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Treatment of depression: time to consider folic acid and vitamin B12.

Abstract

We review the findings in major depression of a low plasma and particularly red cell folate, but also of low vitamin B12 status. Both low folate and low vitamin B12 status have been found in studies of depressive patients, and an association between depression and low levels of the two vitamins is found in studies of the general population. Low plasma or serum folate has also been found in patients with recurrent mood disorders treated by lithium. A link between depression and low folate has similarly been found in patients with alcoholism. It is interesting to note that Hong Kong and Taiwan populations with traditional Chinese diets (rich in folate), including patients with major depression, have high serum folate concentrations. However, these countries have very low life time rates of major depression. Low folate levels are furthermore linked to a poor response to antidepressants, and treatment with folic acid is shown to improve response to antidepressants. A recent study also suggests that high vitamin B12 status may be associated with better treatment outcome. Folate and vitamin B12 are major determinants of one-carbon metabolism, in which S-adenosylmethionine (SAM) is formed. SAM donates methyl groups that are crucial for neurological function. Increased plasma homocysteine is a functional marker of both folate and vitamin B12 deficiency. Increased homocysteine levels are found in depressive patients. In a large population study from Norway increased plasma homocysteine was associated with increased risk of depression but not anxiety. There is now substantial evidence of a common decrease in serum/red blood cell folate, serum vitamin B12 and an increase in plasma homocysteine in depression. Furthermore, the MTHFR C677T polymorphism that impairs the homocysteine metabolism is shown to be overrepresented among depressive patients, which strengthens the association. On the basis of current data, we suggest that oral doses of both folic acid (800 microg daily) and vitamin B12 (1 mg daily) should be tried to improve treatment outcome in depression.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    MRC Neuropsychiatric Research Laboratory, Epsom, Surrey, UK. acoppen@globalnet.co.uk

    Source

    MeSH

    Brain
    Depressive Disorder, Major
    Folic Acid
    Folic Acid Deficiency
    Homocysteine
    Humans
    Methylenetetrahydrofolate Reductase (NADPH2)
    Nutritional Status
    Treatment Outcome
    Vitamin B 12
    Vitamin B 12 Deficiency

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    15671130

    Citation

    Coppen, Alec, and Christina Bolander-Gouaille. "Treatment of Depression: Time to Consider Folic Acid and Vitamin B12." Journal of Psychopharmacology (Oxford, England), vol. 19, no. 1, 2005, pp. 59-65.
    Coppen A, Bolander-Gouaille C. Treatment of depression: time to consider folic acid and vitamin B12. J Psychopharmacol (Oxford). 2005;19(1):59-65.
    Coppen, A., & Bolander-Gouaille, C. (2005). Treatment of depression: time to consider folic acid and vitamin B12. Journal of Psychopharmacology (Oxford, England), 19(1), pp. 59-65.
    Coppen A, Bolander-Gouaille C. Treatment of Depression: Time to Consider Folic Acid and Vitamin B12. J Psychopharmacol (Oxford). 2005;19(1):59-65. PubMed PMID: 15671130.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Treatment of depression: time to consider folic acid and vitamin B12. AU - Coppen,Alec, AU - Bolander-Gouaille,Christina, PY - 2005/1/27/pubmed PY - 2005/4/13/medline PY - 2005/1/27/entrez SP - 59 EP - 65 JF - Journal of psychopharmacology (Oxford, England) JO - J. Psychopharmacol. (Oxford) VL - 19 IS - 1 N2 - We review the findings in major depression of a low plasma and particularly red cell folate, but also of low vitamin B12 status. Both low folate and low vitamin B12 status have been found in studies of depressive patients, and an association between depression and low levels of the two vitamins is found in studies of the general population. Low plasma or serum folate has also been found in patients with recurrent mood disorders treated by lithium. A link between depression and low folate has similarly been found in patients with alcoholism. It is interesting to note that Hong Kong and Taiwan populations with traditional Chinese diets (rich in folate), including patients with major depression, have high serum folate concentrations. However, these countries have very low life time rates of major depression. Low folate levels are furthermore linked to a poor response to antidepressants, and treatment with folic acid is shown to improve response to antidepressants. A recent study also suggests that high vitamin B12 status may be associated with better treatment outcome. Folate and vitamin B12 are major determinants of one-carbon metabolism, in which S-adenosylmethionine (SAM) is formed. SAM donates methyl groups that are crucial for neurological function. Increased plasma homocysteine is a functional marker of both folate and vitamin B12 deficiency. Increased homocysteine levels are found in depressive patients. In a large population study from Norway increased plasma homocysteine was associated with increased risk of depression but not anxiety. There is now substantial evidence of a common decrease in serum/red blood cell folate, serum vitamin B12 and an increase in plasma homocysteine in depression. Furthermore, the MTHFR C677T polymorphism that impairs the homocysteine metabolism is shown to be overrepresented among depressive patients, which strengthens the association. On the basis of current data, we suggest that oral doses of both folic acid (800 microg daily) and vitamin B12 (1 mg daily) should be tried to improve treatment outcome in depression. SN - 0269-8811 UR - https://www.unboundmedicine.com/medline/citation/15671130/full_citation L2 - http://journals.sagepub.com/doi/full/10.1177/0269881105048899?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -