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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 66 to 90 of 103. Go back in thread:
Posted by clipper40 on November 21, 2007, at 16:43:39
In reply to Re: Do you think MegaFolinic could work as well? » clipper40, posted by Iansf on November 21, 2007, at 13:13:24
> > However, if you do the math (assuming 9.5 tabs of MegaFolinic per dosage and $119.69 as price of Deplin from manufacturer's website), you get $57.60 per 90 doses MegaFolinic vs. the $119.69 of 90 doses of Deplin. That's still quite a significant savings - not to mention that you don't need a prescription for the Megafolinic.
> >
> >
> >
> Except I found one source that has Deplin for $45 for 30 tablets and $107 for 90 (equivalent to about $36 for 30). So it can still end up being cheaper.
How is $107 for 90 doses cheaper than $57.60 for 90 equivalent doses?The only way I can see the Deplin being a better deal is if the Megafolinic doesn't work as well - which is entirely possible, if not probable.
Posted by KayeBaby on November 22, 2007, at 0:52:33
In reply to Re: Do you think MegaFolinic could work as well? » Iansf, posted by clipper40 on November 21, 2007, at 16:43:39
No. It is the same. The drug co., Pan American, owns the raw material and for a time sold it to supplement companys. It stopped providing l-methylfolate when it was ready to market Deplin.
This is the info I have read. My Dr. told me the same thing.
Peace,
Kaye
Posted by Ron Hill on November 22, 2007, at 1:21:24
In reply to Re: Any1 have flu symptoms or back pain w/ Deplin?, posted by sparkle on November 17, 2007, at 10:37:15
This study shows why folate supplementation does not help all depressed patients. This has direct application to Deplin efficacy. But more than that, it gives a good rationale for why folate tx does work well in patients with low folate as measured by homocysteine levels.
http://jnnp.bmj.com/cgi/content/full/69/2/228?ijkey=894fd0cb1ea17d8ec0e2ef52e5b7f0ab7739e709
- Ron
Posted by Iansf on November 22, 2007, at 11:43:26
In reply to Re: Do you think MegaFolinic could work as well? » Iansf, posted by clipper40 on November 21, 2007, at 16:43:39
> How is $107 for 90 doses cheaper than $57.60 for 90 equivalent doses?
>This is why you should never hire me to do your income tax forms - unless, of course, you WANT to pay the IRS more than you owe.
Posted by KayeBaby on November 22, 2007, at 11:59:28
In reply to Re: Do you think MegaFolinic could work as well?, posted by Iansf on November 22, 2007, at 11:43:26
I figured out what happened. I sent the wrong link or they switched products. The product I was taking is Metafolin by Source Naturals.
Oh-Merck is the patent holder not Pan Am. I think I was up too late when I posted this.
Sorry for any confusion.
Kaye
Posted by clipper40 on November 22, 2007, at 14:05:44
In reply to Re: Do you think MegaFolinic could work as well?, posted by Iansf on November 22, 2007, at 11:43:26
Posted by Ron Hill on November 22, 2007, at 14:19:20
In reply to Do you think MegaFolinic could work as well?, posted by clipper40 on November 17, 2007, at 18:33:11
Posted by sparkle on November 22, 2007, at 14:34:08
In reply to Please see my post below regarding Metafolin » Ian » clipper40, posted by Ron Hill on November 22, 2007, at 14:19:20
i am really confused now. so is there a drug comparable to deplin out there and substantially cheaper. if so where do you access it? thanks sparkle ps happy thanksgiving
Posted by Ron Hill on November 22, 2007, at 14:48:48
In reply to Re: Please see my post below regarding Metafolin, posted by sparkle on November 22, 2007, at 14:34:08
> i am really confused now. so is there a drug comparable to deplin out there and substantially cheaper. if so where do you access it? thanks sparkle ps happy thanksgiving
No, I doubt that it is cheaper; just available. I did not do the math.
