Guest guest Posted June 13, 2011 Report Share Posted June 13, 2011 TERESA MIGHT CONTRIBUTE HER WISDOM TO THIS QUESTION (THANKS, TERESA!). BELOW IS SOME INFO ON 5MTHF VS FOLIC ACID (SYNTHETIC) AND FOLINIC ACID (BIOLOGICAL FORM). THE DIFFERENCE SEEMS TO BE BIO-AVAILABILITY, AND CLINICALLY I HAVE NOT SEEN ANY DIFFERENCE BETWEEN THE EFFECTS OF FOLINIC ACID (FOLACAL) AND 5-MTHF.  I AVOID THE SYNTHETIC FOLATE AND TRY TO GIVE 400-800MCG DAILY OF EITHER FOLINIC OR 5MTHF. DR. JM  Folate in Depression: Efficacy, Safety, Differences in Formulations, and Clinical Issues Fava, M. and Mischoulon, D. Folate in Depression: Efficacy, Safety, Differences in Formulations, and Clinical Issues. J Clin Psychiatry 2009;70[suppl 5]:12-17. Abstract: Supplementation with folate may help reduce depressive symptoms. Folate, a naturally occurring B vitamin is needed in the brain for the synthesis of norepinephrine, serotonin, and dopamine. Three forms of folate are commonly used: folic acid, 5-methyltetrahydrofolate (5-MTHF) (also known as methylfolate and l-methylfolate), and folinic acid. Some forms may be more bioavailable than others in patients with a genetic polymorphism and in those who take particular medications or use alcohol. Folic acid augmentation in depressed patients may reduce residual symptoms. The 5-MTHF formulation indicated efficacy as adjunctive therapy or monotherapy in reducing depressive symptoms in patients with normal and low folate levels, improving cognitive function and reducing depressive symptoms in elderly patients with dementia and folate deficiency, and reducing depressive and somatic symptoms in patients with depression and alcoholism. Adjunctive folinic acid reduced depressive symptoms in patients who were partially responsive or nonresponsive to a selective serotonin reuptake inhibitor. Evidence for the efficacy of folate in improving cognitive symptoms is equivocal, but most studies used folic acid. Although the studies reviewed have limitations and, historically, concerns have been raised about the role of folate in increasing cancer risk, masking B12 deficiency, and worsening depressive symptoms, folate is generally well tolerated, and 5-MTHF may be less likely to incur some of these risks. Several forms of folate appear to be safe and efficacious in some individuals with major depressive disorder, but more information is needed about dosage and populations most suited to folate therapy. ________________________________ Novel Therapeutics for Depression: L-methylfolate as a Trimonoamine Modulator and Antidepressant-Augmenting Agent Stahl, S.M. Novel Therapeutics for Depression: L-methylfolate as a Trimonoamine Modulator and Antidepressant-Augmenting Agent. CNS Spectr. 2007;12(10):739-44. New 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. ________________________________ ________________________________ To: csb-autism-rx Sent: Mon, June 13, 2011 6:47:05 PM Subject: folinic acid vs 5MTHF  I am confused about bioavailbility and indications for supplementing Folinic Acid as FOLACAL (Thorne) vs 5MTHF. Is one preferred over the other any for what indications. Also, what is the optimal dosing mg/kg? Thank you so much. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2011 Report Share Posted June 14, 2011 Dr. M., Thank you so much for your response. I have a patient whom I suspect has MTHFR Polymorphism. Looking into bloodwork to confirm (do you have a resource for this test?) Considering supplementing prior to labs as I am unaware of any negative side effects of Folinic Acid supplementation. ________________________________ To: csb-autism-rx Sent: Mon, June 13, 2011 10:40:25 PM Subject: Re: folinic acid vs 5MTHF TERESA MIGHT CONTRIBUTE HER WISDOM TO THIS QUESTION (THANKS, TERESA!). BELOW IS SOME INFO ON 5MTHF VS FOLIC ACID (SYNTHETIC) AND FOLINIC ACID (BIOLOGICAL FORM). THE DIFFERENCE SEEMS TO BE BIO-AVAILABILITY, AND CLINICALLY I HAVE NOT SEEN ANY DIFFERENCE BETWEEN THE EFFECTS OF FOLINIC ACID (FOLACAL) AND 5-MTHF. I AVOID THE SYNTHETIC FOLATE AND TRY TO GIVE 400-800MCG DAILY OF EITHER FOLINIC OR 5MTHF. DR. JM Folate in Depression: Efficacy, Safety, Differences in Formulations, and Clinical Issues Fava, M. and Mischoulon, D. Folate in Depression: Efficacy, Safety, Differences in Formulations, and Clinical Issues. J Clin Psychiatry 2009;70[suppl 5]:12-17. Abstract: Supplementation with folate may help reduce depressive symptoms. Folate, a naturally occurring B vitamin is needed in the brain for the synthesis of norepinephrine, serotonin, and dopamine. Three forms of folate are commonly used: folic acid, 5-methyltetrahydrofolate (5-MTHF) (also known as methylfolate and l-methylfolate), and folinic acid. Some forms may be more bioavailable than others in patients with a genetic polymorphism and in those who take particular medications or use alcohol. Folic acid augmentation in depressed patients may reduce residual symptoms. The 5-MTHF formulation indicated efficacy as adjunctive therapy or monotherapy in reducing depressive symptoms in patients with normal and low folate levels, improving cognitive function and reducing depressive symptoms in elderly patients with dementia and folate deficiency, and reducing depressive and somatic symptoms in patients with depression and alcoholism. Adjunctive folinic acid reduced depressive symptoms in patients who were partially responsive or nonresponsive to a selective serotonin reuptake inhibitor. Evidence for the efficacy of folate in improving cognitive symptoms is equivocal, but most studies used folic acid. Although the studies reviewed have limitations and, historically, concerns have been raised about the role of folate in increasing cancer risk, masking B12 deficiency, and worsening depressive symptoms, folate is generally well tolerated, and 5-MTHF may be less likely to incur some of these risks. Several forms of folate appear to be safe and efficacious in some individuals with major depressive disorder, but more information is needed about dosage and populations most suited to folate therapy. ________________________________ Novel Therapeutics for Depression: L-methylfolate as a Trimonoamine Modulator and Antidepressant-Augmenting Agent Stahl, S.M. Novel Therapeutics for Depression: L-methylfolate as a Trimonoamine Modulator and Antidepressant-Augmenting Agent. CNS Spectr. 