RE: Deplin - medical food for depression

[Guest guest]

Very interesting, just a methylated form of folate? Never heard the term medical food, or ever heard of this. But when I went to 2d nutrition conference in Nov, did hear a couple lectures about this mutation, mentioned in the link about some people( they said 40% not 70%) not able to add methyl group to their B vits, which then impairs ability for it to enter the cell. That is, it is absorbed into blood, but doesn't get into cell. They were advocating B vit's already methylated which I have seen a little in local nutrition store ads also lately, maybe this new "medical food" is part of why its getting into the lay media now.

There are what are called gene SNP tests to test for this sort of mutation, to help people "choose" what vitamins they really need, or can use better. A simpler way they told us, was to ask patients if they have "neon yellow urine" when they take B vitamins, if so, then they have the mutation. If it is really up to 70% of the population, why not just have everyone take it?

IN any case, I liked the list of drugs they showed that can interfere with methyl folate use/absorbtion, and will likely use that to recommend increased B vits in these patients. B vits are water soluble, so likely people can't hurt themselves unless they really go crazy on them.

Would a naturopath or functional medicine practictioner with more than 2 d of commercial CME comment please?

CCote

To: "Clinical Procedures" , "practiceimprovement1" < >, "Kim Scheuer" , " Locke" , "Bruce Bowen, MD" , "DeWayne Niebur" , "Anne Goyette" , "Dr. Borchers" Sent: Friday, January 6, 2012 9:20:54 AMSubject: Deplin - "medical food" for depression

Anyone using this in their practice? Had a patient Rx'd it by Psych in addition to her Lexapro.

Not sure if it is helping, but interesting.

Just curious what others have thought of it.

Locke, MD

http://www.deplin.com/deplin-and-depression/how-deplin-works/

Deplin®, a medical food, works differently than antidepressants, which are drugs. It contains L-methylfolate, which the brain uses to make more of the neurotransmitters that affect mood. It is known that many people living with depression do not have enough L-methylfolate in their brain. As a result, they have insufficient levels of neurotransmitters, which can lead todepressive symptoms. With enough L-methylfolate and better levels of neurotransmitters, the brain can maintain the chemical reactions that affect mood.

How Deplin® Works

Your doctor may prescribe Deplin®, a medical food, in addition to your antidepressant medication. Many people with depression have an imbalance of L-methylfolate in their central nervous system (the body’s information system) which limits the brain’s ability to create the neurotransmitters that control mood.

[Guest guest]

Thanks for the replies.More info.Drugstore.com...$3/tabhttp://www.drugstore.com/deplin/7-5mg-tablets/qxn00525041030

Deplin - 7.5mg Tablets

QuantityOur Price30 tablets

$95.99 - save 7% ($6.69)90 tablets

$269.98 - save 12% ($38.06)100 tablets

$299.97 - save 12% ($42.29)180 tablets

$504.94 - save 18% ($111.14)=========================================Of note --> L-methylfolate is available by prescription and is regulated by the FDA as a prescription medical food for the specific nutritional requirements of depressed individuals with suboptimal serum, RBC, or CNS folate. It is specifically intended as adjunctive therapy for depressed patients who have only partially responded to antidepressant therapy. However, L-methylfolate may provide benefit to patients with or without serum or RBC folate deficiency, particularly if they are at risk for low neurotransmitter production. 

http://www.ncbi.nlm.nih.gov/pubmed/21311704

Innov Clin Neurosci. 2011 Jan;8(1):19-28.

L-methylfolate Plus SSRI or SNRI from Treatment Initiation Compared to SSRI or SNRI Monotherapy in a Major Depressive Episode.

Ginsberg LD, Oubre AY, Daoud YA.

Source

Dr. Ginsberg is from Red Oak Psychiatry Associates, PA, Houston, Texas.

bjective: Evaluate the efficacy of L-methylfolate in combination with SSRI or SNRI compared to SSRI or SNRI monotherapy in a major depressive episode.

Design: A retrospective analysis of L-methylfolate plus SSRI/SNRI at treatment initiation (n=95) and SSRI/SNRI monotherapy (n=147) from patient charts.

Setting: Outpatient, private psychiatric clinic/practice.

Participants: Adults 18 to 70 with major depressive episode (single or recurrent).

Measurements: Clinical Global Impressions-Severity (CGI-S) and safety/tolerability measures.

Results: Major improvement (CGI-S reduced by ≥2 points) was experienced by 18.5 percent of L-methylfolate plus SSRI/SNRI patients (CGI-S=4–5) compared to 7.04 percent of SSRI/SNRI monotherapy (p=0.01) patients at 60 days. Forty percent of L-methylfolate plus SSRI/SNRI patients with greater functional impairment (CGI-S=5) experienced major improvement compared to 16.3 percent of SSRI/SNRI monotherapy patients (p=0.02). Median times to major improvement were 177 days for L-methylfolate plus SSRI/SNRI patients and 231 days for SSRI/SNRI monotherapy patients (p=0.03). Median time to major improvement for L-methylfolate plus SSRI/SNRI patients with greater functional impairment (CGI-S=5) was 85 days and 150 days for SSRI/SNRI monotherapy patients (p=0.018). There were no significant differences between groups in adverse events. Discontinuation due to adverse events was 17.9 percent in L-methylfolate plus SSRI/SNRI patients compared to 34 percent in the SSRI/SNRI monotherapy patients over duration of the study (p=0.0078).

Conclusion: L-methylfolate plus antidepressant at treatment onset was more effective in improving depressive symptoms and function measured by CGI-S scores within 60 days than antidepressant monotherapy, led to major symptomatic improvement more rapidly than SSRI/SNRI monotherapy, and was better tolerated.

From:Innov Clin Neurosci. 2011 January; 8(1): 19–28.

Copyright/LicenseRequest permission to reuse

Click on image to enlarge

Figure 4

Median time to major improvement (>2-point) in patients with greater functional impairment was 85 days for the L-methylfolate plus SSRI/SNRI group and 150 days for the SSRI/SNRI group (p=0.018). This effect was sustained throughout the observation period (max # of days: L-methylfolate plus SSRI/SNRI 

http://www.cnsspectrums.com/aspx/articledetail.aspx?articleid=1969

Full article at link.The Role of L-methylfolate in Depressive Disorders

The Evidence for L-methylfolate in Depression

There are five trials that examine folate therapy in depressive disorders. In a study59 with patients who had low or borderline low RBC folate, depressed patients on tricyclic antidepressants or MAOIs were augmented with methylfolate 15 mg (L-methylfolate 7.5 mg) experienced significantly greater clinical improvement and social improvement at 3 months (P<.02) and 6 months (P<.01) compared to patients treated with antidepressants alone. The methylfolate-augmented patients continued to improve for 6 months compared to patients augmented with placebo, and none experienced relapse. In a separate double-blind, controlled trial60 comparing methylfolate 50 mg/day  to trazodone 100 mg/day, depressed patients experienced a significant decrease in HAM-D scores at 4 and 8 weeks in both groups, with response rates in the methylfolate group at 45%, and in the trazodone group (not statistically significant) at 29%.

An open label trial61 of methylfolate as monotherapy in elderly depressed subjects demonstrated an 81% response rate (>50% reduction in HAM-D) by 6 weeks of therapy. A second monotherapy study examined a depressed population of 36 chronic alcoholics. After a week of placebo wash-out, subjects received 4 weeks of 90 mg methylfolate therapy. This dosing (30 mg TID) significantly improved depressive symptoms based on the HAM-D scale with the majority reporting improved mood and less fatigue (P<.01).62 Alpert and colleagues63 conducted an open label trial augmenting selective serotonin reuptake inhibitor (SSRIs) with folinic acid in patients who had failed at least 4 weeks of SSRI therapy. The response to folinic acid was not robust (P<.01, n=22), but it was well tolerated overall.