--Ron
Posted by clipper40 on November 23, 2007, at 2:09:47
In reply to Please see my post below regarding Metafolin » Ian » clipper40, posted by Ron Hill on November 22, 2007, at 14:19:20
> http://www.dr-bob.org/babble/20071115/msgs/796578.html
Hi Ron,I understand that MegaFolinic (folinic acid)is not the same as L-methylfolate but according to the blurb on it at iHerb.com, it converts more easily to L-methylfolate than regular folic acid:
"Folinic acid does not require the enzymatic conversion that folic acid does so there is enhanced effectiveness for many people. Research suggests that folinic acid is more bioavailable than folic acid because it is more rapidly converted into L-methylfolate, the form of folate in circulation that can cross the blood-brain barrier.*"http://www.iherb.com/ProductDetails.aspx?c=1&pid=7735
So I was wondering if it might still work as well, or nearly as well, as L-methylfolate. Probably not but maybe it's worth a try?C40
Posted by clipper40 on November 23, 2007, at 2:23:19
In reply to Cost of Deplin vs HSFolate » sparkle, posted by Ron Hill on November 22, 2007, at 14:48:48
> > i am really confused now. so is there a drug comparable to deplin out there and substantially cheaper. if so where do you access it? thanks sparkle ps happy thanksgiving
>
> No, I doubt that it is cheaper; just available. I did not do the math.
>
> --Ron
You're right. I just did the math and the HSFolate is almost 4 times as expensive as Deplin for equivalent dosage (not taking into account that HSFolate also contains coenzyme B12 and regular B6). Yikes! That's really expensive.
Posted by Ron Hill on November 23, 2007, at 19:22:47
In reply to Re: Please see my post below regarding Metafolin » Ron Hill, posted by clipper40 on November 23, 2007, at 2:09:47
> > http://www.dr-bob.org/babble/20071115/msgs/796578.html
>
>
> Hi Ron,
>
> I understand that MegaFolinic (folinic acid)is not the same as L-methylfolate but according to the blurb on it at iHerb.com, it converts more easily to L-methylfolate than regular folic acid:True. There are four steps that folic acid must go through before it becomes L-methylfolate. The first step is the one that some people (30% to 50% of the general population, depending on who you read) have at least some amount of difficulty in transforming folic acid to dihydrofolate via the dihydrofolate reductase.
This will all make more sense if we look at pictures. Therefore, pull up the following page on the Deplin web site:
http://www.deplin.com/DeplinFacts,VsFolicAcid
Notice on the flowchart that there are four steps for folic acid and it is the first step that is difficult for some people to make. And, of course, no steps are needed for L-methylfolate (Deplin).
Let's look at another picture:
http://www.metafolin.com/pdfs/Scientific_Review_13.12.pdf (the pdf pulls up slowly)
Look on page 5. This bottom drawing shows the steps that folic acid has to go through to become L-methylfolate.
As an aside, read the text on page 5. This is part of the reason why all patients taking folates should also take methylcobalamin (methyl-B12). Further, it is also important to take P-5-P (coenzymatic form of B-6). VERY important to take both. If not, then take Metanx, http://www.metanx.com/ . Scroll to the bottom of the page and notice that Metanx has all three in it already (L-methylfolate, P-5-P, and methyl-B12).
> "Folinic acid does not require the enzymatic conversion that folic acid does so there is enhanced effectiveness for many people. Research suggests that folinic acid is more bioavailable than folic acid because it is more rapidly converted into L-methylfolate, the form of folate in circulation that can cross the blood-brain barrier.*"
>
> http://www.iherb.com/ProductDetails.aspx?c=1&pid=7735
>
>
> So I was wondering if it might still work as well, or nearly as well, as L-methylfolate. Probably not but maybe it's worth a try?I don’t know the answer to your question. In doing some reading, to try to answer your question, my hunch is that it would work nearly as well. But, don’t quote me on that. Folinic acid is a 5-formyl derivative of tetrahydrofolate and it is readily converted to other reduced folic acid derivatives (e.g. tetrahydrofolate). I’m not sure where on the Deplin website flowchart 5-formyl tetrahydrofolate would be located. Is it to the right or left of tetrahydrofolate, or somewhere else? I dunno.
As a side note, folinic acid is used as an adjuvant in cancer chemotherapy. For this purpose, folinic acid is known as leucovorin.
Not much help to you on this one Clipper.
