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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by Phillipa on March 31, 2011, at 21:46:06
Figured I use Deplin as same as other name for medical food. What a surprise to me. Mogger hope you see this. Phillipa
EPA 2011: 19th European Congress of Psychiatry
This coverage is not sanctioned by, nor a part of, the European Congress of Psychiatry.
From Medscape Medical News > Psychiatry
Adjunctive L-Methylfolate May Help in Treatment-Resistant Depression
Folate Deficiency Common in Major Depression
Jill SteinAuthors and Disclosures
March 18, 2011 (Vienna, Austria) L-methylfolate is showing promise as an augmenting agent for depressed patients who are unresponsive to traditional antidepressants, new research suggested.
Presented here at EPA 2011: 19th European Congress of Psychiatry, the study results revealed L-methylfolate, 15 mg/d, was effective, safe, and relatively well tolerated as an adjunct treatment strategy for patients with major depressive disorder (MDD) who were partial responders or nonresponders to selective serotonin reuptake inhibitor (SSRI) therapy.
"According to the literature, only about 1 of every 3 patients with depression will achieve remission with standard antidepressant monotherapy," principal investigator George Papakostas, MD, who is director of treatment-resistant depression (TRD) studies, Psychiatry Division at Massachusetts General Hospital and associate professor of psychiatry at Harvard Medical School in Boston, told Medscape Medical News.
"So it's clear that we need better therapies for depression. We found that L-methylfolate, 15 mg/d, produced favorable results, but the data are preliminary and need to be replicated in a larger trial," he added.
For the roughly two-thirds of patients who are inadequate responders or nonresponders, augmentation strategies or switching strategies altogether are indicated, he added.
A variety of treatment options are available, including atypical agents, folates, or lithium, but the choice of therapy ultimately depends on the patient's individual profile and his/her personal preference.
Dr. Papakostas presented results from 2 multicenter, placebo-controlled trials of L-methylfolate used as an adjunct to SSRI therapy in patients with SSRI-resistant MDD who were 18 to 65 years of age. SSRI doses remained constant throughout the 2 TRD studies, which enrolled a total of 223 patients.
Folate Deficiency Common in MDD
Roughly 70% of patients with MDD have a specific genetic factor that causes L-methylfolate deficiency. Individuals with deficient L-methylfolate are more likely to experience a later onset of action, less improvement, a more severe depressive episode, and a higher chance of relapse when taking conventional antidepressants.
Several studies have examined the use of folic acid or various folic acid metabolites, such as folinic acid and methyltetrahydrofolate, as either monotherapy or adjunctive therapy for MDD.
L-methylfolate was selected as the augmenting agent in the 2 TRD studies because of evidence suggesting it may have advantages with respect to bioavailability over other folates. L-methylfolate is thought to work as an augmenting agent to antidepressants by acting as a trimonoamine modulator, enhancing the synthesis of the 3 monoamines, dopamine, norepinephrine, and serotonin, and thereby boosting the efficacy of antidepressants.
Significant Benefit
In the TRD-1 study, 148 patients were randomized in a 2:3:3 design to receive either L-methylfolate for 60 days (7.5 mg/d in phase 1 and 15 mg/d in phase 2), placebo for 30 days followed by L-methylfolate for 30 days (7.5 mg/d), or placebo for 60 days.
The 75-patient TRD-2 was identical in design to TRD-1 except for a target dose of 15 mg/d of L-methylfolate throughout both phases.
The coprimary endpoints for both studies were the differences in response rates and in degree of improvement in the Hamilton Depression Rating Scale (HDRS-17) between treatment groups. An HDRS-17 response was defined asa 50% or greater reduction in HDRS-17 scale scores during treatment or a final score of 7 or less.
The TRD-1 study found no difference in outcome between the treatment groups.
