Do You Need A Happy Pill?

Do You Need A Happy Pill?

I see a lot of depression in my practice. My experience treating it has been similar to what is discussed in medical literature. In about 70% of patients there has been some improvement with antidepressants, but a full remission has occurred in only 40 to 50%. In the interest of boosting this disappointing remission rate, I have been searching for something that will either augment antidepressants or that could be used alone.

I have found a supplement considered to be medicinal food. It is safe, and it really does work. It is a vitamin that is a form of folic acid known as L-methylfolate.

Folic acid is an essential B vitamin. It is found in green leafy vegetables, eggs, cereals and fortified foods (to name a few). When you take in folate or folic acid in your diet it is absorbed by the small intestine, where it is converted by an enzyme into L-methylfolate. This metabolite is used to make serotonin, norepinephrine and dopamine, which are all important for mood regulation.

Scientists have identified 40 mutations on the gene (known as MTHFR) responsible for making the enzyme that converts folic acid into L-methylfolate. If there is one mutation on this gene, your ability to convert folic acid is reduced by 34%. If you have two mutations, it is reduced by 71%. Now you probably are seeing where I am going with this.

If you have a defective enzyme, you cannot convert folic acid to L-methylfolate properly and you will have lower serotonin, norepinephrine and dopamine levels.

These gene mutations are extremely common.

The treatment is simple: a prescription of L-methylfolate. If given in the proper amounts (7.5 to 15 milligrams) it can improve mild depression relatively quickly. In a study of elderly depressed patients, the response rate at 6 weeks was 81%. Results are often seen in just two weeks.

A recent study of people with major depression found that adding L-methylfolate improved depression from 7% for those on an antidepressant alone to 18.5% with the addition of L-methylfolate over a period of 60 days.

It is well tolerated with no more side effects than placebo. It does not interact with other medications. In my experience, if an antidepressant has produced a positive response but the patient is still somewhat depressed, L-methylfolate can help.

The results I have seen are impressive. When I treat people with MTHFR mutations (with or without mild depression) with L-methylfolate, their mood improves and often they sleep better. Related problems such as irritable bowel syndrome will often get better as well.

If you are depressed and/or on medication for depression, I recommend you ask your doctor to see if you have the genetic abnormality that I mentioned. The blood test is called MTHFR. It just makes sense. If serotonin levels are genetically low, why not find a healthy way to boost them?

Medically reviewed in January 2020.

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