Specific Populations that May BenefitDepressed patients are known to be at risk for C677T polymorphism, which translates into lower serum levels of L-methylfolate64 and possibly lower CNS folate, and thus lower monoamine levels. Specific ethnic groups are at higher risk for the less functional forms of MTHFR. The T/T genotype is present in as many as 10% of whites, and up to 22% of samples of Hispanic or Mediterranean populations.26,54Several other groups are also at risk for lower L-methylfolate levels, including substance abusers, smokers, and those with gastrointestinal disorders (Slide 5).   

 

Safety of L-MethylfolateThe standard dose of L-methylfolate for the augmentation of antidepressants is one 7.5 mg tablet/day. No titration is necessary, and it is not associated with withdrawal symptoms at discontinuation. The maximum amount of L-methylfolate that can be absorbed in one dose is ~15 mg.67 If more than one 7.5 mg tablet/day is needed, it may be prudent to give in divided doses. All reported adverse events occur at placebo rates or lower, and overall it is an extremely well tolerated agent, allowing patients to continue L-methylfolate therapy as long as necessary to maintain remission.  There are no known contraindications and no known drug interactions. 

L-methylfolate is available by prescription and is regulated by the FDA as a prescription medical food for the specific nutritional requirements of depressed individuals with suboptimal serum, RBC, or CNS folate. It is specifically intended as adjunctive therapy for depressed patients who have only partially responded to antidepressant therapy. However, L-methylfolate may provide benefit to patients with or without serum or RBC folate deficiency, particularly if they are at risk for low neurotransmitter production. 

===========================http://www.cnsspectrums.com/aspx/articledetail.aspx?articleid=1267

Novel Therapeutics for Depression: L-methylfolate as a Trimonoamine Modulator and Antidepressant-Augmenting Agent

ew Trend in Psychopharmacology

Folate deficiency may increase the risk of depression and reduce the action of antidepressants. Individuals with an inherited polymorphism that reduces the efficiency of folate formation may be at high risk for folate deficiency and for major depression. Antidepressant effects have been reported when antidepressants are augmented with folic acid, folinic acid, or the centrally active L-methylfolate (known formally as (6(S)-5-methyltetrahydrofolate [MTHF]), particularly in depressed patients with folate deficiency whose major depressive episodes have failed to respond to antidepressants. The putative mechanism of action of MTHF as an augmenting agent to antidepressants is that it acts as a trimonoamine modulator (TMM), enhancing the synthesis of the three monoamines: dopamine (DA), norepinephrine (NE), and serotonin (5-HT), resulting in a boost to the efficacy of antidepressants.

==============================

Sounds like we've known about this since the 1980's and 90's.

Enhancement of recovery from psychiatric illness by methylfolate.

Procter A.

Br J Psychiatry. 1991 Aug;159:271-2.

PMID: 

1773245 

[PubMed - indexed for MEDLINE]

Related citations

2.

Enhancement of recovery from psychiatric illness by methylfolate.

Godfrey PS, Toone BK, Carney MW, Flynn TG, Bottiglieri T, Laundy M, Chanarin I, Reynolds EH.

Lancet. 1990 Aug 18;336(8712):392-5.

PMID: 

1974941 

[PubMed - indexed for MEDLINE]

Related citations

3.

Methylfolate and psychiatric illness.

Wing YK, Lee S.

Br J Psychiatry. 1992 May;160:714-5. No abstract available.

PMID: 

1591586 

[PubMed - indexed for MEDLINE]

Related citations

4.

A randomised double-blind placebo-controlled trial of folic acid supplementation of cholinesterase inhibitors in Alzheimer's disease.

Connelly PJ, Prentice NP, Cousland G, Bonham J.

Int J Geriatr Psychiatry. 2008 Feb;23(2):155-60.

PMID: 

17600848 

[PubMed - indexed for MEDLINE]

Related citations

5.

The biology of folate in depression: implications for nutritional hypotheses of the psychoses.

Abou-Saleh MT, Coppen A.

J Psychiatr Res. 1986;20(2):91-101. Review.

PMID: 

3525819 

[PubMed - indexed for MEDLINE]

Related citations

6.

Folic acid with or without vitamin B12 for cognition and dementia.

Malouf M, Grimley EJ, Areosa SA.

Cochrane Database Syst Rev. 2003;(4):CD004514. Review. Update in: Cochrane Database Syst Rev. 2008;(4):CD004514.

PMID: 

14584018 

[PubMed - indexed for MEDLINE]

Related citations

7.

Enhancement of recovery from psychiatric illness by methylfolate.

Bottiglieri T, Hyland K, Laundy M, Godfrey P, Carney MW, Toone BK, Reynolds EH.

Lancet. 1990 Dec 22-29;336(8730):1579-80. No abstract available.

PMID: 

1979390 

[PubMed - indexed for MEDLINE]

Related citations

8.

Antidepressants in 'depressed' schizophrenic inpatients. A controlled trial.

Kramer MS, Vogel WH, Di C, Dewey DA, Sheves P, Cavicchia S, Little P, Schmidt R, Kimes I.

Arch Gen Psychiatry. 1989 Oct;46(10):922-8.

PMID: 

2679483 

[PubMed - indexed for MEDLINE]

Related citations

9.

Enhancement of the antidepressant action of fluoxetine by folic acid: a randomised, placebo controlled trial.

Coppen A, J.

J Affect Disord. 2000 Nov;60(2):121-30.

PMID: 

10967371 

[PubMed - indexed for MEDLINE]

Related citations

10.

Moclobemide in elderly patients with cognitive decline and depression: an international double-blind, placebo-controlled trial.

Roth M, Mountjoy CQ, Amrein R.

Br J Psychiatry. 1996 Feb;168(2):149-57.

PMID: 

8837903 

[PubMed - indexed for MEDLINE]

Related citations

11.

Implications of the efficacy of thiothixene and a chlorpromazine-imipramine combination for depression in schizophrenia.

Becker RE.

Am J Psychiatry. 1983 Feb;140(2):208-11.

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6336916 

[PubMed - indexed for MEDLINE]

Related citations

12.

Controlled trials of inositol in psychiatry.

Levine J.

Eur Neuropsychopharmacol. 1997 May;7(2):147-55.

PMID: 

9169302 

[PubMed - indexed for MEDLINE]

Related citations

13.

L-methylfolate (Deplin) for depression.

[No authors listed]

Med Lett Drugs Ther. 2010 Apr 19;52(1336):31-2. No abstract available.

PMID: 

20407417 

[PubMed - indexed for MEDLINE]

Related citations

14.

Folate in depression: efficacy, safety, differences in formulations, and clinical issues.

Fava M, Mischoulon D.

J Clin Psychiatry. 2009;70 Suppl 5:12-7. Review.

PMID: 

19909688 

[PubMed - indexed for MEDLINE]

Related citations

15.

Folic acid with or without vitamin B12 for the prevention and treatment of healthy elderly and demented people.

Malouf R, Grimley J.

Cochrane Database Syst Rev. 2008 Oct 8;(4):CD004514. Review.

PMID: 

18843658 

[PubMed - indexed for MEDLINE]

Related citations

16.

Folate and ageing.

Reynolds E.

Lancet. 2007 May 12;369(9573):1601; author reply 1601-2. No abstract available.

PMID: 

17499598 

[PubMed - indexed for MEDLINE]

Related citations

17.

Folic acid and psychopathology.

Young SN, Ghadirian AM.

Prog Neuropsychopharmacol Biol Psychiatry. 1989;13(6):841-63. Review.

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2682787 

[PubMed - indexed for MEDLINE]

Related citations

18.

Diagnosis of secondary depression in schizophrenia.

Becker RE, Colliver JA, Verhulst SJ.

J Clin Psychiatry. 1985 Nov;46(11 Pt 2):4-8.

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Related citations

Anyone using this in their practice?Had a patient Rx'd it by Psych in addition to her Lexapro.Not sure if it is helping, but interesting.Just curious what others have thought of it.

Locke, MDhttp://www.deplin.com/deplin-and-depression/how-deplin-works/

Deplin®, a medical food, works differently than antidepressants, which are drugs. It contains L-methylfolate, which the brain uses to make more of the neurotransmitters that affect mood. It is known that many people living with depression do not have enough L-methylfolate in their brain. As a result, they have insufficient levels of neurotransmitters, which can lead todepressive symptoms. With enough L-methylfolate and better levels of neurotransmitters, the brain can maintain the chemical reactions that affect mood.

How Deplin® Works

Your doctor may prescribe Deplin®, a medical food, in addition to your antidepressant medication. Many people with depression have an imbalance of L-methylfolate in their central nervous system (the body’s information system) which limits the brain’s ability to create the neurotransmitters that control mood.

[Guest guest]

ive used deplin for quite some time.

but ive not used it in one single patient for longer than i want to , to

determine arguable results because of cost. i tide them over mostly to start

with just samples.

i do use methylcobalamin sublingual rather than regular OTC b12 for patients.

cindy, i hear you. you and i should go to some conference thing, but none cheap

enough though i can afford thats available out there . how r u?

>

>

>

> Very interesting, just a methylated form of folate?  Never heard the term

medical food, or ever heard of this.  But when I went to 2d nutrition

conference in Nov, did hear a couple lectures about this mutation, mentioned in

the link about some people( they said 40% not 70%) not able to add methyl group

to their B vits, which then impairs ability for it to enter the cell.  That is,

it is absorbed into blood, but doesn't get into cell.  They were advocating B

vit's already methylated which I have seen a little in local nutrition store ads

also lately, maybe this new " medical food " is part of why its getting into the

lay media now. 

>

> There are what are called gene SNP tests to test for this sort of mutation, to

help people " choose " what vitamins they really need, or can use better.  A

simpler way they told us, was to ask patients if they have " neon yellow urine "

when they take B vitamins, if so, then they have the mutation.  If it is really

up to 70% of the population, why not just have everyone take it? 

>

> IN any case, I liked the list of drugs they showed that can interfere with

methyl folate use/absorbtion, and will likely use that to recommend increased B

vits in these patients.  B vits are water soluble, so likely people can't hurt

themselves unless they really go crazy on them. 

>

> Would a naturopath or functional medicine practictioner with more than 2 d of

commercial CME comment please?

>

> CCote

>

>

>

> Deplin - " medical food " for depression

>

>  

>

>

>

>

> Anyone using this in their practice?

> Had a patient Rx'd it by Psych in addition to her Lexapro.

> Not sure if it is helping, but interesting.

> Just curious what others have thought of it.

>

>

> Locke, MD

>

>

>

>

>

> http://www.deplin.com/deplin-and-depression/how-deplin-works/

>

>

>

>

> Deplin ® , a medical food, works differently than antidepressants, which are

drugs. It contains L-methylfolate, which the brain uses to make more of the

neurotransmitters that affect mood. It is known that many people living with

depression do not have enough  L-methylfolate  in their brain. As a result,

they have insufficient levels of neurotransmitters, which can lead to depressive

symptoms . With enough  L-methylfolate  and better levels of

neurotransmitters, the brain can maintain the chemical reactions that affect

mood. Deplin L-methylfolate How Deplin ®  Works

>

>

>

>

> Your doctor may prescribe  Deplin ® , a medical food, in addition to your

antidepressant medication. Many people with depression have an imbalance of 

L-methylfolate  in their central nervous system (the body’s information

system) which limits the brain’s ability to create the neurotransmitters that

control mood.

>

[Guest guest]

Hi, I use Deplin (the prescription version of L-methylfolate) and well as the OTC versions like Metafolin or Folapro (these are only 800 to 1000mcg vs 7.5 to 15mg of the Deplin).I deal with a lot of neuro issues with chronic neuroborreliosis (spare me...). If patients don't have the money, I will often give a trial of of methylB12 and methylfolate (pre-activated, easily used by the body) versions of B12 and folic acid. I am particularly prodded to use it if : 1) there are MTHFR mutations, 2) elevated MCV, MCH, and/or 3) high homocysteine -- esp if there are neuro or cognitive issues.  I find serum B12's rather useless, particularly if the pt is on a multivitamin (the serum B12 looks high when it's not). Methylmalonic acid urines are the best for detecting B12 def,,, but I'm getting off topic..

OTC products are decent, just lower dosed. Deplin can be $50 WITH insurance, altho today a pt told me she got it for $5 with her insurance. Excellent B complex products with all the " pre-activated " versions of B's are with Pure Encapsulations " B complex Plus " . Health professionals can get these high quality products for 40-50% off MSRP at Emerson Ecologics... pts can find them online for 25% off MRSP.

A great methylcobalamin that often helps my pts as much as deepsq is " Jarrow " 5mg methylcobalamin, held under the tongue for 30 " .  Hope this helps, Anne

 

Anyone using this in their practice?Had a patient Rx'd it by Psych in addition to her Lexapro.Not sure if it is helping, but interesting.Just curious what others have thought of it.

Locke, MDhttp://www.deplin.com/deplin-and-depression/how-deplin-works/

Deplin®, a medical food, works differently than antidepressants, which are drugs. It contains L-methylfolate, which the brain uses to make more of the neurotransmitters that affect mood. It is known that many people living with depression do not have enough L-methylfolate in their brain. As a result, they have insufficient levels of neurotransmitters, which can lead todepressive symptoms. With enough L-methylfolate and better levels of neurotransmitters, the brain can maintain the chemical reactions that affect mood.

How Deplin® Works

Your doctor may prescribe Deplin®, a medical food, in addition to your antidepressant medication. Many people with depression have an imbalance of L-methylfolate in their central nervous system (the body’s information system) which limits the brain’s ability to create the neurotransmitters that control mood.

[Guest guest]

great info anne - thanks

 

Hi, I use Deplin (the prescription version of L-methylfolate) and well as the OTC versions like Metafolin or Folapro (these are only 800 to 1000mcg vs 7.5 to 15mg of the Deplin).I deal with a lot of neuro issues with chronic neuroborreliosis (spare me...). If patients don't have the money, I will often give a trial of of methylB12 and methylfolate (pre-activated, easily used by the body) versions of B12 and folic acid. I am particularly prodded to use it if : 1) there are MTHFR mutations, 2) elevated MCV, MCH, and/or 3) high homocysteine -- esp if there are neuro or cognitive issues.  I find serum B12's rather useless, particularly if the pt is on a multivitamin (the serum B12 looks high when it's not). Methylmalonic acid urines are the best for detecting B12 def,,, but I'm getting off topic..

OTC products are decent, just lower dosed. Deplin can be $50 WITH insurance, altho today a pt told me she got it for $5 with her insurance. Excellent B complex products with all the " pre-activated " versions of B's are with Pure Encapsulations " B complex Plus " . Health professionals can get these high quality products for 40-50% off MSRP at Emerson Ecologics... pts can find them online for 25% off MRSP.

A great methylcobalamin that often helps my pts as much as deepsq is " Jarrow " 5mg methylcobalamin, held under the tongue for 30 " .  Hope this helps, Anne

 

Anyone using this in their practice?Had a patient Rx'd it by Psych in addition to her Lexapro.Not sure if it is helping, but interesting.Just curious what others have thought of it.

Locke, MDhttp://www.deplin.com/deplin-and-depression/how-deplin-works/

Deplin®, a medical food, works differently than antidepressants, which are drugs. It contains L-methylfolate, which the brain uses to make more of the neurotransmitters that affect mood. It is known that many people living with depression do not have enough L-methylfolate in their brain. As a result, they have insufficient levels of neurotransmitters, which can lead todepressive symptoms. With enough L-methylfolate and better levels of neurotransmitters, the brain can maintain the chemical reactions that affect mood.

How Deplin® Works

Your doctor may prescribe Deplin®, a medical food, in addition to your antidepressant medication. Many people with depression have an imbalance of L-methylfolate in their central nervous system (the body’s information system) which limits the brain’s ability to create the neurotransmitters that control mood.

[Guest guest]

Some local psychiatrists prescribe, a few therapists recommend. It sounds like a rational thing. My husband doesn't prescribe it but is prescribing omega 3's. Kris

Anyone using this in their practice? Had a patient Rx'd it by Psych in addition to her Lexapro.

Not sure if it is helping, but interesting.

Just curious what others have thought of it.

Locke, MD

http://www.deplin.com/deplin-and-depression/how-deplin-works/

Deplin®, a medical food, works differently than antidepressants, which are drugs. It contains L-methylfolate, which the brain uses to make more of the neurotransmitters that affect mood. It is known that many people living with depression do not have enough L-methylfolate in their brain. As a result, they have insufficient levels of neurotransmitters, which can lead todepressive symptoms. With enough L-methylfolate and better levels of neurotransmitters, the brain can maintain the chemical reactions that affect mood.

How Deplin® Works

Your doctor may prescribe Deplin®, a medical food, in addition to your antidepressant medication. Many people with depression have an imbalance of L-methylfolate in their central nervous system (the body’s information system) which limits the brain’s ability to create the neurotransmitters that control mood.

[Guest guest]

thanks anne.

so why the neon pee?

grace

>

> > **

> >

> >

> > Anyone using this in their practice?

> > Had a patient Rx'd it by Psych in addition to her Lexapro.

> > Not sure if it is helping, but interesting.

> > Just curious what others have thought of it.

> >

> > Locke, MD

> >

> >

> > http://www.deplin.com/deplin-and-depression/how-deplin-works/

> >

> > *Deplin®*, a medical food, works differently than antidepressants, which

> > are drugs. It contains L-methylfolate, which the brain uses to make more of

> > the neurotransmitters that affect mood. It is known that many people living

> > with depression do not have enough *L-methylfolate* in their brain. As a

> > result, they have insufficient levels of neurotransmitters, which can lead

> > todepressive

symptoms<http://www.deplin.com/depression/my-depression-score/>.

> > With enough *L-methylfolate* and better levels of neurotransmitters, the

> > brain can maintain the chemical reactions that affect mood.

> > [image: Deplin

L-methylfolate]<http://www.deplin.com/the-deplin-experience/informational-videos\

/?vid=5> How

> > Deplin® Works

> >

> >

> > Your doctor may prescribe *Deplin®*, a medical food, in addition to your

> > antidepressant medication. Many people with depression have an imbalance of

> > *L-methylfolate* in their central nervous system (the body's information

> > system) which limits the brain's ability to create the neurotransmitters

> > that control mood.

> >

> >

> >

>

[Guest guest]

Anne, Thanks, that was very informative….. From: [mailto: ] On Behalf Of Anne WalchSent: Friday, January 06, 2012 9:31 AMTo: Subject: Re: Deplin - " medical food " for depression Hi, I use Deplin (the prescription version of L-methylfolate) and well as the OTC versions like Metafolin or Folapro (these are only 800 to 1000mcg vs 7.5 to 15mg of the Deplin).I deal with a lot of neuro issues with chronic neuroborreliosis (spare me...). If patients don't have the money, I will often give a trial of of methylB12 and methylfolate (pre-activated, easily used by the body) versions of B12 and folic acid. I am particularly prodded to use it if : 1) there are MTHFR mutations, 2) elevated MCV, MCH, and/or 3) high homocysteine -- esp if there are neuro or cognitive issues. I find serum B12's rather useless, particularly if the pt is on a multivitamin (the serum B12 looks high when it's not). Methylmalonic acid urines are the best for detecting B12 def,,, but I'm getting off topic..OTC products are decent, just lower dosed. Deplin can be $50 WITH insurance, altho today a pt told me she got it for $5 with her insurance. Excellent B complex products with all the " pre-activated " versions of B's are with Pure Encapsulations " B complex Plus " . Health professionals can get these high quality products for 40-50% off MSRP at Emerson Ecologics... pts can find them online for 25% off MRSP.A great methylcobalamin that often helps my pts as much as deepsq is " Jarrow " 5mg methylcobalamin, held under the tongue for 30 " . Hope this helps, Anne Anyone using this in their practice?Had a patient Rx'd it by Psych in addition to her Lexapro.Not sure if it is helping, but interesting.Just curious what others have thought of it. Locke, MD http://www.deplin.com/deplin-and-depression/how-deplin-works/ Deplin®, a medical food, works differently than antidepressants, which are drugs. It contains L-methylfolate, which the brain uses to make more of the neurotransmitters that affect mood. It is known that many people living with depression do not have enough L-methylfolate in their brain. As a result, they have insufficient levels of neurotransmitters, which can lead todepressive symptoms. With enough L-methylfolate and better levels of neurotransmitters, the brain can maintain the chemical reactions that affect mood.How Deplin® Works Your doctor may prescribe Deplin®, a medical food, in addition to your antidepressant medication. Many people with depression have an imbalance of L-methylfolate in their central nervous system (the body’s information system) which limits the brain’s ability to create the neurotransmitters that control mood.

[Guest guest]

I'm pretty good, my lawsuit thing was decided in my favor back in mid april, still paying off the lawyers, but that took a huge emotional load off. She is still crazy as a loon and has reported me for HIPPA violations, and supposed drug abuse, but each time I've won. It's getting easier to just let her craziness go. Just a little worried that she hasn't found someone else to harrass yet. Would really like to go to that Scripts conf, tell myself next year every year, so I will again, next year.....

Trying to continue the weight loss groups, and selling some supplements in the office to tide over the low spots. Because laser has never really come back from it's fall in 2008, better, but not nearly worth the hassles. Botox and Filler on the other hand are way up, as usual people want a quick, easy fix in life.

Have one son a senior in HS, another a sophmore, so starting to get just a little wistful it is almost over, then I remember all my patients whose kids went to college or got married, and are back.

I will have to start using either this Deplin or the stuff from Pure encapsulations, I am way behind this curve. At least 35-40% of my practice is on some anti-depressant, and most of them "want something more natural".