Why not just get a script from your pdoc for Deplin, Metanx, or CerefolinNAC, and let your insurance company pay for it?
> C40
Posted by clipper40 on November 24, 2007, at 4:37:12
In reply to Folinic Acid vs L-methylfolate » clipper40, posted by Ron Hill on November 23, 2007, at 19:22:47
>>Why not just get a script from your pdoc for >Deplin, Metanx, or CerefolinNAC, and let your >insurance company pay for it?
Thanks for your excellent, in-depth response! I think the script is the best way to go too. (I'm just not sure how much longer I'll be able to afford health insurance.)Take care,
Clipper
Posted by Ron Hill on November 25, 2007, at 1:18:24
In reply to Re: Folinic Acid vs L-methylfolate » Ron Hill, posted by clipper40 on November 24, 2007, at 4:37:12
> I think the script is the best way to go too. (I'm just not sure how much longer I'll be able to afford health insurance.)
C40,Pull up the Deplin home page:
In the header, in the far right column, click "Get a ValueCard", and print the ValueCard.
From the home page click "Price Quote". Print the quote to show your pharmacy.
Use the "Pharmacy Availability" link to see if your pharmacy, or another nearby pharmacy, accepts the coupon.
Clipper, will you do me a favor? If you have time, will you tell me your dx, list your current meds and dosages, list the meds you have tried in the past, and briefly tell me your reaction to your previous med trials. Finally, list the symptoms of your disorder(s) that remain problematic.
I saw in another thread that you are considering an AP, but wisely you're concerned about the possible side effects.
On this end, 34 days ago I modified my med combo by adding 15 mg/day of Deplin, along with 50 mg/day of the VERY IMPORTANT Pyridoxal-5'-Phosphate (P-5-P), and 2000 mcg/day of the VERY IMPORTANT methylcobalamin (methyl-B12).
P-5-P is the coenzyme form of B-6, ready for direct use in metabolic cycles. And, methyl-B12 is the form of B12 used directly in the brain.
As I've stated before, it is very important to take P-5-P and methyl-B12 with Deplin. The P-5-P dosage should not exceed 200 mg/day. Other than that, I'd say the pt should play with the dosages until the dosages feels right.
With only 34 days of use, it's too early to do the victory dance. However, I'm getting such excellent results that I have went ahead and put on my dancing shoes in anticipation of continued remission of my bipolar II ultra rapid cycling depression and dysphoria.
For me, the positive effects of the Deplin/P-5-P/methyl-B12 addition began the second day. My wife tells me that Deplin has changed me from "Growly Boy" to "Lovey-Dovey Boy"
Thanks for allowing me to repeat some of what I have mentioned in the past. I'm just hoping to get the word out.
Thanks, C40. Hope to hear back from you.
-- Ron
Currently in near-full remission.
dx: Bipolar II, with ultra rapid cycling (15 days for one complete cycle), and mild Obsessive Compulsive Personality Disorder (OCPD)600 mg/day Trileptal
200 mg/day Lamictal
875 mg/day Keppra
90 mg/day Nardil
15 mg/day Deplin
P-5-P
Methyl-B12Androgel: 4 pumps of Androgel testosterone on a prn basis (typically administered once) during the two or three days of ultra rapid cycling depressive phases which occur every 15 days.
A few miscellaneous other vitamins and supplements: zinc, phosphatidylserine, selenium, vitamin D, Mg Malate/dietary Ca in yogurt etc, liquid fish oil, a good daily multiple vitamin.
Posted by clipper40 on November 25, 2007, at 17:43:05
In reply to Deplin Cost Reduction Coupon » clipper40, posted by Ron Hill on November 25, 2007, at 1:18:24
Ron,
Thanks so much for caring! I'll send you a babblemail soon.
Clipper
Posted by Ron Hill on December 4, 2007, at 18:59:38
In reply to Deplin Has Made rHill Well (So Far, As of Day 26 ) » Fivefires, posted by Ron Hill on November 16, 2007, at 1:08:35
To All PB Participants Interested in Deplin,
After 39 days of use, Deplin has quit providing any antidepressant effect and it has turned against me.
I am currently in a difficult depression that I can't pull out of.
