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Serum folate, vitamin B12, and homocysteine in major depressive disorder, Part 2: predictors of relapse during the continuation phase of pharmacotherapy.

Abstract

OBJECTIVE

In the present study, we assessed the relationship between serum folate, vitamin B12, and homocysteine levels on the rate of relapse in outpatients with remitted major depressive disorder (MDD) during a 28-week continuation phase of treatment with fluoxetine.

METHOD

Seventy-one outpatients (mean +/- SD age = 40.2 +/- 11.1 years; 56.3% women) with MDD (as assessed with the Structured Clinical Interview for DSM-III-R) who had remitted and who were enrolled in the continuation phase of treatment with fluoxetine had serum folate, vitamin B12, and homocysteine measurements completed at baseline (prior to acute-phase treatment). Patients were followed for 28 weeks of continued treatment with fluoxetine 40 mg/day to monitor for depressive relapse. Folate levels were classified as either low (< or = 2.5 ng/mL) or normal. Vitamin B12 levels were classified as either low (< or = 200 pg/mL) or normal. Homocysteine levels were classified as either elevated (> or = 13.2 micromol/L) or normal. With the use of separate logistic regressions, we then assessed the relationship between folate, vitamin B12, and homocysteine level status and relapse. The study was conducted from November 1992 to January 1999.

RESULTS

The presence of low serum folate levels (p =.004), but not low B12 (p >.05) or elevated homocysteine levels (p >.05), was associated with relapse during continuation treatment with fluoxetine. The relapse rates for patients with (N = 7) and without (N = 64) low folate levels were 42.9% versus 3.2%, respectively.

CONCLUSION

Low serum folate levels were found to place patients with remitted MDD at risk for depressive relapse during the continuation phase of treatment with fluoxetine.

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  • Authors+Show Affiliations

    ,

    Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. gpapakostas@partners.org

    , , , , , , ,

    Source

    The Journal of clinical psychiatry 65:8 2004 Aug pg 1096-8

    MeSH

    Adult
    Ambulatory Care
    Depressive Disorder
    Drug Administration Schedule
    Female
    Fluoxetine
    Folic Acid
    Follow-Up Studies
    Homocysteine
    Humans
    Male
    Probability
    Psychiatric Status Rating Scales
    Recurrence
    Serotonin Uptake Inhibitors
    Treatment Outcome
    Vitamin B 12

    Pub Type(s)

    Clinical Trial
    Comparative Study
    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    15323595

    Citation

    Papakostas, George I., et al. "Serum Folate, Vitamin B12, and Homocysteine in Major Depressive Disorder, Part 2: Predictors of Relapse During the Continuation Phase of Pharmacotherapy." The Journal of Clinical Psychiatry, vol. 65, no. 8, 2004, pp. 1096-8.
    Papakostas GI, Petersen T, Mischoulon D, et al. Serum folate, vitamin B12, and homocysteine in major depressive disorder, Part 2: predictors of relapse during the continuation phase of pharmacotherapy. J Clin Psychiatry. 2004;65(8):1096-8.
    Papakostas, G. I., Petersen, T., Mischoulon, D., Green, C. H., Nierenberg, A. A., Bottiglieri, T., ... Fava, M. (2004). Serum folate, vitamin B12, and homocysteine in major depressive disorder, Part 2: predictors of relapse during the continuation phase of pharmacotherapy. The Journal of Clinical Psychiatry, 65(8), pp. 1096-8.
    Papakostas GI, et al. Serum Folate, Vitamin B12, and Homocysteine in Major Depressive Disorder, Part 2: Predictors of Relapse During the Continuation Phase of Pharmacotherapy. J Clin Psychiatry. 2004;65(8):1096-8. PubMed PMID: 15323595.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Serum folate, vitamin B12, and homocysteine in major depressive disorder, Part 2: predictors of relapse during the continuation phase of pharmacotherapy. AU - Papakostas,George I, AU - Petersen,Timothy, AU - Mischoulon,David, AU - Green,Cassandra H, AU - Nierenberg,Andrew A, AU - Bottiglieri,Teodoro, AU - Rosenbaum,Jerrold F, AU - Alpert,Jonathan E, AU - Fava,Maurizio, PY - 2004/8/25/pubmed PY - 2004/9/24/medline PY - 2004/8/25/entrez SP - 1096 EP - 8 JF - The Journal of clinical psychiatry JO - J Clin Psychiatry VL - 65 IS - 8 N2 - OBJECTIVE: In the present study, we assessed the relationship between serum folate, vitamin B12, and homocysteine levels on the rate of relapse in outpatients with remitted major depressive disorder (MDD) during a 28-week continuation phase of treatment with fluoxetine. METHOD: Seventy-one outpatients (mean +/- SD age = 40.2 +/- 11.1 years; 56.3% women) with MDD (as assessed with the Structured Clinical Interview for DSM-III-R) who had remitted and who were enrolled in the continuation phase of treatment with fluoxetine had serum folate, vitamin B12, and homocysteine measurements completed at baseline (prior to acute-phase treatment). Patients were followed for 28 weeks of continued treatment with fluoxetine 40 mg/day to monitor for depressive relapse. Folate levels were classified as either low (< or = 2.5 ng/mL) or normal. Vitamin B12 levels were classified as either low (< or = 200 pg/mL) or normal. Homocysteine levels were classified as either elevated (> or = 13.2 micromol/L) or normal. With the use of separate logistic regressions, we then assessed the relationship between folate, vitamin B12, and homocysteine level status and relapse. The study was conducted from November 1992 to January 1999. RESULTS: The presence of low serum folate levels (p =.004), but not low B12 (p >.05) or elevated homocysteine levels (p >.05), was associated with relapse during continuation treatment with fluoxetine. The relapse rates for patients with (N = 7) and without (N = 64) low folate levels were 42.9% versus 3.2%, respectively. CONCLUSION: Low serum folate levels were found to place patients with remitted MDD at risk for depressive relapse during the continuation phase of treatment with fluoxetine. SN - 0160-6689 UR - https://www.unboundmedicine.com/medline/citation/15323595/full_citation L2 - http://www.psychiatrist.com/jcp/article/pages/2004/v65n08/v65n0811.aspx DB - PRIME DP - Unbound Medicine ER -