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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 31. This is the beginning of the thread.
Posted by Phillipa on March 21, 2011, at 21:25:35
Seems folate is emerging as a tx for treatment resistant depression boasts dopamine, serotonin, norepenephine. From MedScape News. Phillipa
Adjunctive L-Methylfolate May Help in Treatment-Resistant Depression
Folate Deficiency Common in Major Depression
Jill SteinAuthors and Disclosures
Information from Industry
Therapeutic Goals in Major Depressive Disorder (MDD)
In a survey published in JAMA in 2003, <22% of respondents who received MDD treatment in the past 12 months considered their treatment adequate.
Learn more March 18, 2011 (Vienna, Austria) L-methylfolate is showing promise as an augmenting agent for depressed patients who are unresponsive to traditional antidepressants, new research suggested.Presented here at EPA 2011: 19th European Congress of Psychiatry, the study results revealed L-methylfolate, 15 mg/d, was effective, safe, and relatively well tolerated as an adjunct treatment strategy for patients with major depressive disorder (MDD) who were partial responders or nonresponders to selective serotonin reuptake inhibitor (SSRI) therapy.
"According to the literature, only about 1 of every 3 patients with depression will achieve remission with standard antidepressant monotherapy," principal investigator George Papakostas, MD, who is director of treatment-resistant depression (TRD) studies, Psychiatry Division at Massachusetts General Hospital and associate professor of psychiatry at Harvard Medical School in Boston, told Medscape Medical News.
"So it's clear that we need better therapies for depression. We found that L-methylfolate, 15 mg/d, produced favorable results, but the data are preliminary and need to be replicated in a larger trial," he added.
For the roughly two-thirds of patients who are inadequate responders or nonresponders, augmentation strategies or switching strategies altogether are indicated, he added.
A variety of treatment options are available, including atypical agents, folates, or lithium, but the choice of therapy ultimately depends on the patient's individual profile and his/her personal preference.
Dr. Papakostas presented results from 2 multicenter, placebo-controlled trials of L-methylfolate used as an adjunct to SSRI therapy in patients with SSRI-resistant MDD who were 18 to 65 years of age. SSRI doses remained constant throughout the 2 TRD studies, which enrolled a total of 223 patients.
Folate Deficiency Common in MDD
Roughly 70% of patients with MDD have a specific genetic factor that causes L-methylfolate deficiency. Individuals with deficient L-methylfolate are more likely to experience a later onset of action, less improvement, a more severe depressive episode, and a higher chance of relapse when taking conventional antidepressants.
Several studies have examined the use of folic acid or various folic acid metabolites, such as folinic acid and methyltetrahydrofolate, as either monotherapy or adjunctive therapy for MDD.
L-methylfolate was selected as the augmenting agent in the 2 TRD studies because of evidence suggesting it may have advantages with respect to bioavailability over other folates. L-methylfolate is thought to work as an augmenting agent to antidepressants by acting as a trimonoamine modulator, enhancing the synthesis of the 3 monoamines, dopamine, norepinephrine, and serotonin, and thereby boosting the efficacy of antidepressants.
Significant Benefit
In the TRD-1 study, 148 patients were randomized in a 2:3:3 design to receive either L-methylfolate for 60 days (7.5 mg/d in phase 1 and 15 mg/d in phase 2), placebo for 30 days followed by L-methylfolate for 30 days (7.5 mg/d), or placebo for 60 days.
The 75-patient TRD-2 was identical in design to TRD-1 except for a target dose of 15 mg/d of L-methylfolate throughout both phases.
The coprimary endpoints for both studies were the differences in response rates and in degree of improvement in the Hamilton Depression Rating Scale (HDRS-17) between treatment groups. An HDRS-17 response was defined asa 50% or greater reduction in HDRS-17 scale scores during treatment or a final score of 7 or less.
The TRD-1 study found no difference in outcome between the treatment groups.
The TRD-2 study showed greater efficacy for adjunctive 15 mg/d of L-methylfolate administered for up to 30 days vs placebo when added to continued SSRI therapy plus placebo on both primary outcome measures (degree of change and response rates according to the HDRS, P = .05 and .04, respectively).
There was no difference in the rates of treatment withdrawal due to adverse events in the L-methylfolate 15 mg/d/antidepressant and the placebo/antidepressant groups.