The TRD-2 study showed greater efficacy for adjunctive 15 mg/d of L-methylfolate administered for up to 30 days vs placebo when added to continued SSRI therapy plus placebo on both primary outcome measures (degree of change and response rates according to the HDRS, P = .05 and .04, respectively).
There was no difference in the rates of treatment withdrawal due to adverse events in the L-methylfolate 15 mg/d/antidepressant and the placebo/antidepressant groups.
Finally, the number of patients needed to treat (NNT) for a response in the TRD-2 study was between 5 and 6 patients in favor of adjunctive 15 mg/dof L-methylfolate vs placebo. "This is on a par with NNTs reported for other augmentation strategies in MDD," Dr. Papakostas said.
Posted by floatingbridge on April 1, 2011, at 0:56:38
In reply to Deplin at 15mg effective MDD with SSRI's, posted by Phillipa on March 31, 2011, at 21:46:06
Phillipa, any known longterm side-effects from deplin? Just concentrated folate?
Thanks for your post.
fb
Posted by Phillipa on April 1, 2011, at 12:40:48
In reply to Re: Deplin at 15mg effective MDD with SSRI's » Phillipa, posted by floatingbridge on April 1, 2011, at 0:56:38
FB was taking it before surgery two years ago and since pernicious anemia could be hidden I thought should stop for surgery. But no of no side effects as they say a medical food. To equal a 7.5mg dose so many pills of supplements would be needed it's not something I could afford. Phillipa
Posted by Phillipa on April 1, 2011, at 21:01:26
In reply to Re: Deplin at 15mg effective MDD with SSRI's » floatingbridge, posted by Phillipa on April 1, 2011, at 12:40:48
FB Hope this link works. Phillipa
Posted by Phillipa on April 1, 2011, at 21:10:23
In reply to Re: Deplin at 15mg effective MDD with SSRI's, posted by Phillipa on April 1, 2011, at 21:01:26
Posted by iforgotmypassword on April 2, 2011, at 18:14:56
In reply to Deplin at 15mg effective MDD with SSRI's, posted by Phillipa on March 31, 2011, at 21:46:06
"70% of patients with MDD have a specific genetic factor that causes L-methylfolate deficiency."
is this true? it sounds pretty big.
Posted by linkadge on April 2, 2011, at 20:31:26
In reply to 70% of pts w/ MDD have genetic deficiency? » Phillipa, posted by iforgotmypassword on April 2, 2011, at 18:14:56
Its true, but with some explaination required.
a) The genetic defect is also very high in the general population.
b) The genetic defect only causes a slight reduction in ability to metabolize folates.
Linkadge
Posted by Phillipa on April 2, 2011, at 21:30:44
In reply to Re: 70% of pts w/ MDD have genetic deficiency?, posted by linkadge on April 2, 2011, at 20:31:26
So Link do you recommend Deplin? Phillipa
Posted by SusanWhelan on April 14, 2011, at 11:15:15
In reply to Deplin at 15mg effective MDD with SSRI's, posted by Phillipa on March 31, 2011, at 21:46:06
Hi, I work with Deplin. Thank you for helping spread the word regarding this study. For more information on this study and others, check out: http://www.deplin.com/HealthcareProfessionals,Trials
Thanks.
Posted by floatingbridge on April 14, 2011, at 19:29:00
In reply to Re: Deplin at 15mg effective MDD with SSRI's » Phillipa, posted by SusanWhelan on April 14, 2011, at 11:15:15
Hi Susan,
My understanding of this thread was to discuss possible, if any, benefits or side effects to deplin; my perception is that the initial poster's intention was not to 'help' the mentioned study or pamlabs or deplin; rather, (s)he was posting for feedback and clarification from peers.
Thank you for identifying your affiliation and interest.
This remains a private site owned by Dr. Bob Hsung. Members use it for peer-support and self-help, and as such, I hope remains free of any support or affiliation with the pharmaceutical industry.
