996 that its synthetic form--folic acid--be added to breads, flours, and other grain foods.

The trouble with folic acid supplementation or even naturally occurring dihydrofolate from food sources is that the body must convert them into the active form which is L-methylfolate (known as MTHF--yes, I thought of that word too the first time I read it). Some people are better MTHF producers than others. For purposes of our discussion, we will focus on the effects of MTHF deficiency and the fully developed brain.

The brain is tightly guarded by the 'blood-brain barrier.' Certain molecules can't pass through the blood vessel walls into brain tissue, and folate is one of them. MTHF, on the other hand, slips right in, and a right good thing it does because it is an important co-factor in producing the three most important neurotransmitters involved in mood regulation. If you're low on MTHF, studies suggest that you may subsequently run low on dopamine, norepinephrine, and serotonin. We're talking transmitters with a capital T that rhymes with D that stands for depression.

A host of research shows that supplementing methylfolate--thus skipping the necessary internal steps to activate folic acid--improves depression under a host of circumstances. This being an older person's health blog, let me illustrate with one study which supplied sad, old people with MTHF.

Researchers coaxed 20 elderly people who were not only Italian but also depressed to take 50 mg daily of MTHF rather than antidepressants. Four said the Italian equivalent of 'what's the use' and quit. The remaining subjects showed significant improvement in their depressive symptoms.

But you don't have to be old to enjoy the potential mood elevation of MTHF. A product called Deplin is now available by prescription and specifically indicated for use in patients having a less than stellar response to antidepressants. Theoretically, it might also be useful for persons with mild mood disorders not on other medications.

The basic science literature supporting the theory that MTHF improves brain function is large, but clinical research, except for the random Italian or so, is sketchy. Thus Deplin has been designated a 'medical food' which apparently does not have the stringent proof requirements of prescription drugs. Nevertheless, no adverse effects of MTHF supplementation have occurred, and a downloadable coupon at deplin.com makes this an affordable gamble of a therapy.

14 comments:

Reality Man said...

You just can't say enough good things about folate, including its role in keeping that nasty bad actor, homocysteine, in check.

Mauigirl said...

That's great news - I hope it becomes widely available. So interesting what we keep learning about the brain and what can affect it.

Haralee said...

I just wrote on my blog about Folate in the diet and benefits with cancer.
Shall we say great menopausal minds think alike!

Reality Man said...

Day one: Tobi and I each popped a Deplin. Several hours later, I feel good; of course, it is also the cocktail hour. What about folinic acid? The buzz on the 'net is that it is more bioavailable than folate. It is certain that it is much less expensive than Deplin--the buzz also suggests that Deplin's prescription-only status is yet another cynical drug company move to make money.

Reality Man said...

Day two: I did my first day of volunteer recording for Recording for the Blind and Dyslexic in Colorado Springs, and was able to get through two chapters of James Dobson without going into a coma.

Reality Man said...

Day three: Forgot! Pill three: Walking six dogs still makes me crazy. But I think this is the problem: in the absence of symptoms of clinical depression to alleviate, how do you distinguish the effects of methylfolate from random episodes of feeling good?

mary said...

I've been on 7.5 mg/day of Deplin for 30 plus days now. Also weaned off of Lexapro very slowly during this same time. I gave it rave reviews- until a few days ago..... I'm having bizarre dizziness and when I move my eyes left or right, I get this weird internal electrical wave thing - can feel it all the way to my hands at times. Saw my doc yesterday and he said I would be his first if it is indeed to much Deplin. We're experimenting for the next 2 weeks by cutting the pill in half. Any thoughts out there on getting too much of a good thing? I have not found anything about this yet.... just began looking. Would really appreciate some insight since this is the first "drug" that has really helped in years.

femail doc said...

Mary,

I believe your symptoms are from serotonin withdrawal. Even though you weaned slowly off Lexapro, apparently it was not slowly enough.

Amy said...

I agree with femail doc, though I'm not a doc... those are the same symptoms I had when coming off Lexapro. Do some more research on that and I think you'll find the same thing...

Violetwrites said...

Very interesting. It was prescribed today for my fiance who suffers from bipolar disorder. Problem is (now this is weird) you have to have a prescription to get, but if you want it your coverage won't pay for it and you have to buy it. $55 for 30 pills is kind of steep when you pay $850 a month in child support and 1360 in rent - there's not much left to spread around. Any suggestions?

femail doc said...

Hi Violet, The designation of Deplin as a 'medical food' means many insurance companies won't pay for it. I agree that the price is steep (though not near as steep as other meds like Abilify). Perhaps your fiance's doc could spare two weeks of Deplin samples? That's about how long it would take to see if it would be helpful and therefore worth the money spent. Best of luck!

Richard said...

My shrink put me on deplin yesterday and gave 2 weeks of free samples. I have been on lexapro for several years and it just seem to be working real well at the moment. All the testimonials on this site and others give me lots of encoragement. I will get back when I see some effects.
Blue Boy

Anonymous said...

Deplin is really expensive and not covered by my insurance. Is there a cheaper, or better yet, natural alternative?

denverdoc said...

It is available as a generic. Speak with your pharmacist about pricing. Often when such meds become generic, there is initially very little difference between the brand name and the new offering.