L-Methylfolate, SSRI Synergies

NEW ORLEANSAdding an L-methylfolate prescription medical food to pharmaceutical antidepressant treatment is more effective than drug monotherapy, according to a study (Abstract NR3-46) presented at the American Psychiatric Association (APA) 2010 Annual Meeting here, and reported by Medscape. Investigators from Red Oak Psychiatry Associates, Houston, conducted a large retrospective medical record review study examining the impact of L-methylfolate (as Deplin, from Pamlab) on the efficacy of selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs) in addressing symptoms of depression. The combination group had greater improvements in depressive symptoms compared to monotherapy, and the improvements occurred 23 percent faster.

We found that adding L-methylfolate to an antidepressant at the start of treatment has valuable benefits for these patients, said Lawrence D. Ginsberg, M.D., the principal investigator. The shorter time to improvement strongly implies that combination strategies right from the start may be a more time-efficient approach than antidepressant monotherapy.

The research team evaluated the medical records of 242 adult patients who received either just SSRI or SNRI, or the antidepressant with Deplin at 7.5 to 15 mg. Significantly more of the combination-treated patients showed the two-point reduction on the depressant scale at the 60 day time point, compared with monotherapy. Combination treatment also was more effective in patients with the highest severity score at baseline, and it also resulted in a lower rate of discontinuation of antidepressant therapy due to adverse events.

Don Hilty, M.D., professor of psychiatry and behavioral sciences at the University of CaliforniaDavis, Sacramento, co-chair of the APA Scientific Program Committee, told Medscape Psychiatry the relationship between folate deficiency and depression has long been under investigation. He commented, The important takeaways are that we need to be mindful about folate deficiencies and should probably try medical foods in patients who havent responded to traditional treatments. Also, even though there aren't any real clear side effects from supplements like this, we have to be mindful to watch and see if there are any interactions with prescribed medications.