To: Sent: Friday, January 6, 2012 9:11:35 AMSubject: Re: Deplin - "medical food" for depression

ive used deplin for quite some time.but ive not used it in one single patient for longer than i want to , to determine arguable results because of cost. i tide them over mostly to start with just samples.i do use methylcobalamin sublingual rather than regular OTC b12 for patients.cindy, i hear you. you and i should go to some conference thing, but none cheap enough though i can afford thats available out there . how r u?>> > > Very interesting, just a methylated form of folate? Never heard the term medical food, or ever heard of this. But when I went to 2d nutrition conference in Nov, did hear a couple lectures about this mutation, mentioned in the link about some people( they said 40% not 70%) not able to add methyl group to their B vits, which then impairs ability for it to enter the cell. That is, it is absorbed into blood, but doesn't get into cell. They were advocating B vit's already methylated which I have seen a little in local nutrition store ads also lately, maybe this new "medical food" is part of why its getting into the lay media now. > > There are what are called gene SNP tests to test for this sort of mutation, to help people "choose" what vitamins they really need, or can use better. A simpler way they told us, was to ask patients if they have "neon yellow urine" when they take B vitamins, if so, then they have the mutation. If it is really up to 70% of the population, why not just have everyone take it? > > IN any case, I liked the list of drugs they showed that can interfere with methyl folate use/absorbtion, and will likely use that to recommend increased B vits in these patients. B vits are water soluble, so likely people can't hurt themselves unless they really go crazy on them. > > Would a naturopath or functional medicine practictioner with more than 2 d of commercial CME comment please? > > CCote > > > > Deplin - "medical food" for depression > >  > > > > > Anyone using this in their practice? > Had a patient Rx'd it by Psych in addition to her Lexapro. > Not sure if it is helping, but interesting. > Just curious what others have thought of it. > > > Locke, MD > > > > > > http://www.deplin.com/deplin-and-depression/how-deplin-works/ > > > > > Deplin ® , a medical food, works differently than antidepressants, which are drugs. It contains L-methylfolate, which the brain uses to make more of the neurotransmitters that affect mood. It is known that many people living with depression do not have enough L-methylfolate  in their brain. As a result, they have insufficient levels of neurotransmitters, which can lead to depressive symptoms . With enough L-methylfolate  and better levels of neurotransmitters, the brain can maintain the chemical reactions that affect mood. Deplin L-methylfolate How Deplin ®  Works > > > > > Your doctor may prescribe Deplin ® , a medical food, in addition to your antidepressant medication. Many people with depression have an imbalance of L-methylfolate  in their central nervous system (the body’s information system) which limits the brain’s ability to create the neurotransmitters that control mood.>

[Guest guest]

Yes, Allergan, the maker of botox no longer runs training, but does partner with a company called "Pallete" that hits most major cities 2-3x a year, and the fee is cheap. Usually 250$ for 4 hr, and 1 hr is dinner and a talk, and the other 3 is doing an injection or watching others inject. Usually you bring a "model" read friend, family, staff etc, and the product, which you can often get free or cheap from Allergan for the training, and then the instructor does one side of the face, and you do the other, and you watch other people do their injections also. It's the best, because it's hands on, relatively cheap, and you get CME credit for it. I'll dig through my old emails, and see if I have an old deleted invite, and you can then get "put on the list", so when it comes to your area, you can go. Usually evening, 530ish to 9.

To: Sent: Friday, January 6, 2012 4:18:09 PMSubject: Re: Deplin - "medical food" for depression

should learn botox and filler ... any thoughts where to go?the only thing that's natural out there that works for depression is sleep. which all of us magnificent doctors on this board should have plenty of.cheers again for most beauty and fortune!grace > > > > > > > > Very interesting, just a methylated form of folate? Never heard the term medical food, or ever heard of this. But when I went to 2d nutrition conference in Nov, did hear a couple lectures about this mutation, mentioned in the link about some people( they said 40% not 70%) not able to add methyl group to their B vits, which then impairs ability for it to enter the cell. That is, it is absorbed into blood, but doesn't get into cell. They were advocating B vit's already methylated which I have seen a little in local nutrition store ads also lately, maybe this new "medical food" is part of why its getting into the lay media now. > > > > There are what are called gene SNP tests to test for this sort of mutation, to help people "choose" what vitamins they really need, or can use better. A simpler way they told us, was to ask patients if they have "neon yellow urine" when they take B vitamins, if so, then they have the mutation. If it is really up to 70% of the population, why not just have everyone take it? > > > > IN any case, I liked the list of drugs they showed that can interfere with methyl folate use/absorbtion, and will likely use that to recommend increased B vits in these patients. B vits are water soluble, so likely people can't hurt themselves unless they really go crazy on them. > > > > Would a naturopath or functional medicine practictioner with more than 2 d of commercial CME comment please? > > > > CCote > > > > > > > > Deplin - "medical food" for depression > > > >  > > > > > > > > > > Anyone using this in their practice? > > Had a patient Rx'd it by Psych in addition to her Lexapro. > > Not sure if it is helping, but interesting. > > Just curious what others have thought of it. > > > > > > Locke, MD > > > > > > > > > > > > http://www.deplin.com/deplin-and-depression/how-deplin-works/ > > > > > > > > > > Deplin ® , a medical food, works differently than antidepressants, which are drugs. It contains L-methylfolate, which the brain uses to make more of the neurotransmitters that affect mood. It is known that many people living with depression do not have enough L-methylfolate  in their brain. As a result, they have insufficient levels of neurotransmitters, which can lead to depressive symptoms . With enough L-methylfolate  and better levels of neurotransmitters, the brain can maintain the chemical reactions that affect mood. Deplin L-methylfolate How Deplin ®  Works > > > > > > > > > > Your doctor may prescribe Deplin ® , a medical food, in addition to your antidepressant medication. Many people with depression have an imbalance of L-methylfolate  in their central nervous system (the body’s information system) which limits the brain’s ability to create the neurotransmitters that control mood. > >>

[Guest guest]

Everyone's malpractice may be different, but when I called about 7 yr ago, and discussed with mine, The Doctor's company, I was told as long as I got a training certificate it wouldn't, and hasn't raised my malpractice at all. To quote the gal on the phone "there isn't much risk with botox or temporary filler's, if they wanted to sue you, it'd be worn of by the time, they could". Botox lasts 3-4 months, filler 6 mo -12 depending on what type you use. So my guess would be no increase for most people.

To: Sent: Friday, January 6, 2012 7:22:23 PMSubject: Re: Re: Deplin - "medical food" for depression

, Do you know how malpractice views these procedures? Technically it is invasive,,, Anyone's premiums go up with this inclusion to their practice?Anne

Yes, Allergan, the maker of botox no longer runs training, but does partner with a company called "Pallete" that hits most major cities 2-3x a year, and the fee is cheap. Usually 250$ for 4 hr, and 1 hr is dinner and a talk, and the other 3 is doing an injection or watching others inject. Usually you bring a "model" read friend, family, staff etc, and the product, which you can often get free or cheap from Allergan for the training, and then the instructor does one side of the face, and you do the other, and you watch other people do their injections also. It's the best, because it's hands on, relatively cheap, and you get CME credit for it. I'll dig through my old emails, and see if I have an old deleted invite, and you can then get "put on the list", so when it comes to your area, you can go. Usually evening, 530ish to 9.

To: Sent: Friday, January 6, 2012 4:18:09 PM

Subject: Re: Deplin - "medical food" for depression

should learn botox and filler ... any thoughts where to go?the only thing that's natural out there that works for depression is sleep. which all of us magnificent doctors on this board should have plenty of.cheers again for most beauty and fortune!grace > > > > > > > > Very interesting, just a methylated form of folate? Never heard the term medical food, or ever heard of this. But when I went to 2d nutrition conference in Nov, did hear a couple lectures about this mutation, mentioned in the link about some people( they said 40% not 70%) not able to add methyl group to their B vits, which then impairs ability for it to enter the cell. That is, it is absorbed into blood, but doesn't get into cell. They were advocating B vit's already methylated which I have seen a little in local nutrition store ads also lately, maybe this new "medical food" is part of why its getting into the lay media now. > > > > There are what are called gene SNP tests to test for this sort of mutation, to help people "choose" what vitamins they really need, or can use better. A simpler way they told us, was to ask patients if they have "neon yellow urine" when they take B vitamins, if so, then they have the mutation. If it is really up to 70% of the population, why not just have everyone take it? > > > > IN any case, I liked the list of drugs they showed that can interfere with methyl folate use/absorbtion, and will likely use that to recommend increased B vits in these patients. B vits are water soluble, so likely people can't hurt themselves unless they really go crazy on them. > > > > Would a naturopath or functional medicine practictioner with more than 2 d of commercial CME comment please? > > > > CCote > > > > > > > > Deplin - "medical food" for depression > > > >  > > > > > > > > > > Anyone using this in their practice? > > Had a patient Rx'd it by Psych in addition to her Lexapro. > > Not sure if it is helping, but interesting. > > Just curious what others have thought of it. > > > > > > Locke, MD > > > > > > > > > > > > http://www.deplin.com/deplin-and-depression/how-deplin-works/ > > > > > > > > > > Deplin ® , a medical food, works differently than antidepressants, which are drugs. It contains L-methylfolate, which the brain uses to make more of the neurotransmitters that affect mood. It is known that many people living with depression do not have enough L-methylfolate  in their brain. As a result, they have insufficient levels of neurotransmitters, which can lead to depressive symptoms . With enough L-methylfolate  and better levels of neurotransmitters, the brain can maintain the chemical reactions that affect mood. Deplin L-methylfolate How Deplin ®  Works > > > > > > > > > > Your doctor may prescribe Deplin ® , a medical food, in addition to your antidepressant medication. Many people with depression have an imbalance of L-methylfolate  in their central nervous system (the body’s information system) which limits the brain’s ability to create the neurotransmitters that control mood. > >>