Prior to starting Deplin, my BP II ultra rapid cycling caused me to have 3 days of depression out of every 15 days. This reoccurred over and over like clockwork. I could depend on it, and I would know when the depression would abate.
However, my current depression is lasting longer than three days, and there is no sign of relief in sight. I have no idea how long the depression will last.
I am titrating down my Deplin dosage.
Deplin provided good benefits and showed great promise during the first month or so. But, now it has turned against me and it has left me in a heap unable to function.
I will try, but forgive me if I am unable to reply to posts.
-- Ron
Posted by Phillipa on December 4, 2007, at 19:38:08
In reply to My Deplin Trial Failed » All Interested in Deplin, posted by Ron Hill on December 4, 2007, at 18:59:38
Ron oh no I'm so terribly sorry. Will you stay on the other meds or add something? I feel so bad for you. Love Jan
Posted by elanor roosevelt on December 4, 2007, at 22:21:03
In reply to My Deplin Trial Failed » All Interested in Deplin, posted by Ron Hill on December 4, 2007, at 18:59:38
I am so sorry to hear this.
I know that when meds turn on you it can be ugly.
Have you called your doctor?
It's easy to get stuck where you are in your head after a crash so please take care
To All PB Participants Interested in Deplin,
>
> After 39 days of use, Deplin has quit providing any antidepressant effect and it has turned against me.
>
> I am currently in a difficult depression that I can't pull out of.
>
> Prior to starting Deplin, my BP II ultra rapid cycling caused me to have 3 days of depression out of every 15 days. This reoccurred over and over like clockwork. I could depend on it, and I would know when the depression would abate.
>
> However, my current depression is lasting longer than three days, and there is no sign of relief in sight. I have no idea how long the depression will last.
>
> I am titrating down my Deplin dosage.
>
> Deplin provided good benefits and showed great promise during the first month or so. But, now it has turned against me and it has left me in a heap unable to function.
>
> I will try, but forgive me if I am unable to reply to posts.
>
> -- Ron
Posted by clipper40 on December 5, 2007, at 0:40:02
In reply to My Deplin Trial Failed » All Interested in Deplin, posted by Ron Hill on December 4, 2007, at 18:59:38
Oh Ron, I'm so very sad to read about your current difficulty. It has to be terribly disappointing for you when you had such high hopes for Deplin. Is there any chance that a lower dosage might be the answer?
You will pull out of this bad cycle. You always have.
I wish I could do more than just commiserate with you. You are such a special person and so many of us here care about you and are rooting for you.
Clipper
Posted by stargazer2 on December 5, 2007, at 8:14:02
In reply to My Deplin Trial Failed » All Interested in Deplin, posted by Ron Hill on December 4, 2007, at 18:59:38
Ron, i wouldn' think that could happen with Deplin, as it is considered a medical food product of sorts. Is there a side effect listing for it? Is deplin the only thing that changed since you started it?
I hope you can get back on course soon. do you have a plan as to what to do next?
Stargazer
Posted by Ron Hill on December 6, 2007, at 13:21:51
In reply to Re: My Deplin Trial Failed » Ron Hill, posted by clipper40 on December 5, 2007, at 0:40:02
Jan, Elanor R, C40, Star,
and All PB interested in Deplin;Hey, good news. During my week long depression, I thought my problem was Deplin. But, I kept taking my usual 15 mg/day. Duh!
Yesterday (12/05/07), for the first time, I cut my Deplin dosage down to 1/4 of a 7.5mg tablet (= 1.875 mg). This morning my depression is gone. I will not know for sure until the end of the day, but it would appear that my depressive episode is over.
I do not plan to throw the Deplin baby out with the wash. Instead, these results indicate to me that I was taking too much and I need to hunt around via trial-and-error to find my optimal dosage which remains sustainable over the long-term.
Was remission due to placebo? No way. I did not even remotely think that the one day reduction in Deplin dosage would terminate my depression.
Was the timing of my Deplin dose reduction and the time when I came out of depression merely coincidence? Nope. Whenever I'm about to cycle out of depression, I always start to feel some relief the evening before. However, yesterday I was depressed all day and all evening right up to bedtime.