2007;12(10):739-44. New 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. ________________________________ ________________________________ To: csb-autism-rx Sent: Mon, June 13, 2011 6:47:05 PM Subject: folinic acid vs 5MTHF I am confused about bioavailbility and indications for supplementing Folinic Acid as FOLACAL (Thorne) vs 5MTHF. Is one preferred over the other any for what indications. Also, what is the optimal dosing mg/kg? Thank you so much. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2011 Report Share Posted June 14, 2011 This may be a genetic test, I am not sure, but I could enquire at my doctors' list if or no one else knows. What led you to suspect he has MTHFR Polymorphism? Dr. JM ________________________________ To: csb-autism-rx Sent: Tue, June 14, 2011 6:14:38 AM Subject: Re: folinic acid vs 5MTHF  Dr. M., Thank you so much for your response. I have a patient whom I suspect has MTHFR Polymorphism. Looking into bloodwork to confirm (do you have a resource for this test?) Considering supplementing prior to labs as I am unaware of any negative side effects of Folinic Acid supplementation. ________________________________ To: csb-autism-rx Sent: Mon, June 13, 2011 10:40:25 PM Subject: Re: folinic acid vs 5MTHF TERESA MIGHT CONTRIBUTE HER WISDOM TO THIS QUESTION (THANKS, TERESA!). BELOW IS SOME INFO ON 5MTHF VS FOLIC ACID (SYNTHETIC) AND FOLINIC ACID (BIOLOGICAL FORM). THE DIFFERENCE SEEMS TO BE BIO-AVAILABILITY, AND CLINICALLY I HAVE NOT SEEN ANY DIFFERENCE BETWEEN THE EFFECTS OF FOLINIC ACID (FOLACAL) AND 5-MTHF. I AVOID THE SYNTHETIC FOLATE AND TRY TO GIVE 400-800MCG DAILY OF EITHER FOLINIC OR 5MTHF. DR. JM Folate in Depression: Efficacy, Safety, Differences in Formulations, and Clinical Issues Fava, M. and Mischoulon, D. Folate in Depression: Efficacy, Safety, Differences in Formulations, and Clinical Issues. J Clin Psychiatry 2009;70[suppl 5]:12-17. Abstract: Supplementation with folate may help reduce depressive symptoms. Folate, a naturally occurring B vitamin is needed in the brain for the synthesis of norepinephrine, serotonin, and dopamine. Three forms of folate are commonly used: folic acid, 5-methyltetrahydrofolate (5-MTHF) (also known as methylfolate and l-methylfolate), and folinic acid. Some forms may be more bioavailable than others in patients with a genetic polymorphism and in those who take particular medications or use alcohol. Folic acid augmentation in depressed patients may reduce residual symptoms. The 5-MTHF formulation indicated efficacy as adjunctive therapy or monotherapy in reducing depressive symptoms in patients with normal and low folate levels, improving cognitive function and reducing depressive symptoms in elderly patients with dementia and folate deficiency, and reducing depressive and somatic symptoms in patients with depression and alcoholism. Adjunctive folinic acid reduced depressive symptoms in patients who were partially responsive or nonresponsive to a selective serotonin reuptake inhibitor. Evidence for the efficacy of folate in improving cognitive symptoms is equivocal, but most studies used folic acid. Although the studies reviewed have limitations and, historically, concerns have been raised about the role of folate in increasing cancer risk, masking B12 deficiency, and worsening depressive symptoms, folate is generally well tolerated, and 5-MTHF may be less likely to incur some of these risks. Several forms of folate appear to be safe and efficacious in some individuals with major depressive disorder, but more information is needed about dosage and populations most suited to folate therapy. ________________________________ Novel Therapeutics for Depression: L-methylfolate as a Trimonoamine Modulator and Antidepressant-Augmenting Agent Stahl, S.M. Novel Therapeutics for Depression: L-methylfolate as a Trimonoamine Modulator and Antidepressant-Augmenting Agent. CNS Spectr. 2007;12(10):739-44. New 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. ________________________________ ________________________________ To: csb-autism-rx Sent: Mon, June 13, 2011 6:47:05 PM Subject: folinic acid vs 5MTHF I am confused about bioavailbility and indications for supplementing Folinic Acid as FOLACAL (Thorne) vs 5MTHF. Is one preferred over the other any for what indications. Also, what is the optimal dosing mg/kg? Thank you so much. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 15, 2011 Report Share Posted June 15, 2011 MTHFR is a genetic test. As an aside, there can also be folate binding and blocking autoantibodies. My son was tested by his neurologist for this and had autoantibodies for folate binding. Adding Leucovorin had the effect of mostly resolving his binocular vision to normal ( it was moderately affected). We have not had him tested for MTHFR mutations, but I was tested for something unrelated and we know that I have a single C677T mutation on the MTHFR gene. There is a definitive correlation between deficient binocular vision and a mutation on the MTHFR C677T allele. It has also been shown that folinic acid will correct this deficiency. http://www.ncbi.nlm.nih.gov/pubmed/18317335 Research is being done by Dr. Quadros at SUNY University in NY on the folate autoantibodies... > > This may be a genetic test, I am not sure, but I could enquire at my doctors' > list if or no one else knows. What led you to suspect he has MTHFR > Polymorphism? Dr. JM > > > > > ________________________________ > > To: csb-autism-rx > Sent: Tue, June 14, 2011 6:14:38 AM > Subject: Re: folinic acid vs 5MTHF > >  > Dr. M., > > Thank you so much for your response. > > I have a patient whom I suspect has MTHFR Polymorphism. Looking into bloodwork > to confirm (do you have a resource for this test?) Considering supplementing > prior to labs as I am unaware of any negative side effects of Folinic Acid > supplementation. > > ________________________________ > > To: csb-autism-rx > Sent: Mon, June 13, 2011 10:40:25 PM > Subject: Re: folinic acid vs 5MTHF > > TERESA MIGHT CONTRIBUTE HER WISDOM TO THIS QUESTION (THANKS, TERESA!). BELOW IS > > SOME INFO ON 5MTHF VS FOLIC ACID (SYNTHETIC) AND FOLINIC ACID (BIOLOGICAL > FORM). THE DIFFERENCE SEEMS TO BE BIO-AVAILABILITY, AND CLINICALLY I HAVE NOT > SEEN ANY DIFFERENCE BETWEEN THE EFFECTS OF FOLINIC ACID (FOLACAL) AND 5-MTHF. I > > AVOID THE SYNTHETIC FOLATE AND TRY TO GIVE 400-800MCG DAILY OF EITHER FOLINIC OR > > > 5MTHF. DR. JM > > Folate in Depression: Efficacy, Safety, Differences in Formulations, and > Clinical Issues > Fava, M. and Mischoulon, D. Folate in Depression: Efficacy, Safety, Differences > in Formulations, and Clinical Issues. J Clin Psychiatry 2009;70[suppl 5]:12-17. > Abstract: > Supplementation with folate may help reduce depressive symptoms. Folate, a > naturally occurring B vitamin is needed in the brain for the synthesis of > norepinephrine, serotonin, and dopamine. Three forms of folate are commonly > used: folic acid, 5-methyltetrahydrofolate (5-MTHF) (also known as methylfolate > and l-methylfolate), and folinic acid. Some forms may be more bioavailable than > others in patients with a genetic polymorphism and in those who take particular > medications or use alcohol. Folic acid augmentation in depressed patients may > reduce residual symptoms. The 5-MTHF formulation indicated efficacy as > adjunctive therapy or monotherapy in reducing depressive symptoms in patients > with normal and low folate levels, improving cognitive function and reducing > depressive symptoms in elderly patients with dementia and folate deficiency, and > > > reducing depressive and somatic symptoms in patients with depression and > alcoholism. Adjunctive folinic acid reduced depressive symptoms in patients who > were partially responsive or nonresponsive to a selective serotonin reuptake > inhibitor. Evidence for the efficacy of folate in improving cognitive symptoms > is equivocal, but most studies used folic acid. Although the studies reviewed > have limitations and, historically, concerns have been raised about the role of > folate in increasing cancer risk, masking B12 deficiency, and worsening > depressive symptoms, folate is generally well tolerated, and 5-MTHF may be less > likely to incur some of these risks. Several forms of folate appear to be safe > and efficacious in some individuals with major depressive disorder, but more > information is needed about dosage and populations most suited to folate > therapy. > ________________________________ > > Novel Therapeutics for Depression: L-methylfolate as a Trimonoamine Modulator > and Antidepressant-Augmenting Agent > Stahl, S.M. Novel Therapeutics for Depression: L-methylfolate as a Trimonoamine > Modulator and Antidepressant-Augmenting Agent. CNS Spectr. 2007;12(10):739-44. > New 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. > ________________________________ > > ________________________________ > > To: csb-autism-rx > Sent: Mon, June 13, 2011 6:47:05 PM > Subject: folinic acid vs 5MTHF > > I am confused about bioavailbility and indications for supplementing Folinic > Acid as FOLACAL (Thorne) vs 5MTHF. Is one preferred over the other any for what > indications. Also, what is the optimal dosing mg/kg? Thank you so much. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 15, 2011 Report Share Posted June 15, 2011 Deciding which folate-related supplement to use may remain problematic, given inter-individual differences in responses. Genetic testing for MTHFR alleles is available. See 's comment re: cite 1 herein. *//* - - - - MTHFR DNA Test http://www.kimballgenetics.com/tests-mthfr.html - - - - see folinic in: Parent Ratings of Behavorial Effects of Biomedical Interventions http://www.autism.com/pro_parentratings.asp - - - - from Schneider M.D. re cite 1: " This [1] certainly matches my observations. I get far better results with 5MTHF and I believe that folic and folinic acids may actually cause problems in individuals with MTHFR defects and/or anti-folate receptor antibodies. This study documented our suspicion that high doses of folic acid do not negate the effects of the MTHFR defect. " ...many of my patients seem to have a variant of cerebral folate deficiency. I've talked about this at think tanks and in my immunology lectures at DAN! for few years now. This idea has met some resistance, but what I see clinically has convinced me that most individuals with autism deserve a trial of 5-MTHF. Some require very high doses to achieve seizure control-- occasionally in the 15mg TID range. Even those without obvious seizures can have impressive responses. It falls into the " can't hurt/might really help " category! " - - - - 1. MTHFR 677C->T genotype is associated with folate and homocysteine concentrations in a large, population-based, double-blind trial of folic acid supplementation. <http://www.ncbi.nlm.nih.gov/pubmed/21508090> Crider KS, Zhu JH, Hao L, Yang QH, Yang TP, Gindler J, Maneval DR, Quinlivan EP, Li Z, LB, Berry RJ. Am J Clin Nutr. 2011 Apr 20. MTHFR genotype was an independent predictor of plasma and RBC folate and plasma homocysteine concentrations and did not have a significant interaction with folic acid dose during supplementation. see also: A milk-free diet downregulates folate receptor autoimmunity in cerebral folate deficiency syndrome. <http://www.ncbi.nlm.nih.gov/pubmed/18355335> Ramaekers VT, Sequeira JM, Blau N, Quadros EV. Dev Med Child Neurol. 2008 May;50(5):346-52. Free PMC Article Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 16, 2011 Report Share Posted June 16, 2011 We experienced the problems that Cindi refers to on folic acid and folinic acid. MB12 also caused much aggression at this time so we discontinued it. After reading some of the Yasko material, we used 5methyltetrahydrofolate for a few weeks and then restarted MB12 which was then tolerated fine. Many months after this I added in folinic which was also tolerated. My daughter remains on both 5methyl and folinic. We've not had the opportunity to do genetic testing. > > Deciding which folate-related supplement to use may remain problematic, > given inter-individual differences in responses. Genetic testing for > MTHFR alleles is available. See 's comment re: cite 1 herein. > > *//* > > - - - - > > MTHFR DNA Test > http://www.kimballgenetics.com/tests-mthfr.html > > - - - - > > see folinic in: > Parent Ratings of Behavorial Effects of Biomedical Interventions > http://www.autism.com/pro_parentratings.asp > > - - - - > > from Schneider M.D. re cite 1: > > " This [1] certainly matches my observations. I get far better results > with 5MTHF and I believe that folic and folinic acids may actually cause > problems in individuals with MTHFR defects and/or anti-folate receptor > antibodies. This study documented our suspicion that high doses of > folic acid do not negate the effects of the MTHFR defect. > > " ...many of my patients seem to have a variant of cerebral folate > deficiency. I've talked about this at think tanks and in my immunology > lectures at DAN! for few years now. This idea has met some resistance, > but what I see clinically has convinced me that most individuals with > autism deserve a trial of 5-MTHF. Some require very high doses to > achieve seizure control-- occasionally in the 15mg TID range. Even > those without obvious seizures can have impressive responses. It falls > into the " can't hurt/might really help " category! " > > - - - - > > 1. MTHFR 677C->T genotype is associated with folate and homocysteine > concentrations in a large, population-based, double-blind trial of folic > acid supplementation. <http://www.ncbi.nlm.nih.gov/pubmed/21508090> > Crider KS, Zhu JH, Hao L, Yang QH, Yang TP, Gindler J, Maneval DR, > Quinlivan EP, Li Z, LB, Berry RJ. > Am J Clin Nutr. 2011 Apr 20. > > MTHFR genotype was an independent predictor of plasma and RBC folate and > plasma homocysteine concentrations and did not have a significant > interaction with folic acid dose during supplementation. > > see also: > > A milk-free diet downregulates folate receptor autoimmunity in cerebral > folate deficiency syndrome. <http://www.ncbi.nlm.nih.gov/pubmed/18355335> > Ramaekers VT, Sequeira JM, Blau N, Quadros EV. > Dev Med Child Neurol. 2008 May;50(5):346-52. Free PMC Article > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 16, 2011 Report Share Posted June 16, 2011 I think Genova does the MTHFR or Yasko. Quadros does the folate antibodies test for a minimum $100 donation to his research > > > > This may be a genetic test, I am not sure, but I could enquire at my doctors' > > list if or no one else knows. What led you to suspect he has MTHFR > > Polymorphism? Dr. JM > > > > > > > > > > ________________________________ > > From: Hannifin <drlisahannifin@> > > To: csb-autism-rx > > Sent: Tue, June 14, 2011 6:14:38 AM > > Subject: Re: folinic acid vs 5MTHF > > > >  > > Dr. M., > > > > Thank you so much for your response. > > > > I have a patient whom I suspect has MTHFR Polymorphism. Looking into bloodwork > > to confirm (do you have a resource for this test?) Considering supplementing > > prior to labs as I am unaware of any negative side effects of Folinic Acid > > supplementation. > > > > ________________________________ > > From: JAQUELYN MCCANDLESS <JMcCandless@> > > To: csb-autism-rx > > Sent: Mon, June 13, 2011 10:40:25 PM > > Subject: Re: folinic acid vs 5MTHF > > > > TERESA MIGHT CONTRIBUTE HER WISDOM TO THIS QUESTION (THANKS, TERESA!). BELOW IS > > > > SOME INFO ON 5MTHF VS FOLIC ACID (SYNTHETIC) AND FOLINIC ACID (BIOLOGICAL > > FORM). THE DIFFERENCE SEEMS TO BE BIO-AVAILABILITY, AND CLINICALLY I HAVE NOT > > SEEN ANY DIFFERENCE BETWEEN THE EFFECTS OF FOLINIC ACID (FOLACAL) AND 5-MTHF. I > > > > AVOID THE SYNTHETIC FOLATE AND TRY TO GIVE 400-800MCG DAILY OF EITHER FOLINIC OR > > > > > > 5MTHF. DR. JM > > > > Folate in Depression: Efficacy, Safety, Differences in Formulations, and > > Clinical Issues > > Fava, M. and Mischoulon, D. Folate in Depression: Efficacy, Safety, Differences > > in Formulations, and Clinical Issues. J Clin Psychiatry 2009;70[suppl 5]:12-17. > > Abstract: > > Supplementation with folate may help reduce depressive symptoms. Folate, a > > naturally occurring B vitamin is needed in the brain for the synthesis of > > norepinephrine, serotonin, and dopamine. Three forms of folate are commonly > > used: folic acid, 5-methyltetrahydrofolate (5-MTHF) (also known as methylfolate > > and l-methylfolate), and folinic acid. Some forms may be more bioavailable than > > others in patients with a genetic polymorphism and in those who take particular > > medications or use alcohol. Folic acid augmentation in depressed patients may > > reduce residual symptoms. The 5-MTHF formulation indicated efficacy as > > adjunctive therapy or monotherapy in reducing depressive symptoms in patients > > with normal and low folate levels, improving cognitive function and reducing > > depressive symptoms in elderly patients with dementia and folate deficiency, and > > > > > > reducing depressive and somatic symptoms in patients with depression and > > alcoholism. Adjunctive folinic acid reduced depressive symptoms in patients who > > were partially responsive or nonresponsive to a selective serotonin reuptake > > inhibitor. Evidence for the efficacy of folate in improving cognitive symptoms > > is equivocal, but most studies used folic acid. Although the studies reviewed > > have limitations and, historically, concerns have been raised about the role of > > folate in increasing cancer risk, masking B12 deficiency, and worsening > > depressive symptoms, folate is generally well tolerated, and 5-MTHF may be less > > likely to incur some of these risks. Several forms of folate appear to be safe > > and efficacious in some individuals with major depressive disorder, but more > > information is needed about dosage and populations most suited to folate > > therapy. > > ________________________________ > > > > Novel Therapeutics for Depression: L-methylfolate as a Trimonoamine Modulator > > and Antidepressant-Augmenting Agent > > Stahl, S.M. Novel Therapeutics for Depression: L-methylfolate as a Trimonoamine > > Modulator and Antidepressant-Augmenting Agent. CNS Spectr. 2007;12(10):739-44. > > New 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. > > ________________________________ > > > > ________________________________ > > From: Hannifin <drlisahannifin@> > > To: csb-autism-rx > > Sent: Mon, June 13, 2011 6:47:05 PM > > Subject: folinic acid vs 5MTHF > > > > I am confused about bioavailbility and indications for supplementing Folinic > > Acid as FOLACAL (Thorne) vs 5MTHF. Is one preferred over the other any for what > > indications. Also, what is the optimal dosing mg/kg? Thank you so much. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 16, 2011 Report Share Posted June 16, 2011 Hi Dr. M., I was thinking about genetics and folate following a presentation given by Dr. Dan Rossignol that I recently attended. I have a patient with delayed onset of autism. Parents report child regressed around 5 yrs old. No reactions to vaccines, did not tolerate breast milk as an infant, cow's milk formula was a disaster as was soy. Baby was given pre-digested formula usu reserved for premies until solids were introduced. So far, GI panel only remarkable for extremely low secretory IgA, He is allergic to penicillin. He is extremely small for his age (8 yrs old) a " failure to thrive " kid. Hair reveals low colbalt, germanium and manganese with high copper and uranium. Has no appetite & no food aversions. Still awaiting full full panel of labs. Hannifin, DC ________________________________ To: csb-autism-rx Cc: Binstock Sent: Tue, June 14, 2011 11:39:34 AM Subject: Re: folinic acid vs 5MTHF This may be a genetic test, I am not sure, but I could enquire at my doctors' list if or no one else knows. What led you to suspect he has MTHFR Polymorphism? Dr. JM ________________________________ To: csb-autism-rx Sent: Tue, June 14, 2011 6:14:38 AM Subject: Re: folinic acid vs 5MTHF Dr. M., Thank you so much for your response. I have a patient whom I suspect has MTHFR Polymorphism. Looking into bloodwork to confirm (do you have a resource for this test?) Considering supplementing prior to labs as I am unaware of any negative side effects of Folinic Acid supplementation. ________________________________ To: csb-autism-rx Sent: Mon, June 13, 2011 10:40:25 PM Subject: Re: folinic acid vs 5MTHF TERESA MIGHT CONTRIBUTE HER WISDOM TO THIS QUESTION (THANKS, TERESA!). BELOW IS SOME INFO ON 5MTHF VS FOLIC ACID (SYNTHETIC) AND FOLINIC ACID (BIOLOGICAL FORM). THE DIFFERENCE SEEMS TO BE BIO-AVAILABILITY, AND CLINICALLY I HAVE NOT SEEN ANY DIFFERENCE BETWEEN THE EFFECTS OF FOLINIC ACID (FOLACAL) AND 5-MTHF. I AVOID THE SYNTHETIC FOLATE AND TRY TO GIVE 400-800MCG DAILY OF EITHER FOLINIC OR 5MTHF. DR. JM Folate in Depression: Efficacy, Safety, Differences in Formulations, and Clinical Issues Fava, M. and Mischoulon, D. Folate in Depression: Efficacy, Safety, Differences in Formulations, and Clinical Issues. J Clin Psychiatry 2009;70[suppl 5]:12-17. Abstract: Supplementation with folate may help reduce depressive symptoms. Folate, a naturally occurring B vitamin is needed in the brain for the synthesis of norepinephrine, serotonin, and dopamine. Three forms of folate are commonly used: folic acid, 5-methyltetrahydrofolate (5-MTHF) (also known as methylfolate and l-methylfolate), and folinic acid. Some forms may be more bioavailable than others in patients with a genetic polymorphism and in those who take particular medications or use alcohol. Folic acid augmentation in depressed patients may reduce residual symptoms. The 5-MTHF formulation indicated efficacy as adjunctive therapy or monotherapy in reducing depressive symptoms in patients with normal and low folate levels, improving cognitive function and reducing depressive symptoms in elderly patients with dementia and folate deficiency, and reducing depressive and somatic symptoms in patients with depression and alcoholism. Adjunctive folinic acid reduced depressive symptoms in patients who were partially responsive or nonresponsive to a selective serotonin reuptake inhibitor. Evidence for the efficacy of folate in improving cognitive symptoms is equivocal, but most studies used folic acid. Although the studies reviewed have limitations and, historically, concerns have been raised about the role of folate in increasing cancer risk, masking B12 deficiency, and worsening depressive symptoms, folate is generally well tolerated, and 5-MTHF may be less likely to incur some of these risks. Several forms of folate appear to be safe and efficacious in some individuals with major depressive disorder, but more information is needed about dosage and populations most suited to folate therapy. ________________________________ Novel Therapeutics for Depression: L-methylfolate as a Trimonoamine Modulator and Antidepressant-Augmenting Agent Stahl, S.M. Novel Therapeutics for Depression: L-methylfolate as a Trimonoamine Modulator and Antidepressant-Augmenting Agent. CNS Spectr. 2007;12(10):739-44. New 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. ________________________________ ________________________________ To: csb-autism-rx Sent: Mon, June 13, 2011 6:47:05 PM Subject: folinic acid vs 5MTHF I am confused about bioavailbility and indications for supplementing Folinic Acid as FOLACAL (Thorne) vs 5MTHF. Is one preferred over the other any for what indications. Also, what is the optimal dosing mg/kg? Thank you so much. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 17, 2011 Report Share Posted June 17, 2011 You can look into Dr. Quadros folate receptor autoantibodies test. Also regressing at 5, have parents considered Landau Kleffner Syndrome? > > Hi Dr. M., > I was thinking about genetics and folate following a presentation given by Dr. > Dan Rossignol that I recently attended. I have a patient with delayed onset of > autism. Parents report child regressed around 5 yrs old. No reactions to > vaccines, did not tolerate breast milk as an infant, cow's milk formula was a > disaster as was soy. Baby was given pre-digested formula usu reserved for > premies until solids were introduced. So far, GI panel only remarkable for > extremely low secretory IgA, He is allergic to penicillin. He is extremely > small for his age (8 yrs old) a " failure to thrive " kid. Hair reveals low > colbalt, germanium and manganese with high copper and uranium. Has no appetite & > no food aversions. Still awaiting full full panel of labs. > > Hannifin, DC > > > > > > ________________________________ > > To: csb-autism-rx > Cc: Binstock > Sent: Tue, June 14, 2011 11:39:34 AM > Subject: Re: folinic acid vs 5MTHF > > > This may be a genetic test, I am not sure, but I could enquire at my doctors' > list if or no one else knows. What led you to suspect he has MTHFR > Polymorphism? Dr. JM > > ________________________________ > > To: csb-autism-rx > Sent: Tue, June 14, 2011 6:14:38 AM > Subject: Re: folinic acid vs 5MTHF > > > Dr. M., > > Thank you so much for your response. > > I have a patient whom I suspect has MTHFR Polymorphism. Looking into bloodwork > to confirm (do you have a resource for this test?) Considering supplementing > prior to labs as I am unaware of any negative side effects of Folinic Acid > supplementation. > > ________________________________ > > To: csb-autism-rx > Sent: Mon, June 13, 2011 10:40:25 PM > Subject: Re: folinic acid vs 5MTHF > > TERESA MIGHT CONTRIBUTE HER WISDOM TO THIS QUESTION (THANKS, TERESA!). BELOW IS > > SOME INFO ON 5MTHF VS FOLIC ACID (SYNTHETIC) AND FOLINIC ACID (BIOLOGICAL > FORM). THE DIFFERENCE SEEMS TO BE BIO-AVAILABILITY, AND CLINICALLY I HAVE NOT > SEEN ANY DIFFERENCE BETWEEN THE EFFECTS OF FOLINIC ACID (FOLACAL) AND 5-MTHF. I > > AVOID THE SYNTHETIC FOLATE AND TRY TO GIVE 400-800MCG DAILY OF EITHER FOLINIC OR > > > 5MTHF. DR. JM > > Folate in Depression: Efficacy, Safety, Differences in