L-Methylfolate: Who Will benefit

Q: Which patients with depression are candidate for L-Methylfolate Treatment?

Answer:
1. Low levels of folate and its active metabolites such as L-methylfolate.
* Documented low levels of MTHFR (methylene tetrahydrofolate reductase). Note:- RBC folate level preferred.
* Documented high homocysteine levels (inverse relation with folate levels)

2. Poor or Inadequate response to antidepressants.

3. High risk populations:
(a) Alcoholism
(b) Pregnancy
(c) Eating disorders
(d) Gastrointestinal disorders
(e) Hispanic and Mediterranean populations: decreased levels of MTHFR (methylene tetrahydrofolate reductase)
(f) Patients with C677-T polymorphism: decreased levels of MTHFR (methylene tetrahydrofolate reductase)

4. Medications that can interfere with the conversion of folate to L-methylfolate:
* Lamotrigine
* Valproate
* Oral contraceptives
* Metformin
* Warfarin
* Fenofibrates
* Certain retinoids.

Source:
1. Stephen M. Stahl. L-methylfolate: A vitamin for your monoamines. J Clin Psychiatry 69:9, September 2008.
2. L-methylfolate: Another weapon against depression Current Psychiatry. 2012 January;11(1):72-72.