Two additional adjunctive therapies for mental health
I was excited to read Dr. Nasrallah’s editorial about adjunctive therapies for mental health disorders (Are you neuroprotecting your patients? 10 Adjunctive therapies to consider, Current Psychiatry. December 2016, p. 12-14). I am a psychiatric physician assistant and have incorporated the principles of integrative medicine into my practice over the past year. I was thrilled to see the editorial outline many of the holistic treatments I use with clients.
The article missed 2 important vitamins that play a crucial role in positive mental health treatment outcomes: folic acid and vitamin B12. In my practice, I have found up to 50% of my patients with depression have a vitamin B12 deficiency. After supplementation, these patients’ symptoms improve to the point that we often can reduce or eliminate medication. Folic acid deficiency has been found among individuals with depression and linked to poor response to treatment.1 Higher serum levels of homocysteine—a consequence of low folic acid levels—are linked to increased risk of developing depression later in life, as well as higher risk of cardiovascular disease.2,3 Folate also can be used for enhancing treatment response to antidepressants by increasing production of neurotransmitters.2
Another factor to consider is methylenetetrahydrofolate reductase (MTHFR) variants. Approximately 20% of the population cannot methylate B vitamins because of a variation on the MTHFR gene.4,5 These patients are at increased risk for depression because they are unable to use B vitamins, which are essential in the synthesis of serotonin and dopamine. These patients do not respond to B12 and folate supplements. For these individuals, I recommend methylated products, which can be purchased online.
I have found these practices, as well as many of those listed in the editorial, are effective in treating depression and anxiety.
Lara Kain, PA-C, MPAS
Psychiatric Physician Assistant
Tidewater Psychotherapy Services
Virginia Beach, Virginia
References
1. Kaner G, Soylu M, Yüksel N, et al. Evaluation of nutritional status of patients with depression. Biomed Res Int. 2015;2015:521481. doi: 10.1155/2015/521481.
2. Seppälä J, Koponen H, Kautiainen H, et al. Association between vitamin B12 and melancholic depressive symptoms: a Finnish population-based study. BMC Psychiatry. 2013;13:145. doi: 10.1186/1471-244X-13-145.
3. Petridou ET, Kousoulis AA, Michelakos T, et al. Folate and B12 serum levels in association with depression in the aged: a systemic review and meta-analysis. Aging Ment Health. 2016;20(9):965-973.
4. Lynch B. MTHFR mutations and the conditions they cause. MTHFR.Net. http://mthfr.net/mthfr-mutations-and-the-conditions-they-cause/2011/09/07. Accessed February 16, 2017.
5. Eszlari N, Kovacs D, Petschner P, et al. Distinct effects of folate pathway genes MTHFR and MTHFD1L on ruminative response style: a potential risk mechanism for depression. Transl Psychiatry. 2016;6(3):e745. doi: 10.1038/tp.2016.19.