Formulations, and > Clinical Issues > Fava, M. and Mischoulon, D. Folate in Depression: Efficacy, Safety, Differences > in Formulations, and Clinical Issues. J Clin Psychiatry 2009;70[suppl 5]:12-17. > Abstract: > Supplementation with folate may help reduce depressive symptoms. Folate, a > naturally occurring B vitamin is needed in the brain for the synthesis of > norepinephrine, serotonin, and dopamine. Three forms of folate are commonly > used: folic acid, 5-methyltetrahydrofolate (5-MTHF) (also known as methylfolate > and l-methylfolate), and folinic acid. Some forms may be more bioavailable than > others in patients with a genetic polymorphism and in those who take particular > medications or use alcohol. Folic acid augmentation in depressed patients may > reduce residual symptoms. The 5-MTHF formulation indicated efficacy as > adjunctive therapy or monotherapy in reducing depressive symptoms in patients > with normal and low folate levels, improving cognitive function and reducing > depressive symptoms in elderly patients with dementia and folate deficiency, and > > > reducing depressive and somatic symptoms in patients with depression and > alcoholism. Adjunctive folinic acid reduced depressive symptoms in patients who > were partially responsive or nonresponsive to a selective serotonin reuptake > inhibitor. Evidence for the efficacy of folate in improving cognitive symptoms > is equivocal, but most studies used folic acid. Although the studies reviewed > have limitations and, historically, concerns have been raised about the role of > folate in increasing cancer risk, masking B12 deficiency, and worsening > depressive symptoms, folate is generally well tolerated, and 5-MTHF may be less > likely to incur some of these risks. Several forms of folate appear to be safe > and efficacious in some individuals with major depressive disorder, but more > information is needed about dosage and populations most suited to folate > therapy. > ________________________________ > > Novel Therapeutics for Depression: L-methylfolate as a Trimonoamine Modulator > and Antidepressant-Augmenting Agent > Stahl, S.M. Novel Therapeutics for Depression: L-methylfolate as a Trimonoamine > Modulator and Antidepressant-Augmenting Agent. CNS Spectr. 2007;12(10):739-44. > New 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. > ________________________________ > > ________________________________ > > To: csb-autism-rx > Sent: Mon, June 13, 2011 6:47:05 PM > Subject: folinic acid vs 5MTHF > > I am confused about bioavailbility and indications for supplementing Folinic > Acid as FOLACAL (Thorne) vs 5MTHF. Is one preferred over the other any for what > indications. Also, what is the optimal dosing mg/kg? Thank you so much. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 18, 2011 Report Share Posted June 18, 2011 I'll check to see if LK has been ruled out. Thanks. ________________________________ To: csb-autism-rx Sent: Fri, June 17, 2011 7:08:04 PM Subject: Re: folinic acid vs 5MTHF You can look into Dr. Quadros folate receptor autoantibodies test. Also regressing at 5, have parents considered Landau Kleffner Syndrome? > > Hi Dr. M., > I was thinking about genetics and folate following a presentation given by Dr. > > Dan Rossignol that I recently attended. I have a patient with delayed onset >of > > autism. Parents report child regressed around 5 yrs old. No reactions to > vaccines, did not tolerate breast milk as an infant, cow's milk formula was a > disaster as was soy. Baby was given pre-digested formula usu reserved for > premies until solids were introduced. So far, GI panel only remarkable for > extremely low secretory IgA, He is allergic to penicillin. He is extremely > small for his age (8 yrs old) a " failure to thrive " kid. Hair reveals low > colbalt, germanium and manganese with high copper and uranium. Has no appetite > & > > no food aversions. Still awaiting full full panel of labs. > > Hannifin, DC > > > > > > ________________________________ > > To: csb-autism-rx > Cc: Binstock > Sent: Tue, June 14, 2011 11:39:34 AM > Subject: Re: folinic acid vs 5MTHF > > > This may be a genetic test, I am not sure, but I could enquire at my doctors' > list if or no one else knows. What led you to suspect he has MTHFR > Polymorphism? Dr. JM > > ________________________________ > > To: csb-autism-rx > Sent: Tue, June 14, 2011 6:14:38 AM > Subject: Re: folinic acid vs 5MTHF > > > Dr. M., > > Thank you so much for your response. > > I have a patient whom I suspect has MTHFR Polymorphism. Looking into bloodwork > to confirm (do you have a resource for this test?) Considering supplementing > prior to labs as I am unaware of any negative side effects of Folinic Acid > supplementation. > > ________________________________ > > To: csb-autism-rx > Sent: Mon, June 13, 2011 10:40:25 PM > Subject: Re: folinic acid vs 5MTHF > > TERESA MIGHT CONTRIBUTE HER WISDOM TO THIS QUESTION (THANKS, TERESA!). BELOW IS > > > SOME INFO ON 5MTHF VS FOLIC ACID (SYNTHETIC) AND FOLINIC ACID (BIOLOGICAL > FORM). THE DIFFERENCE SEEMS TO BE BIO-AVAILABILITY, AND CLINICALLY I HAVE NOT > SEEN ANY DIFFERENCE BETWEEN THE EFFECTS OF FOLINIC ACID (FOLACAL) AND 5-MTHF. I > > > AVOID THE SYNTHETIC FOLATE AND TRY TO GIVE 400-800MCG DAILY OF EITHER FOLINIC >OR > > > > 5MTHF. DR. JM > > Folate in Depression: Efficacy, Safety, Differences in Formulations, and > Clinical Issues > Fava, M. and Mischoulon, D. Folate in Depression: Efficacy, Safety, Differences > > in Formulations, and Clinical Issues. J Clin Psychiatry 2009;70[suppl 5]:12-17. > Abstract: > Supplementation with folate may help reduce depressive symptoms. Folate, a > naturally occurring B vitamin is needed in the brain for the synthesis of > norepinephrine, serotonin, and dopamine. Three forms of folate are commonly > used: folic acid, 5-methyltetrahydrofolate (5-MTHF) (also known as methylfolate > > and l-methylfolate), and folinic acid. Some forms may be more bioavailable than > > others in patients with a genetic polymorphism and in those who take particular > > medications or use alcohol. Folic acid augmentation in depressed patients may > reduce residual symptoms. The 5-MTHF formulation indicated efficacy as > adjunctive therapy or monotherapy in reducing depressive symptoms in patients > with normal and low folate levels, improving cognitive function and reducing > depressive symptoms in elderly patients with dementia and folate deficiency, >and > > > > reducing