Thursday, June 16, 2011

Folate can help with depression

 The co-editor for Journal of Psychiatry and Neuroscience wrote an editorial in 2007 on the importance of folate supplements in treating depression. The title was folate and depression - a neglected problem. He had this to say:
The current explosion of work on serotonin [genetics] ...... is in sharp contrast to the much smaller number of recent studies on an entirely reversible environmental factor known to lower serotonin synthesis—folate deficiency
Ok so current researchers are not looking at the most easily corrected issue. Folate deficiency, or sub optimal levels can be easily changed by a simple vitamin pill.

Many studies, going back to the 1960s, show an elevated incidence of folate deficiency in patients with depression. Studies vary depending on the criteria used to define folate deficiency, but often, about one-third of depression patients were deficient. Given that depression is often accompanied by decreased appetite and weight loss, the high incidence of folate deficiency in depression patients is not surprising. However, there is some evidence, though not conclusive, that folate deficiency may be involved in the etiology of depression in a minority of patients. Alternatively, depressed mood may decrease appetite, lower folate levels and thereby help to prevent recovery from depression.
So for over 50 years we have know that depressed patients might have folate deficiency, yet doctors still don't recommend folate supplements to depressed patients. This really makes me mad and drives my motivation to blog. For I don't speak, then who will ?! Furthermore if you don't have folate deficiency when you begin your depression journey, due to eating habits you are likely to develop it, which then can keep you depressed !    
The conclusion was that daily dosages of 0.8 mg folic acid or more, in addition to dietary intake, are typically required to achieve the maximal reduction in plasma homocysteine concentrations (about 25%). Vitamin B12 (0.4 mg/day) produced a further 7% reduction
So any supplement should be at least 0.8 mg

Given the low cost of folate tablets (1 mg folic acid tablets can cost less than 5 cents each), there is no economic reason to avoid giving folate to all patients with depression, 
This  is the insanity of not using supplements. Supplements are very cheap compared to a drug. In NZ drugs are subsidized, so we don't directly see the cost of medication. This often means that a good multi supplement is more expensive to the consumer, than some prescribed drug.
Several concerns have been raised about the supplementation of food with folate. The main concern relevant to the short-term use of folate supplements in depression patients is the possible masking of vitamin B12 deficiency symptoms. For this reason, it might be prudent to add a vitamin B12 supplement to the folate
Ok, so take B12 as well. I would recommend a good B multi instead of just folate (or folate + B12). This means you cover your bases so to speak.
What about the recommendation that 2 mg of folate be given during the acute, continuation and maintenance treatment of depression? The actual dosage may be debatable; 1 mg may suffice, particularly in countries where there is voluntary or compulsory fortification of food with folate, and the addition of a vitamin B12 supplement may be prudent, but the general principle is reasonable. With our current knowledge, the potential benefits seem to far outweigh any disadvantages.
So in summary, take folate for depression, in high doses as part of a B multi that has B12 in its formulation. 

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