1080946_24278190What’s new with depression treatments?

The numbers remain dismal.

According to a 2003 study, about half of all patients with depression fail to experience a remission while taking anti-depressants.

What about the remaining 50 percent who are finding some relief from medication? Of those, over one third still have significant symptoms.

That’s a lot of people who are not finding relief from medication.

Another dismal fact: SSRIs (the most widely prescribed form of antidepressants for major depression) have to be tried out by the patient, often one after another, until an effective one is found. This can take weeks or months, assuming one is found to work at all. Naturally this is frustrating to physicians and painful for patients.

Which is why psychiatrists and others who prescribe antidepressants are always looking for a “miracle” cure, the drug that is going to really work.

It’s true that psychotherapy combined with medication has shown better results. It’s also true that other factors may affect outcomes.

For example, I often encourage those in treatment for depression or other mental illnesses to explore supportive therapies and advocate for themselves. Two areas which can significantly augment traditional talk therapy and medication (and which I think have been largely neglected by professionals and researchers) arespirituality and nutrition.

Today, psychiatrists are studying the efficacy of nutritional supplementation combined with medication or used alone. A 2010 study and a study just published in Psychiatric Times shows that one such supplement is a familiar kind of B vitamin: folic acid (folate/l-methylfolate).

A deficiency of folic acid has long been linked with depression.

The latest study shows that supplementing with l-methyfolate (the active form of folic acid which crosses the blood-brain barrier) helps patients with major depressive disorder who are taking SSRIs. Earlier studies have shown that even folate alone, in some cases, may improve symptoms of depression.

(In other news… folate may improve schizophrenia, too.)

While anecdotal evidence is not the same thing as rigorously conducted scientific evidence, my experience has shown that folate supplementation does seem to help some patients’ symptoms of depression. There are a few mental health professionals like me who are aware of the important role nutrition plays in mental illness and it’s treatment, and who agree that suggesting folate supplementation (preferably with the guidance of a nutritionist or other professional who is expert in this area and who can help determine the correct dosage) is part of our responsibility to patients.

The dirty little secret is that therapists are human, too. Like most other humans, it is nearly instinctive for us to recommend services or products that we are able to provide. You don’t see a car salesman recommending you get a bike, instead.

Therapists can provide and “sell” talk therapy. But *folate can be bought at any health food or vitamin shop.

While it’s true that some believe the evidence of folate supplementation isn’t perhaps conclusive, it is also true that the hit and miss/trial and error aspects of prescribing medications for depression isn’t as “scientific” as it could be.

Depression that doesn’t respond to psychotherapy or medication is labeled “treatment resistant depression.” In other words, the treatments available don’t work.

If you look at this list of recommendations for treatment resistant depression, from the Mayo Clinic, you’ll notice that the very last item on the list of things to consider is physical health!  I’m afraid that physical health is among the very first things which should be addressed with mental illness in general and depression specifically. Other often ignored aspects of an evaluation are substance abuse and spirituality.

Has your therapist suggested you explore dietary improvements and/or nutritional supplementation as an adjunct to therapy or medication?

*It’s important to note that the dosage used in the most recent clinical trial was 15 mg. per day. It is also important to note that taking a B vitamin (folate is B9) without the other B vitamins may lead to a significant imbalance. (See our recent post on anxiety, depression, and Vitamin B12). And, remember: mega-dosing (taking large doses) of vitamins can be harmful, which is why working with a qualified MD or nutritionist is important.