depressive and somatic symptoms in patients with depression and > alcoholism. Adjunctive folinic acid reduced depressive symptoms in patients who > > were partially responsive or nonresponsive to a selective serotonin reuptake > inhibitor. Evidence for the efficacy of folate in improving cognitive symptoms > is equivocal, but most studies used folic acid. Although the studies reviewed > have limitations and, historically, concerns have been raised about the role of > > folate in increasing cancer risk, masking B12 deficiency, and worsening > depressive symptoms, folate is generally well tolerated, and 5-MTHF may be less > > likely to incur some of these risks. Several forms of folate appear to be safe > and efficacious in some individuals with major depressive disorder, but more > information is needed about dosage and populations most suited to folate > therapy. > ________________________________ > > Novel Therapeutics for Depression: L-methylfolate as a Trimonoamine Modulator > and Antidepressant-Augmenting Agent > Stahl, S.M. Novel Therapeutics for Depression: L-methylfolate as a Trimonoamine > > Modulator and Antidepressant-Augmenting Agent. CNS Spectr. 2007;12(10):739-44. > New 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. > ________________________________ > > ________________________________ > > To: csb-autism-rx > Sent: Mon, June 13, 2011 6:47:05 PM > Subject: folinic acid vs 5MTHF > > I am confused about bioavailbility and indications for supplementing Folinic > Acid as FOLACAL (Thorne) vs 5MTHF. Is one preferred over the other any for what > > indications. Also, what is the optimal dosing mg/kg? Thank you so much. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 18, 2011 Report Share Posted June 18, 2011 Forgot to mention pt just had 72 hr EEG as he appeared to me, to be having absence seizures but not abnormalities picked up. ________________________________ To: csb-autism-rx Sent: Fri, June 17, 2011 7:08:04 PM Subject: Re: folinic acid vs 5MTHF You can look into Dr. Quadros folate receptor autoantibodies test. Also regressing at 5, have parents considered Landau Kleffner Syndrome? > > Hi Dr. M., > I was thinking about genetics and folate following a presentation given by Dr. > > Dan Rossignol that I recently attended. I have a patient with delayed onset >of > > autism. Parents report child regressed around 5 yrs old. No reactions to > vaccines, did not tolerate breast milk as an infant, cow's milk formula was a > disaster as was soy. Baby was given pre-digested formula usu reserved for > premies until solids were introduced. So far, GI panel only remarkable for > extremely low secretory IgA, He is allergic to penicillin. He is extremely > small for his age (8 yrs old) a " failure to thrive " kid. Hair reveals low > colbalt, germanium and manganese with high copper and uranium. Has no appetite > & > > no food aversions. Still awaiting full full panel of labs. > > Hannifin, DC > > > > > > ________________________________ > > To: csb-autism-rx > Cc: Binstock > Sent: Tue, June 14, 2011 11:39:34 AM > Subject: Re: folinic acid vs 5MTHF > > > This may be a genetic test, I am not sure, but I could enquire at my doctors' > list if or no one else knows. What led you to suspect he has MTHFR > Polymorphism? Dr. JM > > ________________________________ > > To: csb-autism-rx > Sent: Tue, June 14, 2011 6:14:38 AM > Subject: Re: folinic acid vs 5MTHF > > > Dr. M., > > Thank you so much for your response. > > I have a patient whom I suspect has MTHFR Polymorphism. Looking into bloodwork > to confirm (do you have a resource for this test?) Considering supplementing > prior to labs as I am unaware of any negative side effects of Folinic Acid > supplementation. > > ________________________________ > > To: csb-autism-rx > Sent: Mon, June 13, 2011 10:40:25 PM > Subject: Re: folinic acid vs 5MTHF > > TERESA MIGHT CONTRIBUTE HER WISDOM TO THIS QUESTION (THANKS, TERESA!). BELOW IS > > > SOME INFO ON 5MTHF VS FOLIC ACID (SYNTHETIC) AND FOLINIC ACID (BIOLOGICAL > FORM). THE DIFFERENCE SEEMS TO BE BIO-AVAILABILITY, AND CLINICALLY I HAVE NOT > SEEN ANY DIFFERENCE BETWEEN THE EFFECTS OF FOLINIC ACID (FOLACAL) AND 5-MTHF. I > > > AVOID THE SYNTHETIC FOLATE AND TRY TO GIVE 400-800MCG DAILY OF EITHER FOLINIC >OR > > > > 5MTHF. DR. JM > > Folate in Depression: Efficacy, Safety, Differences in Formulations, and > Clinical Issues > Fava, M. and Mischoulon, D. Folate in Depression: Efficacy, Safety, Differences > > in Formulations, and Clinical Issues. J Clin Psychiatry 2009;70[suppl 5]:12-17. > Abstract: > Supplementation with folate may help reduce depressive symptoms. Folate, a > naturally occurring B vitamin is needed in the brain for the synthesis of > norepinephrine, serotonin, and dopamine. Three forms of folate are commonly > used: folic acid, 5-methyltetrahydrofolate (5-MTHF) (also known as methylfolate > > and l-methylfolate), and folinic acid. Some forms may be more bioavailable than > > others in patients with a genetic polymorphism and in those who take particular > > medications or use alcohol. Folic acid augmentation in depressed patients may > reduce residual symptoms. The 5-MTHF formulation indicated efficacy as > adjunctive therapy or monotherapy in reducing depressive symptoms in patients > with normal and low folate levels, improving cognitive function and reducing > depressive symptoms in elderly patients with dementia and folate deficiency, >and > > > > reducing depressive and somatic symptoms in patients with depression and > alcoholism. Adjunctive folinic acid reduced depressive symptoms in patients who > > were partially responsive or nonresponsive to a selective serotonin reuptake > inhibitor. Evidence for the efficacy of folate in improving cognitive symptoms > is equivocal, but most studies used folic acid. Although the studies reviewed > have limitations and, historically, concerns have been raised about the role of > > folate in increasing cancer risk, masking B12 deficiency, and worsening > depressive symptoms, folate is generally well tolerated, and 5-MTHF may be less > > likely to incur some of these risks. Several forms of folate appear to be safe > and efficacious in some individuals with major depressive disorder, but more > information is needed about dosage and populations most suited to folate > therapy. > ________________________________ > > Novel Therapeutics for Depression: L-methylfolate as a Trimonoamine Modulator > and Antidepressant-Augmenting Agent > Stahl, S.M. Novel Therapeutics for Depression: L-methylfolate as a Trimonoamine > > Modulator and Antidepressant-Augmenting Agent. CNS Spectr. 