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Folate for depressive disorders.

Abstract

BACKGROUND

There are a number of effective interventions for the treatment of depression. It is possible that the efficacy of these treatments will be improved further by the use of adjunctive therapies such as folate.

OBJECTIVES

1. To determine the effectiveness of folate in the treatment of depression 2. To determine the adverse effects and acceptability of treatment with folate.

SEARCH STRATEGY

The Cochrane Controlled Trials Register (CCTR), and the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (CCDANCTR) incorporating results of group searches of EMBASE, MEDLINE, LILACS, CINAHL, PSYNDEX and PsycLIT were searched. Reference lists of relevant papers and major textbooks of affective disorder were checked. Experts in the field and pharmaceutical companies were contacted regarding unpublished material.

SELECTION CRITERIA

All randomised controlled trials that compared treatment with folic acid or 5'-methyltetrahydrofolic acid to an alternative treatment, whether another antidepressant medication or placebo, for patients with a diagnosis of depressive disorder (diagnosed according to explicit criteria).

DATA COLLECTION AND ANALYSIS

Data were independently extracted from the original reports by two reviewers. Statistical analysis was conducted using Review Manager version 4.1.

MAIN RESULTS

Three trials involving 247 people were included. Two studies involving 151 people assessed the use of folate in addition to other treatment, and found that adding folate reduced Hamilton Depression Rating Scale scores on average by a further 2.65 points (95% confidence interval 0.38 to 4.93). Fewer patients treated with folate experienced a reduction in their HDRS score of less than 50% at ten weeks (relative risk (RR) 0.47, 95% CI 0.24 to 0.92) The number needed to treat with folate for one additional person to experience a 50% reduction on this scale was 5 (95% confidence interval 4 to 33). One study involving 96 people assessed the use of folate instead of the antidepressant trazodone and did not find a significant benefit from the use of folate. The trials identified did not find evidence of any problems with the acceptability or safety of folate.

REVIEWER'S CONCLUSIONS

The limited available evidence suggests folate may have a potential role as a supplement to other treatment for depression. It is currently unclear if this is the case both for people with normal folate levels, and for those with folate deficiency.

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  • Authors+Show Affiliations

    ,

    Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK, OX3 7JK. john.geddes@psych.ox.ac.uk

    , ,

    Source

    MeSH

    Antidepressive Agents
    Depressive Disorder
    Drug Therapy, Combination
    Folic Acid
    Humans
    Randomized Controlled Trials as Topic

    Pub Type(s)

    Journal Article
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    12804463

    Citation

    Taylor, M J., et al. "Folate for Depressive Disorders." The Cochrane Database of Systematic Reviews, 2003, p. CD003390.
    Taylor MJ, Carney S, Geddes J, et al. Folate for depressive disorders. Cochrane Database Syst Rev. 2003.
    Taylor, M. J., Carney, S., Geddes, J., & Goodwin, G. (2003). Folate for depressive disorders. The Cochrane Database of Systematic Reviews, (2), p. CD003390.
    Taylor MJ, et al. Folate for Depressive Disorders. Cochrane Database Syst Rev. 2003;(2)CD003390. PubMed PMID: 12804463.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Folate for depressive disorders. AU - Taylor,M J, AU - Carney,S, AU - Geddes,J, AU - Goodwin,G, PY - 2003/6/14/pubmed PY - 2003/7/29/medline PY - 2003/6/14/entrez SP - CD003390 EP - CD003390 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 2 N2 - BACKGROUND: There are a number of effective interventions for the treatment of depression. It is possible that the efficacy of these treatments will be improved further by the use of adjunctive therapies such as folate. OBJECTIVES: 1. To determine the effectiveness of folate in the treatment of depression 2. To determine the adverse effects and acceptability of treatment with folate. SEARCH STRATEGY: The Cochrane Controlled Trials Register (CCTR), and the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (CCDANCTR) incorporating results of group searches of EMBASE, MEDLINE, LILACS, CINAHL, PSYNDEX and PsycLIT were searched. Reference lists of relevant papers and major textbooks of affective disorder were checked. Experts in the field and pharmaceutical companies were contacted regarding unpublished material. SELECTION CRITERIA: All randomised controlled trials that compared treatment with folic acid or 5'-methyltetrahydrofolic acid to an alternative treatment, whether another antidepressant medication or placebo, for patients with a diagnosis of depressive disorder (diagnosed according to explicit criteria). DATA COLLECTION AND ANALYSIS: Data were independently extracted from the original reports by two reviewers. Statistical analysis was conducted using Review Manager version 4.1. MAIN RESULTS: Three trials involving 247 people were included. Two studies involving 151 people assessed the use of folate in addition to other treatment, and found that adding folate reduced Hamilton Depression Rating Scale scores on average by a further 2.65 points (95% confidence interval 0.38 to 4.93). Fewer patients treated with folate experienced a reduction in their HDRS score of less than 50% at ten weeks (relative risk (RR) 0.47, 95% CI 0.24 to 0.92) The number needed to treat with folate for one additional person to experience a 50% reduction on this scale was 5 (95% confidence interval 4 to 33). One study involving 96 people assessed the use of folate instead of the antidepressant trazodone and did not find a significant benefit from the use of folate. The trials identified did not find evidence of any problems with the acceptability or safety of folate. REVIEWER'S CONCLUSIONS: The limited available evidence suggests folate may have a potential role as a supplement to other treatment for depression. It is currently unclear if this is the case both for people with normal folate levels, and for those with folate deficiency. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/12804463/full_citation L2 - https://doi.org/10.1002/14651858.CD003390 DB - PRIME DP - Unbound Medicine ER -