Finally, the number of patients needed to treat (NNT) for a response in the TRD-2 study was between 5 and 6 patients in favor of adjunctive 15 mg/dof L-methylfolate vs placebo. "This is on a par with NNTs reported for other augmentation strategies in MDD," Dr. Papakostas said
Posted by Phillipa on March 21, 2011, at 21:37:05
In reply to L-Methylfolate Found To Work With TX RES DEPressio, posted by Phillipa on March 21, 2011, at 21:25:35
Deplin isn't a new topic on this board. If a gene variant is responsible for some not getting enough folate could explain why so few did that well on it. Phillipa
http://www.cnsspectrums.com/aspx/articledetail.aspx?articleid=1267
Posted by Christ_empowered on March 22, 2011, at 13:21:35
In reply to L-Methylfolate Found To Work With TX RES DEPressio, posted by Phillipa on March 21, 2011, at 21:25:35
Hopefully deplin will catch on and more doctors will try that before resorting to the "atypical" antipsychotics. Even though I take an "atypical," it bothers me that they're being given to people who don't really need a major tranquilizer.
Posted by linkadge on March 22, 2011, at 16:19:36
In reply to great news, posted by Christ_empowered on March 22, 2011, at 13:21:35
>Roughly 70% of patients with MDD have a specific >genetic factor that causes L-methylfolate >deficiency.
Are there any large studies which show this?
I noticed that you could purchase l-methylfolate in canada (1mg tabs) without a prescription. Is methylfolate available in the states OTC?
Linkadge
Posted by Phillipa on March 22, 2011, at 20:02:56
In reply to Re: great news, posted by linkadge on March 22, 2011, at 16:19:36
Link no need a doc's RX. I think Ron Hill takes it. No formal studies. I truly wish I did!!! Phillipa
Posted by hansi555 on March 23, 2011, at 13:14:44
In reply to L-Methylfolate Found To Work With TX RES DEPressio, posted by Phillipa on March 21, 2011, at 21:25:35
Seems almost to good to be true:
http://www.drugs.com/comments/l-methylfolate/for-depression.html
Posted by linkadge on March 23, 2011, at 14:09:49
In reply to Re: L-Methylfolate Found To Work With TX RES DEPressio, posted by hansi555 on March 23, 2011, at 13:14:44
Yeah,
I'm wondering how many people would simply respond to folic acid supplementation vs. deplin.
I have been reading a bit about the so called dysfunctional gene which involves the conversion of folates to methylfolate. Apparently even if you have the dysfunctional genes, this only results in a small reduction in the ability of the body to produce methylfolate. If this is true, I would think that folic acid supplementation would also help. There are some studies showing that prozac + folic acid is better than folic acid alone. Alas, some people need a "prescription".
Linkadge
Posted by hansi555 on March 23, 2011, at 16:10:04
In reply to Re: L-Methylfolate Found To Work With TX RES DEPressio, posted by linkadge on March 23, 2011, at 14:09:49
From what I have read, the acid alone would have to be taken in huge amounts to make it equil to 7,5 mg Deplin.
I am wondering if Deplin is available in Europe?
Posted by linkadge on March 23, 2011, at 20:02:13
In reply to Re: L-Methylfolate Found To Work With TX RES DEPressio, posted by hansi555 on March 23, 2011, at 16:10:04
Not to get too pessimistic, but high folic acid levels have been associated with certain cancers.
I would personally like to use it in association with some sort of level test.
It could be working in depression as does thyroid (ie. supraphysiological levels improving depression), but this may come with adverse biological effects.
Linkadge
Posted by Phillipa on March 23, 2011, at 21:30:18
In reply to Re: L-Methylfolate Found To Work With TX RES DEPressio, posted by hansi555 on March 23, 2011, at 13:14:44
Hansi good reviews. I was on it stopped as having surgery and didn't want to scew the results of bloodwork as can effect is it B12? Maybe half a pill at first. I do know I felt nothing different when taking it before. I do have the remains of that RX probably two years old wonder if still good? Phillipa
Posted by Phillipa on March 23, 2011, at 22:11:53
In reply to Re: L-Methylfolate Found To Work With TX RES DEPressio, posted by linkadge on March 23, 2011, at 20:02:13
Link folate is given to pregnant women to help prevent neural tube defects. So where does cancer fit in not that what I said is connected to the other? Phillipa
Posted by morgan miller on March 24, 2011, at 9:20:34
In reply to Re: great news, posted by linkadge on March 22, 2011, at 16:19:36
> >Roughly 70% of patients with MDD have a specific >genetic factor that causes L-methylfolate >deficiency.
>
> Are there any large studies which show this?
>
> I noticed that you could purchase l-methylfolate in canada (1mg tabs) without a prescription. Is methylfolate available in the states OTC?
>
> LinkadgeYep, I buy it at the organic grocery store I work at(sort of a Ma and Pa Wholefoods). The Vitamin Shoppe will have it.
Posted by morgan miller on March 24, 2011, at 9:24:51
In reply to Re: L-Methylfolate Found To Work With TX RES DEPressio, posted by linkadge on March 23, 2011, at 20:02:13
>Not to get too pessimistic, but high folic acid levels have been associated with certain cancers.
