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Re: l-methyfolate rescue

Posted by PeterMartin on June 2, 2018, at 20:44:39

In reply to Re: l-methyfolate rescue PeterMartin, posted by SLS on June 2, 2018, at 10:57:39

> >I found myself feeling worse on L-methylfolate after experiencing an initial improvement. Do you know the reason why the efficacy of Lamictal is reduced?
>
> Thanks.
>
>
> - Scott

This is where that info came from - thoughts?

"Folic acid seems to nullify the effect of lamotrigine."

https://www.sciencedirect.com/science/article/pii/S2215036615004502

===

Comparative evaluation of quetiapine plus lamotrigine combination versus quetiapine monotherapy (and folic acid versus placebo) in bipolar depression (CEQUEL): a 2  2 factorial randomised trial

Background
Depressive symptoms are a major cause of disability in bipolar disorder and there are few safe and effective treatments. The combination of lamotrigine plus quetiapine potentially offers improved outcomes for people with bipolar depression. We aimed to determine if combination therapy with quetiapine plus lamotrigine leads to greater improvement in depressive symptoms over 12 weeks than quetiapine monotherapy plus lamotrigine placebo.

Methods
In this double-blind, randomised, placebo-controlled, parallel group, 2  2 factorial trial (CEQUEL), patients with DSM-IV bipolar disorder I or II, who were aged 16 years or older, and required new treatment for a depressive episode, were enrolled from 27 sites in the UK. Patients were randomly assigned (1:1) by an adaptive minimisation algorithm to lamotrigine or placebo and to folic acid or placebo. Participants and investigators were masked to the treatment groups. The primary outcome was improvement in depressive symptoms at 12 weeks with the Quick Inventory of Depressive Symptomatologyself report version 16 (QIDS-SR16). Analysis was by modified intention-to-treat. This trial is registered with EUdraCT, number 2007-004513-33.

Findings
Between Oct 21, 2008, and April 27, 2012, 202 participants were randomly assigned; 101 to lamotrigine and 101 to placebo. The mean difference in QIDS-SR16 total score between the group receiving lamotrigine versus the placebo group at 12 weeks was −173 ([95% CI −357 to 011]; p=0066) and at 52 weeks was −269 ([489 to −049]; p=0017). Folic acid was not superior to placebo. There was a significant interaction (p=0028), with folic acid reducing the effectiveness of lamotrigine at 12 weeks. The mean difference on QIDS-SR16 was −414 ([95% CI −690 to −137]; p=0004) for patients receiving lamotrigine without folic acid compared with 012 ([258 to 282]; p=0931) for those receiving lamotrigine and folic acid.

Interpretation
Addition of lamotrigine to quetiapine treatment improved outcomes. Folic acid seems to nullify the effect of lamotrigine. CEQUEL should encourage clinicians and patients to consider lamotrigine for bipolar depression, but also to be aware that concurrent folic acid might reduce its effectiveness.


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poster:PeterMartin thread:1098985
URL: http://www.dr-bob.org/babble/20180521/msgs/1099014.html