Can Folic Acid Help Ease Depression?
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Can Folic Acid Help Ease Depression?

Image for HCA, folic acid and depressionFolic acid (found in nature as folate), the B vitamin that is famous for its role in preventing birth defects, is now under scrutiny for its effects on depression.

A group of researchers from Tufts University in Boston, Massachusetts found that blood levels of folate were much lower among people with depression than in people who were not depressed. Findings like these have suggested a link between low folate levels and depression.

If low levels of this vitamin lead to depressive symptoms, it seems logical to conclude that giving folic acid supplements to people with depression will help their recovery. However, research shows that the connection is not that simple.

Folate in the Brain

Folate, which is needed to make DNA and RNA, the building blocks of cells, is quite active in the brain and central nervous system. It affects the production of certain essential compounds and neurotransmitters—substances that carry messages to different parts of the brain.

For example, folate deficiency leads to lower levels of S-adenosylmethionine (SAM) in the brain. Some research has suggested that supplementation with SAM can play a positive role in the treatment of depression. Therefore, one possible theory is that low folate levels leads to low SAM, which increases symptoms of depression. By improving folate status, SAM increases, and depressive symptoms drop.

What the Studies Have Found

Some studies have found depressed patients to be deficient in folate, while others have shown no statistically significant differences in folate levels between people with and without depression. And when a link is found, it is unclear which came first—the deficiency or the depression.

Many depressed people tend to eat poor diets, which can lead to deficiencies of many vitamins and minerals, not just folate. Another possibility is that a third, unknown factor causes both folate deficiency and depression. However, there is a small amount of direct evidence to indicate that folate supplements might be helpful for depression.

A study in the Journal of Clinical Psychiatry found that sufficient amounts of folate are needed for the brain to work well. Deficiencies may cause a higher risk for depression and worsen the response to antidepressant medication.

In a study published in the American Journal of Psychiatry, a group of researchers gave fluoxetine (Prozac) to 213 patients with major depressive disorder. The researchers also measured blood levels of folate in all study volunteers. After eight weeks on fluoxetine, the patients with low folate levels were significantly less likely to show improvement from the drug therapy.

Also, a study found that folic acid combined with fluoxetine was effective in the initial treatment of depression. However, this response was seen only in women; folic acid did not affect the men in the study. Researchers are not sure why only women responded, although it could have been that men needed a higher dose of folic acid.

Should Folic Acid Be Part of Depression Treatment?

Depression is a serious condition that requires careful, ongoing treatment with talk therapy, medication, or a combination of the two. The research looking into folic acid and depression is still quite new. As the authors in an editorial in Psychotherapy and Psychosomatics explain, “Our understanding of the role of folate in mental disorders is still insufficient to make practical recommendations.” There are no clear guidelines for dosage or duration of treatment.

Other researchers argue that it's reasonable to ask your doctor about folic acid since it may be helpful when taking selective serotonin reuptake inhibitors (SSRIs). Also, the cost of the supplement is low.

The Bottom Line

If you are living with depression, talk with your doctor about folic acid. If you are deficient, your doctor may recommend taking a daily multivitamin and mineral supplement as well as increasing your intake of foods rich in this vitamin.

These include:

  • Green leafy vegetables (like spinach and turnip greens)
  • Legumes (black beans, lentils, peas, etc)
  • Citrus fruits and juices
  • Fortified cereals and grain products (including rice, pasta, bread, and certain breakfast cereals)

Note, however, do not take more than 400 micrograms daily of folic acid daily because a high intake may hide a vitamin B12 deficiency.

Keep in mind that a deficiency of folate might increase the risk of heart disease and stroke . In addition, for women considering pregnancy, sufficient folic acid intake can help decrease the risk of having a baby with a neural tube defect such as spina bifida. Folic acid certainly is a vitamin worth getting your fair share of; it’s just not yet clear if it can also help improve your mental state.

RESOURCES:

National Institute of Mental Health
http://www.nimh.nih.gov/

National Alliance for the Mentally Ill
http://www.nami.org/

Depression & Bipolar Support Alliance
http://www.DBSAlliance.org/

CANADIAN RESOURCES:

Canada's Food Guide
http://www.hc-sc.gc.ca/

Canadian Psychological Association
http://www.cpa.ca/cpasite/home.asp/

References

Bjelland I, Useland PM, Vollset SE. Folate and depression [editorial]. Psychother and Psychosom. 2003;72:59-60.

Bottiglieri T, Laundy M, Crellin R, Toone BK, Carney MW, Reynolds EH. Homocysteine, folate, methylation, and monoamine metabolism in depression [abstract]. J Neurol Neurosurg Psychiatry. 2000;69:228-232.

Fava M, Borus JS, Alpert JE, Nierenberg AA, Rosenbaum JF, Bottiglieri T. Folate, vitamin B12, and homocysteine in major depressive disorder [abstract]. Am J Psychiatry. 1997;154:426-428.

Folate. EBSCO Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=81. Accessed June 3, 2008.

Mischoulon D, Raab MF. The role of folate in depression and dementia—review article. J Clin Psych. 2007;68(suppl):10:28-33.

Morris MS, Fava M, Jacques PF, Selhub J, Rosenberg IH. Depression and folate status in the US population [abstract]. Psychother and Psychosom. 2003;72:80-87.

Skerritt UM. A prevalence study of folate deficiency in a psychiatric in-patient population [abstract]. Acta Psychiatr Scand. 1998;97:28-232.

Tiemeier H, van Tuijl HR, Hofman A, Meijer J, Kiliaan AJ, Breteler MM. Vitamin B12, folate, and homocysteine in depression: the Rotterdam Study [abstract]. Am J Psychiatry. 2002;159:2099-2101.

Young SN, Ghadirian AM. Folic acid and psychopathology [abstract]. Prog Neuropsychopharmacol Biol Psychiatry. 1989;13:841-863.



Last reviewed May 2008 by Theodor B. Rais, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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