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Dr. Bob is Robert Hsiung, MD,
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Posted by Astounder on November 1, 2007, at 20:02:36
In reply to Re: Anyone tried Deplin? » KayeBaby, posted by Phillipa on October 27, 2007, at 14:00:24
This article explains the mechanism of Deplin (L-methylfolate):
http://www.cnsspectrums.com/aspx/article_pf.aspx?articleid=1267
The jist of it:
"Antidepressants boost the actions of one or more of the three monoamines: DA, NE, and/or 5-HT. MTHF acts as an important regulator of a critical co-factor for trimonoamine neurotransmitter synthesis. This co-factor is known as tetrahydrobiopterin (BH4).... By boosting trimonoamine neurotransmitter synthesis via enhancement of BH4, MTHF presumably is able to augment the antidepressant actions of known antidepressants."
So basically what it does is recycle BH4. BH4 is a necessary cofactor in the enzymatic conversion of L-phenylalanine to to L-tyrosine by phenylalanine hydroxylase, L-tyrosine to L-DOPA by tyrosine hydroxylase, L-tryptophan to 5-HTP by tryptophan hydroxylase. It is not a cofactor for the conversion of L-DOPA to dopamine or 5-HTP to serotonin by aromatic L-amino acid decarboxylase.
Two questions: 1) Wouldn't this have the same effect as supplementing with 5-HTP + L-DOPA + carbidopa? And 2) couldn't you simply supplement BH4 directly? They do sell it online at a comparable cost to Deplin:
http://www.schircks.com/tablets/sys/tetrahydrobiopterin_tab_frame31.htm
BH4 100x 10 mg tablets = $113Quoted from Deplin website:
L-methylfolate 90x 7.5 mg tablets = $119.69
Posted by Phillipa on November 1, 2007, at 22:21:30
In reply to Antidepressant mechanism of Deplin, posted by Astounder on November 1, 2007, at 20:02:36
So you compare Deplin with Samee? Phillipa
Posted by Astounder on November 3, 2007, at 9:57:53
In reply to Re: Antidepressant mechanism of Deplin » Astounder, posted by Phillipa on November 1, 2007, at 22:21:30
> So you compare Deplin with Samee? Phillipa
Well, the way it looks like is that SAM-e's metabolite homocysteine can steal the methyl group from L-methylfolate (MTHF), turning it into THF. Both MTHF & THF can recycle BH4 using a different enzyme, cofactor, and precursor--I suppose this would make synthesis of BH4 more efficient, fully utilizing both pathways.
Homocysteine indirectly damages the walls of you blood vessels and high levels are a big risk factor for heart disease. So, recycling it into SAM-e is good for your health in general. SAM-e is a methyl donor that's important for the upkeep of a lot of cellular functions, including polyamine & mRNA synthesis. SAM-e is also a necessary cofactor in the conversion of norepinephrine to epinephrine, as well as in the metabolism of monoamines and their (neurotoxic) MAO metabolites by COMT. Conversion of NE to normetanephrine by COMT may be responsible for the latency in response to noradrenergic antidepressants.
Taking both Deplin & SAM-e should be synergistic, and the combination might have advantages over simply taking BH4.
Posted by Phillipa on November 3, 2007, at 20:02:43
In reply to SAM-e, Deplin, and BH4 » Phillipa, posted by Astounder on November 3, 2007, at 9:57:53
So is a combo of Sam-e and deplin better than a prescription ad? Phillipa
Posted by crawdad105 on November 6, 2007, at 11:32:19
In reply to Anyone tried Deplin?, posted by KayeBaby on September 24, 2007, at 17:08:31
My doc says that in simple terms Deplin acts to make antidepressents more effective by increasing folate in the brain. He has had good results with it. It can take up to 4-6 weeks for it to kick in. He says that most of the ingredients in over the counter folic acid pills pass out your body in your urine so that is why he prescribes the Deplin.
