Homocysteine, folate, methylation,
and monoamine metabolism in depression
by
Bottiglieri T, Laundy M, Crellin R,
Toone BK, Carney MW, Reynolds EH
Department of Neurology,
King's College Hospital,
London, UK.
J Neurol Neurosurg Psychiatry 2000 Aug; 69(2):228-232

ABSTRACT

OBJECTIVES: Previous studies suggest that folate deficiency may occur in up to one third of patients with severe depression, and that treatment with the vitamin may enhance recovery of the mental state. There are, however, difficulties in interpreting serum and red cell folate assays in some patients, and it has been suggested that total plasma homocysteine is a more sensitive measure of functional folate (and vitamin B12) deficiency. Other studies suggest a link between folate deficiency and impaired metabolism of serotonin, dopamine, and noradrenaline (norepinephrine), which have been implicated in mood disorders. A study of homocysteine, folate, and monoamine metabolism has, therefore, been undertaken in patients with severe depression. METHODS: In 46 inpatients with severe DSM III depression, blood counts, serum and red cell folate, serum vitamin B12, total plasma homocysteine, and, in 28 patients, CSF folate, S-adenosylmethionine, and the monoamine neurotransmitter metabolites 5HIAA, HVA, and MHPG were examined. Two control groups comprised 18 healthy volunteers and 20 patients with neurological disorders, the second group undergoing CSF examination for diagnostic purposes. RESULTS: Twenty four depressed patients (52%) had raised total plasma homocysteine. Depressed patients with raised total plasma homocysteine had significant lowering of serum, red cell, and CSF folate, CSF S-adenosylmethionine and all three CSF monoamine metabolites. Total plasma homocysteine was significantly negatively correlated with red cell folate in depressed patients, but not controls. CONCLUSIONS: Utilising total plasma homocysteine as a sensitive measure of functional folate deficiency, a biological subgroup of depression with folate deficiency, impaired methylation, and monoamine neurotransmitter metabolism has been identified. Detection of this subgroup, which will not be achieved by routine blood counts, is important in view of the potential benefit of vitamin replacement.

B12
SAMe
Folate
Nutrition
Selenium
Magnesium
Natural drugs
Nutritional psychiatry
Catecholamine depletion
Folate as an antidepressant
Folate and unipolar depression
Folic acid plus fluoxetine (Prozac)
Augmenting antidepressants with folate
Antidepressant folic acid and the opioid system
Antidepressant efficacy of folic acid supplementation
Folic acid and PUFAs prevent depression and dementia
Does folic acid improve the efficacy of antidepressants?

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