Folic Acid - The Equalizing B Vitamin

As a follow up to my March 24, 2011 PT blog about some beneficial (yes, beneficial) interactions of St. John’s wort with medications (click here for article), this blog is going to discuss a front runner in the field of beneficial antidepressant interaction: folate.

About two thirds of patients do not enjoy remission from depression when given medication. Oftentimes, these patients are run through a series of ‘adjunctive’ and ‘add-on’ drugs (like anti-psychotic medications) in the hopes of a combination that may help the patient feel better. One nutrient that may avoid this round about is folate.

The word folate comes from the Latin word ‘folium’ which means ‘leaf’ for it was realized decades ago that there was plenty of this nutrient in leafy greens. Folate, also known as folic acid, has been studied in the literature for its benefit in mood issues for the last 25 years. It is well-known to be a factor in depression when depleted in the body. Folate depletion can be encouraged by eating poorly, by taking certain drugs (like anti-epileptic medication), and also alcohol intake.

One of the more recent folate studies looks at 75 patients who were already taking antidepressant medication but were not responding. It was shown that patients taking 15 milligrams of folate per day found their medication to work significantly better – and these effects were as good or better than the conventional medications studied according to the authors . This study suggests that this water soluble B-vitamin may be a viable alternative to the vast array of adjunctive and add-on medications, including anti-psychotic medications, that awaits the initial drug non-responder.

As a note, the best form of folate is l-methylfolate, which is the most available for the body to use. Because some people have a genetic inability to convert the typical folic acid into l-methylfolate, it is recommended to supplement with this form of folic acid. Methylfolate is most like the form that appears in natural vegetables. In fact, using the common form of the supplement folic acid, which is employed in most vitamins, pregnancy formulas and in enriched foods, may actually make the more bioavailable l-methylfolate form less available for the body to use.

As I stated, about two-thirds of patients who use medication do not achieve remission. In my opinion, it makes sense that when possible, patients already using medication should augment their therapy with natural solutions instead of layering on another pharmaceutical. In my practice, whether a patient is utilizing medications or not, I find the naturopathic model of balancing sleep, exercise, healthful diet, counseling work, and the right nutrients (which often includes extra folate) will help a person with mood disorder rebalance optimally.

Peter Bongiorno ND, LAc practices in New York, and recently authored Healing Depression: Integrated Naturopathic and Conventional Therapies.

Reference: Fava M, Shelton RC, Zajecka JM, et al. L-methylfolate as adjunctive therapy for selective serotonin reuptake inhibitor-resistant major depressive disorder: results of two randomized, double-blind, parallel-sequential trials [poster]. Presented at the 49th annual meeting of the American College of Neuropsychopharmacology; December 5–9, 2010; Miami Beach, FL.