[Guest guest]

ive asked for my acupuncture and the botox and fillers and they said it's

covered, no rider needed

grace

> > > >

> > > >

> > > >

> > > > Very interesting, just a methylated form of folate? Never heard

> > the term medical food, or ever heard of this. But when I went to 2d

> > nutrition conference in Nov, did hear a couple lectures about this

> > mutation, mentioned in the link about some people( they said 40% not 70%)

> > not able to add methyl group to their B vits, which then impairs ability

> > for it to enter the cell. That is, it is absorbed into blood, but

> > doesn't get into cell. They were advocating B vit's already methylated

> > which I have seen a little in local nutrition store ads also lately, maybe

> > this new " medical food " is part of why its getting into the lay media

> > now.ÂÂ

> > > >

> > > > There are what are called gene SNP tests to test for this sort of

> > mutation, to help people " choose " what vitamins they really need, or can

> > use better. A simpler way they told us, was to ask patients if they

> > have " neon yellow urine " when they take B vitamins, if so, then they have

> > the mutation. If it is really up to 70% of the population, why not just

> > have everyone take it?ÂÂ

> > > >

> > > > IN any case, I liked the list of drugs they showed that can interfere

> > with methyl folate use/absorbtion, and will likely use that to recommend

> > increased B vits in these patients. B vits are water soluble, so likely

> > people can't hurt themselves unless they really go crazy on them.ÂÂ

> > > >

> > > > Would a naturopath or functional medicine practictioner with more than

> > 2 d of commercial CME comment please?

> > > >

> > > > CCote

> > > >

> > > >

> > > >

> > > > Deplin - " medical food " for depression

> > > >

> > > > ÂÂ

> > > >

> > > >

> > > >

> > > >

> > > > Anyone using this in their practice?

> > > > Had a patient Rx'd it by Psych in addition to her Lexapro.

> > > > Not sure if it is helping, but interesting.

> > > > Just curious what others have thought of it.

> > > >

> > > >

> > > > Locke, MD

> > > >

> > > >

> > > >

> > > >

> > > >

> > > > http://www.deplin.com/deplin-and-depression/how-deplin-works/

> > > >

> > > >

> > > >

> > > >

> > > > Deplin ® , a medical food, works differently than antidepressants,

> > which are drugs. It contains L-methylfolate, which the brain uses to make

> > more of the neurotransmitters that affect mood. It is known that many

> > people living with depression do not have enough L-methylfolate  in

> > their brain. As a result, they have insufficient levels of

> > neurotransmitters, which can lead to depressive symptoms . With enoughÂÂ

> > L-methylfolate  and better levels of neurotransmitters, the brain can

> > maintain the chemical reactions that affect mood. Deplin L-methylfolate How

> > Deplin ®  Works

> > > >

> > > >

> > > >

> > > >

> > > > Your doctor may prescribe Deplin ® , a medical food, in

> > addition to your antidepressant medication. Many people with depression

> > have an imbalance of L-methylfolate  in their central nervous system

> > (the body’s information system) which limits the brain’s

> > ability to create the neurotransmitters that control mood.

> > > >

> > >

> >

> >

> >

>

[Guest guest]

My carrier did not increase for botox and fillers because it only involves needles and syringes.   Since joint injections are already covered, this could be considered “less invasive”. From: [mailto: ] On Behalf Of Anne WalchSent: Friday, January 06, 2012 5:22 PMTo: Subject: Re: Re: Deplin - " medical food " for depression , Do you know how malpractice views these procedures? Technically it is invasive,,, Anyone's premiums go up with this inclusion to their practice?Anne Yes, Allergan, the maker of botox no longer runs training, but does partner with a company called " Pallete " that hits most major cities 2-3x a year, and the fee is cheap. Usually 250$ for 4 hr, and 1 hr is dinner and a talk, and the other 3 is doing an injection or watching others inject. Usually you bring a " model " read friend, family, staff etc, and the product, which you can often get free or cheap from Allergan for the training, and then the instructor does one side of the face, and you do the other, and you watch other people do their injections also. It's the best, because it's hands on, relatively cheap, and you get CME credit for it. I'll dig through my old emails, and see if I have an old deleted invite, and you can then get " put on the list " , so when it comes to your area, you can go. Usually evening, 530ish to 9. To: Sent: Friday, January 6, 2012 4:18:09 PMSubject: Re: Deplin - " medical food " for depression should learn botox and filler ... any thoughts where to go?the only thing that's natural out there that works for depression is sleep. which all of us magnificent doctors on this board should have plenty of.cheers again for most beauty and fortune!grace > > > > > > > > Very interesting, just a methylated form of folate? Never heard the term medical food, or ever heard of this. But when I went to 2d nutrition conference in Nov, did hear a couple lectures about this mutation, mentioned in the link about some people( they said 40% not 70%) not able to add methyl group to their B vits, which then impairs ability for it to enter the cell. That is, it is absorbed into blood, but doesn't get into cell. They were advocating B vit's already methylated which I have seen a little in local nutrition store ads also lately, maybe this new " medical food " is part of why its getting into the lay media now. > > > > There are what are called gene SNP tests to test for this sort of mutation, to help people " choose " what vitamins they really need, or can use better. A simpler way they told us, was to ask patients if they have " neon yellow urine " when they take B vitamins, if so, then they have the mutation. If it is really up to 70% of the population, why not just have everyone take it? > > > > IN any case, I liked the list of drugs they showed that can interfere with methyl folate use/absorbtion, and will likely use that to recommend increased B vits in these patients. B vits are water soluble, so likely people can't hurt themselves unless they really go crazy on them. > > > > Would a naturopath or functional medicine practictioner with more than 2 d of commercial CME comment please? > > > > CCote > > > > > > > > Deplin - " medical food " for depression > > > >  > > > > > > > > > > Anyone using this in their practice? > > Had a patient Rx'd it by Psych in addition to her Lexapro. > > Not sure if it is helping, but interesting. > > Just curious what others have thought of it. > > > > > > Locke, MD > > > > > > > > > > > > http://www.deplin.com/deplin-and-depression/how-deplin-works/ > > > > > > > > > > Deplin ® , a medical food, works differently than antidepressants, which are drugs. It contains L-methylfolate, which the brain uses to make more of the neurotransmitters that affect mood. It is known that many people living with depression do not have enough L-methylfolate  in their brain. As a result, they have insufficient levels of neurotransmitters, which can lead to depressive symptoms . With enough L-methylfolate  and better levels of neurotransmitters, the brain can maintain the chemical reactions that affect mood. Deplin L-methylfolate How Deplin ®  Works > > > > > > > > > > Your doctor may prescribe Deplin ® , a medical food, in addition to your antidepressant medication. Many people with depression have an imbalance of L-methylfolate  in their central nervous system (the body’s information system) which limits the brain’s ability to create the neurotransmitters that control mood. > >>

[Guest guest]

Thanks for the info, Anne

Eads, MD

Pinnacle Family Medicine

Colorado Springs, CO

www.PinnacleFamilyMedicine.com

From:

[mailto: ] On Behalf Of Anne Walch

Sent: Friday, January 06, 2012 10:31 AM

To:

Subject: Re: Deplin - " medical food "

for depression

Hi,

I use Deplin (the prescription version of L-methylfolate) and well as the OTC

versions like Metafolin or Folapro (these are only 800 to 1000mcg vs 7.5 to

15mg of the Deplin).

I deal with a lot of neuro issues with chronic neuroborreliosis (spare me...).

If patients don't have the money, I will often give a trial of of methylB12 and

methylfolate (pre-activated, easily used by the body) versions of B12 and folic

acid. I am particularly prodded to use it if : 1) there are MTHFR mutations, 2)

elevated MCV, MCH, and/or 3) high homocysteine -- esp if there are neuro or

cognitive issues. I find serum B12's rather useless, particularly if the

pt is on a multivitamin (the serum B12 looks high when it's not). Methylmalonic

acid urines are the best for detecting B12 def,,, but I'm getting off topic..

OTC products are decent, just lower dosed. Deplin can be $50 WITH insurance,

altho today a pt told me she got it for $5 with her insurance.

Excellent B complex products with all the " pre-activated " versions of

B's are with Pure Encapsulations " B complex Plus " . Health

professionals can get these high quality products for 40-50% off MSRP at

Emerson Ecologics... pts can find them online for 25% off MRSP.

A great methylcobalamin that often helps my pts as much as deepsq is

" Jarrow " 5mg methylcobalamin, held under the tongue for

30 " .

Hope this helps,

Anne

Anyone using this in their practice?

Had a patient Rx'd it by Psych in

addition to her Lexapro.

Not sure if it is helping, but

interesting.

Just curious what others have

thought of it.

Locke, MD

http://www.deplin.com/deplin-and-depression/how-deplin-works/

Deplin®, a medical food, works differently

than antidepressants, which are drugs. It contains L-methylfolate, which the

brain uses to make more of the neurotransmitters that affect mood. It is known

that many people living with depression do not have enough L-methylfolate in

their brain. As a result, they have insufficient levels of neurotransmitters,

which can lead todepressive

symptoms. With enough L-methylfolate and better

levels of neurotransmitters, the brain can maintain the chemical reactions that

affect mood.

Error! Filename

not specified.

How

Deplin® Works

Your doctor may prescribe Deplin®, a

medical food, in addition to your antidepressant medication. Many people with

depression have an imbalance of L-methylfolate in their

central nervous system (the body’s information system) which limits the brain’s

ability to create the neurotransmitters that control mood.

[Guest guest]

Thanks for the research, !

Eads, MD

Pinnacle Family Medicine

Colorado Springs, CO

www.PinnacleFamilyMedicine.com

From:

[mailto: ] On Behalf Of Locke

Sent: Friday, January 06, 2012 9:38 AM

To: Clinical Procedures; practiceimprovement1; Kim Scheuer; Locke;

Glenn Kotz; Bruce Bowen, MD; DeWayne Niebur; Anne Goyette; Dr. Borchers

Subject: Re: Deplin - " medical food "

for depression

Thanks for the replies.

More info.

Drugstore.com...$3/tab

http://www.drugstore.com/deplin/7-5mg-tablets/qxn00525041030

Deplin - 7.5mg Tablets

Quantity

Our Price

( )30 tablets

$95.99 - save 7% ($6.69)

( )90 tablets

$269.98 - save 12% ($38.06)

( )100 tablets

$299.97 - save 12% ($42.29)

(X)180 tablets

$504.94 - save 18% ($111.14)

=========================================

Of note --> L-methylfolate is available by

prescription and is regulated by the FDA as a prescription medical food for the

specific nutritional requirements of depressed individuals with suboptimal

serum, RBC, or CNS folate. It is specifically intended as adjunctive therapy

for depressed patients who have only partially responded to antidepressant

therapy. However, L-methylfolate may provide benefit to patients with or

without serum or RBC folate deficiency, particularly if they are at risk for

low neurotransmitter production.

http://www.ncbi.nlm.nih.gov/pubmed/21311704

Innov Clin Neurosci. 2011

Jan;8(1):19-28.

L-methylfolate Plus SSRI or SNRI from Treatment Initiation

Compared to SSRI or SNRI Monotherapy in a Major Depressive Episode.

Ginsberg LD, Oubre AY, Daoud YA.

Source

Dr.

Ginsberg is from Red Oak Psychiatry Associates, PA, Houston, Texas.

bjective: Evaluate

the efficacy of L-methylfolate in combination with SSRI or SNRI compared to

SSRI or SNRI monotherapy in a major depressive episode.

Design: A

retrospective analysis of L-methylfolate plus SSRI/SNRI at treatment initiation

(n=95) and SSRI/SNRI monotherapy (n=147) from patient charts.

Setting: Outpatient,

private psychiatric clinic/practice.

Participants: Adults

18 to 70 with major depressive episode (single or recurrent).

Measurements: Clinical

Global Impressions-Severity (CGI-S) and safety/tolerability measures.

Results: Major

improvement (CGI-S reduced by ≥2 points) was experienced by 18.5 percent of

L-methylfolate plus SSRI/SNRI patients (CGI-S=4–5) compared to 7.04 percent of

SSRI/SNRI monotherapy (p=0.01)

patients at 60 days. Forty percent of L-methylfolate plus SSRI/SNRI patients

with greater functional impairment (CGI-S=5) experienced major improvement

compared to 16.3 percent of SSRI/SNRI monotherapy patients (p=0.02). Median times to

major improvement were 177 days for L-methylfolate plus SSRI/SNRI patients and

231 days for SSRI/SNRI monotherapy patients (p=0.03).

Median time to major improvement for L-methylfolate plus SSRI/SNRI patients

with greater functional impairment (CGI-S=5) was 85 days and 150 days for

SSRI/SNRI monotherapy patients (p=0.018).

There were no significant differences between groups in adverse events.

Discontinuation due to adverse events was 17.9 percent in L-methylfolate plus

SSRI/SNRI patients compared to 34 percent in the SSRI/SNRI monotherapy patients

over duration of the study (p=0.0078).

Conclusion: L-methylfolate

plus antidepressant at treatment onset was more effective in improving

depressive symptoms and function measured by CGI-S scores within 60 days than

antidepressant monotherapy, led to major symptomatic improvement more rapidly

than SSRI/SNRI monotherapy, and was better tolerated.

From:

Innov Clin

Neurosci. 2011 January; 8(1): 19–28.

Copyright/LicenseRequest permission to reuse

Click

on image to enlarge

Figure 4

Median time to major improvement

(>2-point) in patients with greater functional impairment was 85 days for

the L-methylfolate plus SSRI/SNRI group and 150 days for the SSRI/SNRI group (p=0.018). This effect was

sustained throughout the observation period (max # of days: L-methylfolate plus

SSRI/SNRI

http://www.cnsspectrums.com/aspx/articledetail.aspx?articleid=1969

Full article at link.

