Medford physician Robin Miller is turning her patients on to an alternative to Prozac and other prescription antidepressants. It's cheap, has no side effects and is considered a vitamin or "medicinal food."
Available by prescription — but also found over the counter — the substance is called L-methylfolate. It is made from folic acid, an essential B vitamin found in leafy, dark-green vegetables, eggs and grains.
"The kind of patients who come to me for it don't want to take drugs," says Miller. "Sometimes we can pull them off Prozac. Sometimes we see the (antidepressant) effects in a few weeks, sometimes in a few months. Most have a definite response."
The undesirable side effects of prescription antidepressants, says Miller, may include "being dulled out," sexual dysfunction, insomnia, anxiety and nausea. L-methylfolate doesn't cause these problems.
Miller notes that prescription antidepressants bring remission (absence of depression) in about 30 percent of patients, with some effect in 70 percent. L-methylfolate doesn't interact with other meds, so it can be used in concert with antidepressants if some level of depression persists — or if those drugs have little effect.
Twelve percent of men and 25 percent of women take Prozac and other "selective serotonin-uptake inhibitors."
"If it seems that almost everyone you know is on antidepressants," jokes Miller, "your perceptions would be correct."
So a large population on antidepressants is still depressed — or doesn't want to live with the side effects — thus showing a big satisfaction gap, one that L-methylfolate fills, she says.
It comes down to genetic defects, which lots of us seem to have and which keep a range of neurotransmitters from doing their work. It's a complicated story, but here's the short version.
"When folic acid is absorbed in the small intestine, enzymes convert it to L-methylfolate, which is needed to create three neurotransmitters that stabilize moods and make you happy," notes Miller. "This metabolite, L-methylfolate, makes serotonin, norepinephrine and dopamine, which are all important for mood regulation."
A gene called MTHFR is responsible for our ability to make the enzyme that converts folic acid into L-methylfolate. Scientists have found 40 mutations on that gene that block manufacture of enzymes that make L-methylfolate — and if you have just one of them, she says, your ability to make L-methylfolate is chopped by 34 percent. If you have two mutations, it goes down 71 percent, notes Miller in an article on her blog (www.sharecare.com/user/dr-robin-miller/blogs/show/a-new-approach-to-depression).
What to do? Ask your doctor for a blood test for MTHFR to confirm whether that gene is "off," advises Miller.
The test is easy and cheap, and insurance covers it, she says, noting that "most people have the deficiency in enzymes to turn folic acid into L-methylfolate."
"If given in the proper amounts — 7.5 to 15 milligrams — it can improve depression relatively quickly," notes Miller. "In a study of elderly, depressed patients, the response rate at six weeks was 81 percent ... We call them the happy pills."
Miller also likes to prescribe cerefolin, which has L-methylfolate and vitamin B12. She prescribes aerobic workouts or walking for depression, too.
"Our culture ... is so ingrained to the quick fix," says Miller, referring to the proliferation of antidepressant drugs. "L-methylfolate is a medicinal food, not a drug. As a medical food, it's overseen by the FDA, so it's covered by prescription plans."
Miller's Triune Integrative Medicine clinic has arranged with many area pharmacies to stock L-methylfolate, though one resisted, citing lack of status as a "real" med, she said.
"Integrative" refers to her philosophy of combining Western medical approaches with "alternative" methods.
"When I treat my depressed patients with this vitamin," says Miller, "I have seen amazing results. It just makes sense. If serotonin levels are genetically low, then why not find a healthy way to boost them? This is not a be-all, but it's a beginning of the discussion about how, if people can't make those three neurotransmitters (including serotonin), how do we help them do it?"