He just prescribed it to me today. My health plan doesn't cover it so I'll look for the least expensive cash price at various pharmacies.
Posted by Ron Hill on November 6, 2007, at 18:46:31
In reply to Re: Anyone tried Deplin?, posted by crawdad105 on November 6, 2007, at 11:32:19
> My health plan doesn't cover it so I'll look for the least expensive cash price at various pharmacies.
Crawdad,Don't forget to use the coupon.
Pull up the Deplin site:
Look for the "ValueCardRx Program" links in the far right column at the top of the Deplin Home Page. Click through the column of links and print the coupon. No strings attached that I have found.
Make sure to check the list of participating pharmacies in you area.
-- 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
15 mg/day Deplin
Posted by Phillipa on November 6, 2007, at 19:20:04
In reply to Re: Anyone tried Deplin? » crawdad105, posted by Ron Hill on November 6, 2007, at 18:46:31
Saw ob-gyn senior doc who's doing surgery in January on me and he hadn't heard of it . You'd think he would have as this practice takes the high risk births. I explained what it was he understood and said he would have to be on his toes with me. And did you get your mail? Love Phillipa/Jan
Posted by Ron Hill on November 6, 2007, at 20:20:08
In reply to Re: Anyone tried Deplin? » Ron Hill, posted by Phillipa on November 6, 2007, at 19:20:04
Yeah, I saw this in your previous post in another thread. Did you charge him for your time taken to educate him. Seems only fair given that he charges you so much.
-- Ron
> Saw ob-gyn senior doc who's doing surgery in January on me and he hadn't heard of it . You'd think he would have as this practice takes the high risk births. I explained what it was he understood and said he would have to be on his toes with me. And did you get your mail? Love Phillipa/Jan
Posted by Phillipa on November 6, 2007, at 21:13:39
In reply to Re: Anyone tried Deplin? » Phillipa, posted by Ron Hill on November 6, 2007, at 20:20:08
Ron still have my active nursing license he knows I'm not working and likes older nurses. Medicaire he said would pay for the proceedure. But just did the Deplin check pharmacies the one I use has it and it's across the street from the hospital. Wish I had brochures on it as I would play drug rep and give them to him. Love Jan
Posted by rskontos on November 8, 2007, at 18:54:07
In reply to Re: Anyone tried Deplin? » Ron Hill, posted by Phillipa on November 6, 2007, at 21:13:39
Would deplin work without a an AD if I wanted to go off my SSRI. IT isn't working so well. Thanks rk
Posted by Phillipa on November 8, 2007, at 21:04:17
In reply to Re: Anyone tried Deplin?, posted by rskontos on November 8, 2007, at 18:54:07
I second that question. Phillipa
Posted by Questionmark on November 11, 2007, at 23:03:41
In reply to Re: Anyone tried Deplin?, posted by rskontos on November 8, 2007, at 18:54:07
I'm a pessimist, but, if i were to guess, i doubt it. Possible though.
> Would deplin work without a an AD if I wanted to go off my SSRI. IT isn't working so well. Thanks rk
Posted by rskontos on November 12, 2007, at 10:16:02
In reply to Re: Anyone tried Deplin? » rskontos, posted by Questionmark on November 11, 2007, at 23:03:41
Posted by KayeBaby on November 12, 2007, at 22:24:29
In reply to Re: Anyone tried Deplin?, posted by rskontos on November 8, 2007, at 18:54:07
If low folic acid is the cause or a large portion of your depression, it would help a lot.
If the SSRI is not so good and you have given it a fair trial then try something else in another class. SSRI's don't work well for all.
The right med should make you feel well or close enough to cope.
Best wishes,
Kaye
Posted by Fivefires on November 13, 2007, at 17:43:57
In reply to Re: Anyone tried Deplin?, posted by crawdad105 on November 6, 2007, at 11:32:19
I'm just now on my way to p/u some samples of Deplin.
I'm in a pretty bad depressive state ... not wanting to get out of bed, cryin' a lot.