Floatingbridge
Posted by Phillipa on April 14, 2011, at 21:30:07
In reply to Re: Deplin at 15mg effective MDD with SSRI's » SusanWhelan, posted by floatingbridge on April 14, 2011, at 19:29:00
I welcome Susan's disclosing that she works for Deplin. I'd love and am going to read her thread. Other drug reps have often visited this site. At one time a lunesta rep also did and we became fast friends. Looking forward to reading above. Sorry couldn't make the web cam tonight. It's okay FB as she disclosed her identity. Phillipa
Posted by Phillipa on April 14, 2011, at 21:37:13
In reply to Re: Deplin at 15mg effective MDD with SSRI's » Phillipa, posted by SusanWhelan on April 14, 2011, at 11:15:15
Susan I didn't realize there was a risk of cancer with Deplin could you please comment on that and also I had heard that if you take 7.5mg of Deplin you would see results quickly if you had this missing gene. The study suggests at least 60 days could you also coment on this? Thanks Phillipa
Posted by SusanWhelan on April 15, 2011, at 10:41:43
In reply to Re: Deplin at 15mg effective MDD with SSRI's » SusanWhelan, posted by floatingbridge on April 14, 2011, at 19:29:00
Hi, I appreciate your insight. It is our goal to engage in conversations regarding Deplin and disseminate information. If we overstep our bounds in any way, feel free to tell us. We will listen.
Thanks for your feedback.
Posted by SusanWhelan on April 15, 2011, at 14:29:22
In reply to Re: Deplin at 15mg effective MDD with SSRI's » SusanWhelan, posted by Phillipa on April 14, 2011, at 21:37:13
There is no risk of cancer associated with Deplin. You may be confused with high doses of unmetabolized folic acid, which is different. Deplin is L-methylfolate, the active form of folate your body makes naturally from folic acid.
Some patients with MTHFR do get a rapid response. Some get response at 7.5mg dose level but research shows (the study you posted) that 15mg dose is far more impactful for many patients. Some patients get a response in 1-2 weeks but others may get a response in 4-6 weeks.
I hope this information helps.
Posted by Phillipa on April 15, 2011, at 21:24:36
In reply to Re: Deplin at 15mg effective MDD with SSRI's, posted by SusanWhelan on April 15, 2011, at 14:29:22
Susan hope it's okay to post the link to Deplin that you provided me as know another on this site trialing now also. BTW went back on tonight. Thanks Phillipa
Posted by Phillipa on April 15, 2011, at 21:27:22
In reply to Re: Deplin at 15mg effective MDD with SSRI's, posted by SusanWhelan on April 15, 2011, at 10:41:43
The link I hope all four parts have audio. Turn up speakers. Phillipa
Posted by jono_in_adelaide on April 16, 2011, at 18:25:19
In reply to Re: Deplin at 15mg effective MDD with SSRI's, posted by Phillipa on April 15, 2011, at 21:27:22
I might be a bit dense, but why/how is Deplin more effective than standard folic acid pills that cost almost nothing?
Posted by Phillipa on April 16, 2011, at 20:40:36
In reply to Re: Deplin at 15mg effective MDD with SSRI's, posted by jono_in_adelaide on April 16, 2011, at 18:25:19
Did you visit the site and see how many folic acid tabs you would need to consume to equal a dose of 7.5mg of Deplin? Phillipa. The provided site is all audio.
Posted by mrtook on April 18, 2011, at 10:07:22
In reply to Re: Deplin at 15mg effective MDD with SSRI's, posted by jono_in_adelaide on April 16, 2011, at 18:25:19
> I might be a bit dense, but why/how is Deplin more effective than standard folic acid pills that cost almost nothing?
not dense it all is complicated.
Basically folic acid has to undergo chemical changes in the body before it can be used. Some people have genetics such that they aren't very good at making those chemical changes. It so happens that people who are depressed have a very high chance of having those genetic deficiencies. Deplin is folic acid that has already undergone all the required changes before you even take it so one's ability to convert folic acid to the usable form doesn't matter in receiving the benefits of folic acid.