Yes they have. Some over at Imminst/Longecity have theorized that the form of folic acid put in foods and supplements that needs to be converted, and as a result may not get fully absorbed. This could result in left over products that might explain the cancer causing effects. We MAY not have to worry about this as much with l-methylfolate.
Morgan
Posted by hansi555 on March 24, 2011, at 10:24:12
In reply to Re: great news, posted by linkadge on March 22, 2011, at 16:19:36
So 7,5 of this pill would do the same as one 7,5 Deplin pill:
> >Roughly 70% of patients with MDD have a specific >genetic factor that causes L-methylfolate >deficiency.
>
> Are there any large studies which show this?
>
> I noticed that you could purchase l-methylfolate in canada (1mg tabs) without a prescription. Is methylfolate available in the states OTC?
>
> Linkadge
Posted by Phillipa on March 24, 2011, at 20:31:54
In reply to Re: great news, posted by morgan miller on March 24, 2011, at 9:20:34
Morgan the Vitamin Shoppe that is where I shop. Do you take the equivalent of 7.5mg of Deplin? Notice anything good. What type of CA's noticed warnings about the B12 aplastic anemia I think it was. Phillipa
Posted by mogger on March 25, 2011, at 15:16:55
In reply to Re: great news » morgan miller, posted by Phillipa on March 24, 2011, at 20:31:54
My Psychiatrist is one of the heads at UCLA and he says it is very promising but he says Deplin is expensive. I trust him. Does anyone know what vitamin company makes the highest potency of L-Methylfolate? Thanks,
Joseph
Posted by hansi555 on March 25, 2011, at 15:50:52
In reply to Re: great news » Phillipa, posted by mogger on March 25, 2011, at 15:16:55
> My Psychiatrist is one of the heads at UCLA and he says it is very promising but he says Deplin is expensive. I trust him. Does anyone know what vitamin company makes the highest potency of L-Methylfolate? Thanks,
>
> JosephCompared to other "promising" medicines for depression, this really seems to the most really promising:
http://www.healthcentral.com/depression/c/49/16751/comments
You can get it here w/o prescription, but you would need 7,5 pills to equal one 7,5 mg Deplin pill:
Posted by mogger on March 25, 2011, at 17:05:50
In reply to Re: great news + more good reviews, posted by hansi555 on March 25, 2011, at 15:50:52
Does anyone have experience taking lower doses or does the minimum dose have to be 15mg to be effective? Thanks,
Joseph
Posted by Phillipa on March 25, 2011, at 21:31:54
In reply to Re: great news » Phillipa, posted by mogger on March 25, 2011, at 15:16:55
I don't remember what I paid for it seriously your pdoc thinks it's a good med? Did he say what he thought it would be best for treating? Thanks still have some. It couldn't have been that expensive as have medicaire? Phillipa
Posted by mogger on March 25, 2011, at 21:41:22
In reply to Re: great news » mogger, posted by Phillipa on March 25, 2011, at 21:31:54
Yes Phillipa my doctor says it is very promising. My sister and I completely trust him not only for his merits but his demeanor as has treated us both and saved our lives. He said that it is a promising adjunct to antidepressants but didn't expand on that as I was just emailing him after forwarding your excellent article. If you still have some jump on it! :)
Posted by Phillipa on March 25, 2011, at 22:02:44
In reply to Re: great news » Phillipa, posted by mogger on March 25, 2011, at 21:41:22
Mogger you shared with doc that's impressive that he feels it's a good med for ad's. Please keep me posted on anything else he/she may say on Deplin. I'd like to try it again. I forget also morning or night? I do remember one person doing extremly well on Deplin here but most others didn't. I do think Ron Hill is still using some not sure? Phillipa
Posted by mogger on March 27, 2011, at 12:39:43
In reply to Re: great news » mogger, posted by Phillipa on March 25, 2011, at 22:02:44
He just said it was to be taken once a day in the morning. I will definitely keep you updated for sure but I will really be interested to see how you feel on it!
Joseph
Posted by Phillipa on March 27, 2011, at 19:55:51
In reply to Re: great news » Phillipa, posted by mogger on March 27, 2011, at 12:39:43
I will have to find the bottle and see how many I took and then see if enough left for a fair trial. See her in about a week and a half. Don't remember any side effects though? Phillipa
Posted by mogger on March 27, 2011, at 21:07:04
In reply to Re: great news » mogger, posted by Phillipa on March 27, 2011, at 19:55:51
no side effects reported so nothing to lose.
Posted by Phillipa on March 27, 2011, at 23:59:05
In reply to Re: great news » Phillipa, posted by mogger on March 27, 2011, at 21:07:04
And can't find the Deplin. Looked so will have to wait. What is the cost? I don't remember it costing a lot. Phillipa
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