I'll have to run down the thread here and read up a bit ... or not! Sometimes the POS can be so influencing I'd rather not know. I just told him I'd had one too many birds sh*t on my head lately and was feeling very abandoned and very rejected. He came up w/ this.
Funny as my gyn said, couple mos back, I needed folic acid and B12 re: last lab tests.
Anyway, pdoc said this should work better and help my depression. He didn't call it an anti-depressant per se. Guess I'll know soon enough. Better hit the road b4 they close their doors.
Any1 feeling the need to warn me of anything in particular would be appreciated, but it would also be appreciated if the 'it didn't work for mes' were held back a bit, at least until I find out for myself ... if ya' know what I mean.
Don't think could take another blow at this time.
Can't believe Thanksgiving is next week.
I'm soooo NOT thankful it's downright selfish.
5f
Posted by sparkle on November 13, 2007, at 20:51:11
In reply to Re: Anyone tried Deplin?, posted by Fivefires on November 13, 2007, at 17:43:57
iT seems to have helped me in combination with celexa. i am praying it helps you too.
Posted by Fivefires on November 13, 2007, at 22:35:58
In reply to Re: Anyone tried Deplin?, posted by sparkle on November 13, 2007, at 20:51:11
I'm not on an AD. Hmm.
Guess could use some prayers.
tks
5f
Posted by Ron Hill on November 14, 2007, at 6:33:33
In reply to Re: Anyone tried Deplin?, posted by Fivefires on November 13, 2007, at 17:43:57
5Fires,
> Funny as my gyn said, couple mos back, I needed folic acid and B12 re: last lab tests.
Interesting.
> Anyway, pdoc said this should work better and help my depression. He didn't call it an anti-depressant per se.Are you currently taking an antidepressant? I ask because Deplin is typically used to help the antidepressant medication to work better. However, in your situation (i.e.; low folate) it may help you even without an antidepressant on-board. Have you read the Deplin web site? Here is the link. Click through all the web pages.
Deplin is 100% Metafolin. Metafolin is L-methylfolate, although it is called several different names. The drug company Merck has patents on the production process of L-methylfolate. Here is the link to the Metafolin website:
Click through all the links on the Metafolin page. This is technical information, but worth the read. Just scan the parts you don't understand, if any.
> Any1 feeling the need to warn me of anything in particular would be appreciated,
I find it best to split the dosage; one-half in the morning, and the second half at about 2 pm. When I started out taking the entire daily dosage in the morning, the positive effects of Deplin would wane in the afternoon and evening. I believe this is due to the short half-life of Deplin in blood plasma as illustrated in the dose/response curve at the bottom of the following webpage on the Deplin site:
http://www.deplin.com/HealthcareProfessionals,Deplin
Please notice in the dose/response graph at the bottom of the webpage, that the plasma levels of 6(S) 5-MTHF (another name for L-methylfolate -- i.e.; Deplin) declines. This correlates well with my personal reaction to Deplin.
I take 15 mg/day, 7.5 mg in the morning and 7.5 in the early afternoon. I was looking for a reason why the benefits of Deplin dropped off after about six hours. When I saw the graph, it made sense to me, so I have been spliting my daily dosage ever since.
For me, the positive effects of Deplin kicked-in on the second day, and it continues to provide good results. However, I have only been taking it for 24 days, so time will tell if it continues to work on a long-term basis. In any case, as always, your mileage may vary.
It is ABSOLUTELY, POSITIVELY, ESSENTIAL for all patients taking Deplin to also take B12. For the reason why this is true, see page five of this document on the Metafolin website:
http://www.metafolin.com/pdfs/Scientific_Review_13.12.pdf
Also, buy and use methylcobalamin (methyl-B12), not cyanocobalamin, the cheaper and more common form of B12. The cyanide functional group is not healthy.
