Increase in the folate level can decrease the intensity of disorder in patients with depression who use citalopram: a randomized clinical trial

Abstract

Background Depression is one of the most common mental health disorders, which affiliated more than four percent of world population. Several antidepressant agents, including citalopram were developed. High dose and long-term treatment with these agents along with their side effects decrease the treatment adherence. Using supplements such as acid folic is a way to increase these drug’s efficacy. The aim of this study was to assess the effect of acid folic supplement and increase in blood folate level of the intensity of depression symptoms.Methods This was a randomized-controlled clinical trial. Twenty-four patients with major depression were randomly assigned to two groups. Both groups received citalopram as their standard treatment. The intervention group received acid folic supplement (1mg/daily). The folate levels of blood, Beck's depression inventory and Hamilton depression scale scores were measured. The measurements were conducted before intervention, and in 45 and 90 days follow ups. Data were analyzed using Mann-Whitney U and Friedman tests.Results The blood level of folate was increased for the intervention group. The Hamilton depression scale and Beck Depression Inventory Scores were reduced significantly in both groups after 90 days follow up. There were no significant differences between two groups in the reduction of depression scores. In the intervention group, the decrease of Hamilton's depression scale score was negatively correlated to the increase of blood folate level.Conclusions The increase in blood folate level may be correlate with the decrease in depression symptoms. The use of 1mg/d supplement of acid folic was not effective in the reduction of depression symptoms in patients with major depression.Registered in Iranian Registry of Clinical Trials (IRCT20180115038373N1)

The Effect of Natural Therapies in Combination with Usual Care for Depression: A Narrative Review

“…Doses of 1 mg/day of folic acid produced no significant changes in the HAM-D scores although it raised the serum level of folate in the intervention group significantly [43]. The increase in serum folate was inversely correlated with a decrease in HAM-D score [43]. Earlier studies have also shown an inverse correlation between serum folate levels and symptoms of depression [52].…”

“…Earlier studies have also shown an inverse correlation between serum folate levels and symptoms of depression [52]. The relationship between dietary folate and depression severity significantly differs by race and ethnicity [43] and baseline levels of folic acid can affect the outcomes in patients without folic acid deficiency [45]. Gender differences in handling folic acid are another factor that might influence the outcomes as the response to folic acid supplementation is more pronounced in females than men [45].…”

“…Folate at doses < 5 mg/day or methylfolate at a dose of 15 mg/day may be considered as an adjunct therapy to SSRIs in patients with MDD [44]. Doses of 1 mg/day of folic acid produced no significant changes in the HAM-D scores although it raised the serum level of folate in the intervention group significantly [43]. The increase in serum folate was inversely correlated with a decrease in HAM-D score [43].…”

“…In the case of folic acid, an excess amount can mask the symptoms of anemia due to vitamin B12 deficiency leading to neurological complications [56,57]. Monitoring the level of minerals and vitamins in patients with MDD who receive antidepressants helps to optimize the outcome of supplementation with folic acid [43]. The adverse effects associated with acupuncture are few.…”