2007;12(10):739-44. > New 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. > ________________________________ > > ________________________________ > > To: csb-autism-rx > Sent: Mon, June 13, 2011 6:47:05 PM > Subject: folinic acid vs 5MTHF > > I am confused about bioavailbility and indications for supplementing Folinic > Acid as FOLACAL (Thorne) vs 5MTHF. Is one preferred over the other any for what > > indications. Also, what is the optimal dosing mg/kg? Thank you so much. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 20, 2011 Report Share Posted June 20, 2011 A SPECT scan or MEG would pick them up. If you can get your hands on papers or videos of Dr. Lewine or Dr. Frye that would be helpful. Dr. Lewine's presentation at Autism One was interesting. > > > > Hi Dr. M., > > I was thinking about genetics and folate following a presentation given by Dr. > > > > Dan Rossignol that I recently attended. I have a patient with delayed onset > >of > > > > autism. Parents report child regressed around 5 yrs old. No reactions to > > vaccines, did not tolerate breast milk as an infant, cow's milk formula was a > > > disaster as was soy. Baby was given pre-digested formula usu reserved for > > premies until solids were introduced. So far, GI panel only remarkable for > > extremely low secretory IgA, He is allergic to penicillin. He is extremely > > small for his age (8 yrs old) a " failure to thrive " kid. Hair reveals low > > colbalt, germanium and manganese with high copper and uranium. Has no appetite > > & > > > > no food aversions. Still awaiting full full panel of labs. > > > > Hannifin, DC > > > > > > > > > > > > ________________________________ > > From: JAQUELYN MCCANDLESS <JMcCandless@> > > To: csb-autism-rx > > Cc: Binstock <binstock@> > > Sent: Tue, June 14, 2011 11:39:34 AM > > Subject: Re: folinic acid vs 5MTHF > > > > > > This may be a genetic test, I am not sure, but I could enquire at my doctors' > > list if or no one else knows. What led you to suspect he has MTHFR > > Polymorphism? Dr. JM > > > > ________________________________ > > From: Hannifin <drlisahannifin@> > > To: csb-autism-rx > > Sent: Tue, June 14, 2011 6:14:38 AM > > Subject: Re: folinic acid vs 5MTHF > > > > > > Dr. M., > > > > Thank you so much for your response. > > > > I have a patient whom I suspect has MTHFR Polymorphism. Looking into bloodwork > > > to confirm (do you have a resource for this test?) Considering supplementing > > prior to labs as I am unaware of any negative side effects of Folinic Acid > > supplementation. > > > > ________________________________ > > From: JAQUELYN MCCANDLESS <JMcCandless@> > > To: csb-autism-rx > > Sent: Mon, June 13, 2011 10:40:25 PM > > Subject: Re: folinic acid vs 5MTHF > > > > TERESA MIGHT CONTRIBUTE HER WISDOM TO THIS QUESTION (THANKS, TERESA!). BELOW IS > > > > > > SOME INFO ON 5MTHF VS FOLIC ACID (SYNTHETIC) AND FOLINIC ACID (BIOLOGICAL > > FORM). THE DIFFERENCE SEEMS TO BE BIO-AVAILABILITY, AND CLINICALLY I HAVE NOT > > SEEN ANY DIFFERENCE BETWEEN THE EFFECTS OF FOLINIC ACID (FOLACAL) AND 5-MTHF. I > > > > > > AVOID THE SYNTHETIC FOLATE AND TRY TO GIVE 400-800MCG DAILY OF EITHER FOLINIC > >OR > > > > > > > > 5MTHF. DR. JM > > > > Folate in Depression: Efficacy, Safety, Differences in Formulations, and > > Clinical Issues > > Fava, M. and Mischoulon, D. Folate in Depression: Efficacy, Safety, Differences > > > > in Formulations, and Clinical Issues. J Clin Psychiatry 2009;70[suppl > 5]:12-17. > > Abstract: > > Supplementation with folate may help reduce depressive symptoms. Folate, a > > naturally occurring B vitamin is needed in the brain for the synthesis of > > norepinephrine, serotonin, and dopamine. Three forms of folate are commonly > > used: folic acid, 5-methyltetrahydrofolate (5-MTHF) (also known as methylfolate > > > > and l-methylfolate), and folinic acid. Some forms may be more bioavailable than > > > > others in patients with a genetic polymorphism and in those who take particular > > > > medications or use alcohol. Folic acid augmentation in depressed patients may > > reduce residual symptoms. The 5-MTHF formulation indicated efficacy as > > adjunctive therapy or monotherapy in reducing depressive symptoms in patients > > with normal and low folate levels, improving cognitive function and reducing > > depressive symptoms in elderly patients with dementia and folate deficiency, > >and > > > > > > > > reducing depressive and somatic symptoms in patients with depression and > > alcoholism. Adjunctive folinic acid reduced depressive symptoms in patients who > > > > were partially responsive or nonresponsive to a selective serotonin reuptake > > inhibitor. Evidence for the efficacy of folate in improving cognitive symptoms > > > is equivocal, but most studies used folic acid. Although the studies reviewed > > have limitations and, historically, concerns have been raised about the role of > > > > folate in increasing cancer risk, masking B12 deficiency, and worsening > > depressive symptoms, folate is generally well tolerated, and 5-MTHF may be less > > > > likely to incur some of these risks. Several forms of folate appear to be safe > > > and efficacious in some individuals with major depressive disorder, but more > > information is needed about dosage and populations most suited to folate > > therapy. > > ________________________________ > > > > Novel Therapeutics for Depression: L-methylfolate as a Trimonoamine Modulator > > and Antidepressant-Augmenting Agent > > Stahl, S.M. Novel Therapeutics for Depression: L-methylfolate as a Trimonoamine > > > > Modulator and Antidepressant-Augmenting Agent. CNS Spectr. 2007;12(10):739-44. > > New 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. > > ________________________________ > > > > ________________________________ > > From: Hannifin <drlisahannifin@> > > To: csb-autism-rx > > Sent: Mon, June 13, 2011 6:47:05 PM > > Subject: folinic acid vs 5MTHF > > > > I am confused about bioavailbility and indications for supplementing Folinic > > Acid as FOLACAL (Thorne) vs 5MTHF. Is one preferred over the other any for what > > > > indications. Also, what is the optimal dosing mg/kg? Thank you so much. > > > > Quote Link to comment Share on other sites More sharing options...
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