Take the methyl-B12 sublingually, hold under tongue until the tablet is fully dissolved and gone. Here is a good methyl-B12 product, and there are others on this site. Search the iherb site for methyl B-12, and the other name for the same thing, methylcobalamin:
http://www.iherb.com/ProductDetails.aspx?c=1&pid=129
I also take P-5-P, the coenzymatic form of B-6. This is very good stuff to take, especially when taking Deplin. I take about 50 mg/day. The upper limit of P-5-P is 200 mg/day. Further, I take about 30 or 40 mg/day of zinc. Zinc has antidepressant qualities, but do not take more than 100 mg/day. If the P-5-P or zinc causes some nausea, just eat a little food after taking them.
> I'm soooo NOT thankful it's downright selfish.
Not so. You are depressed, not a selfish person at your core.
I wish you well and I hope Deplin helps you.
-- 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
15 mg/day Deplin
Posted by Ron Hill on November 14, 2007, at 6:35:40
In reply to Re: Anyone tried Deplin?, posted by Ron Hill on November 14, 2007, at 6:33:33
Posted by Ron Hill on November 14, 2007, at 6:39:06
In reply to Above Post is For FiveFires (nm) » Ron Hill, posted by Ron Hill on November 14, 2007, at 6:35:40
Posted by Fivefires on November 14, 2007, at 16:59:41
In reply to Re: Anyone tried Deplin?, posted by Ron Hill on November 14, 2007, at 6:33:33
Talk about 'going off like a rocket'!
Deplin 7.5mg had me laughing and giggling and behaving 'like a silly school girl' within an hour after taking it last eve!
I thought to myself 'is this what mania feels like?'
It was so much fun and I was so excited, I could hardly settle down to get to bed, but managed to take care of that situation.
I 'SO' 'WAY' hear what you're saying about meds waning Ron, and will keep this in mind.
I've noticed even extended release or slow release meds don't last their official half-times when I'm concerned. Think I'm a megatabolizer!
Prob' should have started on half tab' last eve, b4 I realized how good I could actually feel o_o. Recalled no instructions per pdoc phone conversation. Will try handle appropriately.
As a result of recent labs, was not only told to start folic acid or folate, but also B12 shots monthly, so already got that one covered.
Feelin' a lil guilty about getting down on my pdoc re: lack of commmunication. Think he made a good call here. I'm going to continue down this Deplin path and get every drop of good feeling out of it I can.
5f
Posted by Phillipa on November 14, 2007, at 18:27:17
In reply to Re: Anyone tried Deplin?, posted by Fivefires on November 14, 2007, at 16:59:41
Five Fires where have you been? Phillipa
Posted by Fivefires on November 14, 2007, at 20:44:59
In reply to Re: Anyone tried Deplin? » Fivefires, posted by Phillipa on November 14, 2007, at 18:27:17
I wish I could say 'I've been somewhere', but nope, just here. Have had an onslaught of uncomfortable issues hit me the last couple weeks which took be down a bit, so much I guess I've not posted much at all.
stillhere, 5f
Posted by brooke484 on November 15, 2007, at 11:02:39
In reply to Anyone tried Deplin?, posted by KayeBaby on September 24, 2007, at 17:08:31
My doctor has never heard of Deplin and I want to give him some information about it when I see him next month. Does anyone know where I can find some? I know about the website, but I didn't want to print all of that out. I want something short and to the point.
Thanks so much,
Brooke
Posted by Ron Hill on November 16, 2007, at 1:08:35
In reply to Re: Anyone tried Deplin?, posted by Fivefires on November 14, 2007, at 16:59:41
5Fires,
> Talk about 'going off like a rocket'!
> Deplin 7.5mg had me laughing and giggling and behaving 'like a silly school girl' within an hour after taking it last eve!
> I thought to myself 'is this what mania feels like?'I'm very happy for you 5F! It feels good to be able laugh and feel well again, doesn't it? Good for you. Get the word out, as best ya can 'cause I suspect Deplin might help several people here in PB land.