So yippy, skippy; I'm good to go. I feel great; motivation and energy are good, mood is good, outlook on life is good, and etc. Now, I can get back to working on my projects just in the nick of time. Winter is coming and I do not have my outside work done for the year. Time to get hoppin'.
My wish is for all in PB-land to find wellness, and yet I know how difficult the path can be for those who cannot find relief. My heart goes out to each of you who find yourself in the unrelenting pain yet again today. We're all pulling for you, and cheering as you continue the fight to find wellness and simultaneously endure today's pain.
Jan, Elanor, Clipper, and Star; a special thanks to each of you. In the mist of my depression, your words brought a smile to my face, a warm feeling in my heart, and moisture to my eyes. Thanks for being there!
For all interested in Deplin, please look at this study (hopefully you can pull these links up without a password):
http://www.ajcn.org/cgi/content/full/84/1/156#F1
In particular, all I want us to look at is Figure 1 and Figure 2 from the above study:
http://www.ajcn.org/cgi/content-nw/full/84/1/156/F1
http://www.ajcn.org/cgi/content-nw/full/84/1/156/F2
It is not the point of this article, nor the point of these graphs. However, I observe that, for a constant dosage (0.416 mg/day) of [6S]-5-methyltetrahydrofolate, which is another name for L-methylfolate (i.e.; Deplin), the red blood cell folate concentration (Fig 1) and the plasma folate concentration (Fig 2) continue to increase over the 24 week period shown.
Put more simply, as I continue to take the same daily dosage of Deplin, the folate concentrations continually raise in my red blood cells and in my plasma.
So even though I kept my Deplin dosage constant, internal folate levels continued to increase over time. Could this be part of the reason I became depressed while continuing to take the same daily dosage (15 mg/day) that worked so well for me in the beginning of my Deplin trial?
And further, does this mean that all of us on Deplin should consider reducing our daily dosages as our time (i.e.; weeks) on the Deplin progresses? The one fly in the ointment in all this is that the graphs are not showing actually brain cell levels of folate. However, as I understand it, red blood cell folate concentrations are fairly well correlated with brain level concentrations.
What da-ya-think? Are my observations of the graphed data all wet?
As a final note, I do not, nor have I ever, anticipated Deplin would stop my rapid cycling. There are no research data to support it. Instead, my hope has always been that it would reduce the severity and perhaps the duration of my ultra rapid cycle depressive phases.
-- Ron
dx: Bipolar II, with ultra rapid cycling (15 days for one complete cycle), and mild Obsessive Compulsive Personality Disorder (OCPD)
600 mg/day Trileptal
200 mg/day Lamictal
875 mg/day Keppra
90 mg/day Nardil
1.9 mg/day Deplin
Posted by clipper40 on December 6, 2007, at 16:31:23
In reply to I'm Well Again.Thanks » Jan, Elanor, C40, Star, PB, posted by Ron Hill on December 6, 2007, at 13:21:51
Ron,
I'm so happy for you! It's so nice to read that you're back on track again. Your conclusion makes total sense to me. I can see that you will have a lot of experimenting to do to find the best dosage for you that it is sustainable over the long-run. But I'm sure you will find that ultimate dosage and get the maximum benefit from Deplin.
Good luck with all of your projects and have a wonderful holiday season!
Clipper
Posted by Phillipa on December 6, 2007, at 19:39:56
In reply to Re: I'm Well Again.Thanks » Ron Hill, posted by clipper40 on December 6, 2007, at 16:31:23
Ron yeah!!!!!! I've been thinking a lot about you and how that could happen private conversations too. Just happy you're better. Love Jan
Posted by Ron Hill on December 6, 2007, at 21:56:27
In reply to Re: I'm Well Again.Thanks » Ron Hill, posted by clipper40 on December 6, 2007, at 16:31:23
Clipper,
I have not forgot about finishing my reply to your B-mail regarding your dx, related brain chemisty issues, and possible tx's to consider.
I'll get my reply to you as soon as time allows. I hope to reply sooner rather than later.
-- Ron
Posted by Ron Hill on December 6, 2007, at 21:58:32
In reply to Re: I'm Well Again.Thanks, posted by Phillipa on December 6, 2007, at 19:39:56
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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
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