The Role of L-methylfolate in Depressive Disorders

The

Evidence for L-methylfolate in Depression

There are five trials that examine folate

therapy in depressive disorders. In a study59 with patients who

had low or borderline low RBC folate, depressed patients on tricyclic

antidepressants or MAOIs were augmented with methylfolate 15 mg (L-methylfolate

7.5 mg) experienced significantly greater clinical improvement and social

improvement at 3 months (P<.02)

and 6 months (P<.01)

compared to patients treated with antidepressants alone. The

methylfolate-augmented patients continued to improve for 6 months compared to

patients augmented with placebo, and none experienced relapse. In a separate

double-blind, controlled trial60 comparing methylfolate 50

mg/day to trazodone 100 mg/day, depressed patients experienced a

significant decrease in HAM-D scores at 4 and 8 weeks in both groups, with

response rates in the methylfolate group at 45%, and in the trazodone group

(not statistically significant) at 29%.

An open label trial61 of methylfolate as monotherapy in elderly

depressed subjects demonstrated an 81% response rate (>50% reduction in

HAM-D) by 6 weeks of therapy. A second monotherapy study examined a depressed

population of 36 chronic alcoholics. After a week of placebo wash-out, subjects

received 4 weeks of 90 mg methylfolate therapy. This dosing (30 mg TID)

significantly improved depressive symptoms based on the HAM-D scale with the

majority reporting improved mood and less fatigue (P<.01).62 Alpert and

colleagues63 conducted an open label trial augmenting selective

serotonin reuptake inhibitor (SSRIs) with folinic acid in patients who had

failed at least 4 weeks of SSRI therapy. The response to folinic acid was not

robust (P<.01,

n=22), but it was well tolerated overall.

Specific Populations that May Benefit

Depressed patients are known to be at risk for C677T polymorphism, which

translates into lower serum levels of L-methylfolate64 and

possibly lower CNS folate, and thus lower monoamine levels. Specific ethnic

groups are at higher risk for the less functional forms of MTHFR. The T/T

genotype is present in as many as 10% of whites, and up to 22% of samples of

Hispanic or Mediterranean populations.26,54Several other groups are

also at risk for lower L-methylfolate levels, including substance abusers,

smokers, and those with gastrointestinal disorders (Slide 5).

Safety of L-Methylfolate

The standard dose of L-methylfolate for the augmentation of antidepressants

is one 7.5 mg tablet/day. No titration is necessary, and it is not associated

with withdrawal symptoms at discontinuation. The maximum amount of

L-methylfolate that can be absorbed in one dose is ~15 mg.67 If

more than one 7.5 mg tablet/day is needed, it may be prudent to give in divided

doses. All reported adverse events occur at placebo rates or lower, and overall

it is an extremely well tolerated agent, allowing patients to continue

L-methylfolate therapy as long as necessary to maintain remission. There

are no known contraindications and no known drug interactions.

L-methylfolate is available by prescription and is regulated by the FDA as a

prescription medical food for the specific nutritional requirements of

depressed individuals with suboptimal serum, RBC, or CNS folate. It is

specifically intended as adjunctive therapy for depressed patients who have

only partially responded to antidepressant therapy. However, L-methylfolate may

provide benefit to patients with or without serum or RBC folate deficiency,

particularly if they are at risk for low neurotransmitter production.

===========================

http://www.cnsspectrums.com/aspx/articledetail.aspx?articleid=1267

Novel Therapeutics for Depression:

L-methylfolate as a Trimonoamine Modulator and Antidepressant-Augmenting Agent

ew Trend in Psychopharmacology

Folate deficiency may increase the risk of depression and reduce the

action of antidepressants. Individuals with an inherited polymorphism that

reduces the efficiency of folate formation may be at high risk for folate

deficiency and for major depression. Antidepressant effects have been reported

when antidepressants are augmented with folic acid, folinic acid, or the

centrally active L-methylfolate (known formally as (6(S)-5-methyltetrahydrofolate

[MTHF]), particularly in depressed patients with folate deficiency whose major

depressive episodes have failed to respond to antidepressants. The putative

mechanism of action of MTHF as an augmenting agent to antidepressants is that

it acts as a trimonoamine modulator (TMM), enhancing the synthesis of the three

monoamines: dopamine (DA), norepinephrine (NE), and serotonin (5-HT), resulting

in a boost to the efficacy of antidepressants.

==============================

Sounds like we've known about this since the 1980's and 90's.

Enhancement of recovery from

psychiatric illness by methylfolate.

Procter A.

Br J Psychiatry. 1991 Aug;159:271-2.

PMID:

1773245

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Related citations

[ ]2.

Enhancement of recovery from

psychiatric illness by methylfolate.

Godfrey PS, Toone BK, Carney MW,

Flynn TG, Bottiglieri T, Laundy M, Chanarin I, Reynolds EH.

Lancet. 1990 Aug 18;336(8712):392-5.

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Wing YK, Lee S.

Br J Psychiatry. 1992 May;160:714-5. No abstract available.

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1591586

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A randomised double-blind placebo-controlled

trial of folic acid supplementation of cholinesterase inhibitors in Alzheimer's

disease.

Connelly PJ, Prentice NP, Cousland

G, Bonham J.

Int J Geriatr

Psychiatry. 2008 Feb;23(2):155-60.

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The biology of folate in depression:

implications for nutritional hypotheses of the psychoses.

Abou-Saleh MT, Coppen A.

J Psychiatr Res. 1986;20(2):91-101. Review.

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Malouf M, Grimley EJ, Areosa SA.

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psychiatric illness by methylfolate.

Bottiglieri T, Hyland K, Laundy M,

Godfrey P, Carney MW, Toone BK, Reynolds EH.

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Antidepressants in 'depressed'

schizophrenic inpatients. A controlled trial.

Kramer MS, Vogel WH, Di C,

Dewey DA, Sheves P, Cavicchia S, Little P, Schmidt R, Kimes I.

Arch Gen

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action of fluoxetine by folic acid: a randomised, placebo controlled trial.

Coppen A, J.

J Affect Disord. 2000 Nov;60(2):121-30.

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Moclobemide in elderly patients with

cognitive decline and depression: an international double-blind,

placebo-controlled trial.

Roth M, Mountjoy CQ, Amrein R.

Br J Psychiatry. 1996 Feb;168(2):149-57.

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thiothixene and a chlorpromazine-imipramine combination for depression in

schizophrenia.

Becker RE.

Am J Psychiatry. 1983 Feb;140(2):208-11.

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psychiatry.

Levine J.

Eur Neuropsychopharmacol. 1997 May;7(2):147-55.

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L-methylfolate (Deplin) for

depression.

[No authors listed]

Med Lett Drugs

Ther. 2010 Apr 19;52(1336):31-2. No

abstract available.

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safety, differences in formulations, and clinical issues.

Fava M, Mischoulon D.

J Clin

Psychiatry. 2009;70 Suppl 5:12-7.

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B12 for the prevention and treatment of healthy elderly and demented people.

Malouf R, Grimley J.

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Reynolds E.

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Related citations

Anyone using this in their practice?

Had a patient Rx'd it by Psych in addition to her Lexapro.

Not sure if it is helping, but interesting.

Just curious what others have thought of it.

Locke, MD

http://www.deplin.com/deplin-and-depression/how-deplin-works/

Deplin®, a

medical food, works differently than antidepressants, which are drugs. It

contains L-methylfolate, which the brain uses to make more of the

neurotransmitters that affect mood. It is known that many people living with

depression do not have enough L-methylfolate in

their brain. As a result, they have insufficient levels of neurotransmitters,

which can lead todepressive

symptoms. With enough L-methylfolate and

better levels of neurotransmitters, the brain can maintain the chemical

reactions that affect mood.

How

Deplin® Works

Your doctor may prescribe Deplin®, a medical food, in

addition to your antidepressant medication. Many people with depression have an

imbalance of L-methylfolate in

their central nervous system (the body’s information system) which limits the

brain’s ability to create the neurotransmitters that control mood.