I take Deplin 7.5mg in addition to lexapro 20mg. It is not a wonder drug for me, but I do think it helps.
Posted by Phillipa on April 18, 2011, at 20:32:43
In reply to Re: Deplin at 15mg effective MDD with SSRI's, posted by mrtook on April 18, 2011, at 10:07:22
Thanks for explaining in such a helpful manner. Humm you feel most or a lot of depressed people do have this genetic defect? Not a wonder drug you say but if on 20mg of lexapro did you then add the Deplina and notice a difference? Sitting on fence with this? Thanks Phillipa
Posted by mrtook on April 20, 2011, at 8:03:40
In reply to Re: Deplin at 15mg effective MDD with SSRI's » mrtook, posted by Phillipa on April 18, 2011, at 20:32:43
About 2 years ago I had a relapse after 4 great years on lexapro 10 mg only. My pdoc and i went to 20 mg lexapro and then added 7.5 mg deplin and I have been pretty good since then. I didn't notice a ton of benefit going to 20mg lexapro alone.
i don't know for sure that a lot of depressed people have this genetic defect, but the information published with Deplin claims this. If I weren't blessed with good insurance I would be a little more on the fence. As it is I will continue taking it.
I do think everyone who has struggled with MDD should give it a trial if they are financially able.
Posted by Phillipa on April 20, 2011, at 21:20:36
In reply to Re: Deplin at 15mg effective MDD with SSRI's, posted by mrtook on April 20, 2011, at 8:03:40
Hi MrTook did you find the results of the Deplin kicked in right away? Seems that the boards other than this one say that if have the genetic defect it kicks in within a week. Did you raise lexapro or Add Deplin first. Any side effects you remember. And thanks for posting to this thread. Phillipa
Posted by henryo on April 22, 2011, at 7:23:49
In reply to Deplin at 15mg effective MDD with SSRI's, posted by Phillipa on March 31, 2011, at 21:46:06
I felt the effects of Deplin in about 48 hours. I have several posts about it. I've been on it over 4 years. I think its great stuff. Interestingly I am also an alcoholic. The possible interrelatedness of folate deficiencies, depression and alcoholism are tantalizing. I tell anybody who will listen. It is amazing how many doctors have never heard of it. My sister felt no benefit, but my brother-in- law was like me. He felt brighter in 2 or three days and still takes it. I want to get a big group of ex-drunks like me, depressed or not and give them this stuff just to see how they say it makes them feel.
Posted by mrtook on April 22, 2011, at 11:21:28
In reply to Re: Deplin at 15mg effective MDD with SSRI's » mrtook, posted by Phillipa on April 20, 2011, at 21:20:36
So I raised lexapro for about 6 months prior to adding deplin.
From what I understand your genes can have
2 copies of the good folic acid metabolizer
2 copies of the bad
or 1 of eachThe majority of depressed people will have 1 of each and as a result might experience a smaller and more delayed response from deplin. I believe this is where I fall into although I have never had the genetic workup done.
A minority of people would have two copies of the bad and would see a more immediate and larger effect from the deplin.
From the deplin site they indicated that their research indicated 60% of a depressed population would have one of each and 10% would have both bad copies. Ergo it is not a depression and mental illness smoking gun, but it certainly has a role.
All in all I would recommend most people at least give it a try. It is really a supplement that has some good science behind it. I order it in 90 day 15mg supply and split it and take half every day. This costs around $1 a day.
Best of luck to everyone.
MrTook
Posted by Phillipa on April 22, 2011, at 19:06:19
In reply to Re: Deplin at 15mg effective MDD with SSRI's, posted by henryo on April 22, 2011, at 7:23:49
Henryo that's right it was you would responded so marvelously to Deplin when new. I wonder if there is a connection with genes and alcholism also? Phillipa so glad it's still working well for you!!!
This is the end of the thread.
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