I am Bipolar II, so I am very familiar with what hypomania feels like; this is not it. This is just normal. I had forgotten what it feels like to laugh and enjoy the world around me, and enjoy the people around me. Further, Deplin has stopped my dysphoric mood states, which is a blessing to me and my wife.
5f, I can't speak for you, but for me this is NOT hypomania. Instead, it is just a very nice normal.
It's pretty cool when it works, huh?
> It was so much fun and I was so excited, I could hardly settle down to get to bed, but managed to take care of that situation.Yes, I hear ya. I picked up my first script at 9 pm on 10/22, and I was so eager to try it that I did not wait until the next morning. So I took it in the late evening and, like you, I had trouble getting to sleep.
As I stated earlier, I find it best to split my dose and take them morning and early afternoon. You might want to try something similar, as you indicate below.
> I 'SO' 'WAY' hear what you're saying about meds waning Ron, and will keep this in mind.
>
> I've noticed even extended release or slow release meds don't last their official half-times when I'm concerned. Think I'm a megatabolizer!
>
> Prob' should have started on half tab' last eve, b4 I realized how good I could actually feel o_o. Recalled no instructions per pdoc phone conversation. Will try handle appropriately.Same here. The Prescribing Information document makes no reference to splitting the daily dosage. However, splitting the dose works best for me, and it makes sense from the dose response graph.
As you know, Deplin tabs are not scored. When I was taking 7.5 mg/day, I used my teeth to bite the tablet in two. Half of the tablet is outside my mouth and the other half is inside. I set the dry one aside for my early afternoon dose.
I currently take 15 mg/day, but based on what you have written, it sounds to me that 7.5 mg/day will be plenty for you. But, of course, you know what's best.
> As a result of recent labs, was not only told to start folic acid or folate, but also B12 shots monthly, so already got that one covered.
Once the shots get you into the normal B-12 range, I'd bet that you can very easily maintain an optimal level using a sublingual methylcobalamin (methyl-B12) tablet daily.
Sublingual administration works great because the methyl-B12 goes directly into the bloodstream. However, when swallowed down-the-hatch, the intestines transfer only about 1% of the dose to the blood stream.
In my opinion, sublingual administration has a couple advantages over the periodic B-12 shots. First, the B-12 levels in the body stay more constant when the body is supplied the vitamin on daily basis instead of periodic boost followed by a decline over time until the next booster shot.
Second, most people dislike getting poked with needles! Plus, the pt has to drive to the clinic, and pay the copay.
If you think it is important, you might want to take a couple of B-12 blood tests over time in order to determine if you are taking an adequate sublingual dosage.
I posted the following links before, but I'll post them again. The links take you to a site that shows some methylcobalamin products. However, whichever product you buy, make sure it is sublingual and make sure that it is methylcobalamin, absolutely NOT cyanocobalamin.
http://www.iherb.com/Search.aspx?c=1&kw=methylcobalamin
In particular, I like these two the best:
http://www.iherb.com/ProductDetails.aspx?c=1&pid=129&at=0
http://www.iherb.com/ProductDetails.aspx?c=1&pid=117&at=0
The only difference in the two products is the amout of methyl-B12 in the tablets.
> Feelin' a lil guilty about getting down on my pdoc re: lack of commmunication. Think he made a good call here. I'm going to continue down this Deplin path and get every drop of good feeling out of it I can.5f, do me a favor if you have time. Tell me your dx and list all of the meds and dosages that you take.
Thanks. I'm happy for you! Relief at last!!
When you reply, change the subject line of your post to reflect your positive response to Deplin. It might cause more people to read this thread if they see that you also are finding success with Deplin.
Congratulations. Let's hope Deplin continues to work over the long term. To me, it feels like it will, but as always, time will tell.
-- Ron
Currently in 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
4 pumps of Androgel testosterone on a prn basis.
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Dr. Bob is Robert Hsiung, MD,
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Script revised: February 4, 2008
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