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Treating depression with prescription "medical foods"

L-methylfolate is an add-on treatment to antidepressants


Medical foods” aren’t vegetables or vitamin supplements – they are substances that are specifically formulated to meet unique nutrient needs that result from a specific disease or condition. They require physician supervision and are available only by prescription.

Medical foods have been developed to treat a variety of conditions, including depression, schizophrenia, insomnia and Alzheimer’s disease.

They are made of natural ingredients similar to the vitamins, minerals and amino acids used in supplements, but in concentrated, therapeutic amounts. They are usually taken in powdered mix or pill form.

One such product, Deplin®, is prescribed as an add-on treatment to antidepressants for depression, and as an add-on treatment to antipsychotics in schizophrenia. Deplin® contains L-methylfolate, which is used to manage low levels of folate, believed to be a factor in depression. L-methylfolate boosts the synthesis of the neurotransmitters serotonin, norepinephrine and dopamine, which are associated with mood. It’s processed by the brain immediately, faster and more effectively than folic acid or folate from one’s diet.

Food and Drug Administration requirements for medical foods are more stringent than those for supplements but much less so than those for drugs. Medical foods are not required to conduct the type of clinical trials required for drugs, however, clinical trials on Deplin® have been completed or are ongoing. Medical foods must meet FDA compliance guidelines for good manufacturing practices, registration of food facilities and truthful and non-misleading labeling. All ingredients must be “Generally Recognized As Safe” or be FDA-approved food additives.

Side effects of L-methylfolate are minimal, according to the manufacturer, and it has not been associated with weight gain, sexual dysfunction, nausea, or akathisia. It should not be taken by individuals with a known hypersensitivity to folate or folic acid.

Medical foods cost less than most drugs, but they are usually not covered under health insurance plans.

There's nothing fishy about this:


Omega 3 fatty acids can ease symptoms of mood disorders

While some fats, such as saturated fats and trans-fatty acids, are responsible for heart disease, obesity and other health hazards, there are other, good fats that are essential to good physical and mental health.

Several studies have established a clear connection between omega-3 fatty acids and the treatment of depression, memory loss and cognitive function. People who added a daily fish-oil supplement to their antidepressant treatment had significant improvement in symptoms, including anxiety, insomnia, sadness, decreased sexual desire and suicidal thoughts. Researchers at Harvard Medical School have successfully used fish oil to treat bipolar disorder.

Fish oil contains EPA (eicosapentaenoic acid), which is essential to normal brain function, and DHA (docosahexaenoic acid). Low DHA levels have been linked to low brain serotonin levels and an increased tendency to depression and suicide.

Omega 3 fatty acids can be found in fish, especially oily, coldwater fishes. Good fish choices include mackerel, salmon, canned sardines, herring, bluefish and squid. (A 3-oz. serving of mackerel provides 2.5 grams of omega 3 fatty acids, while the same size serving of tuna provides only .3 grams.) A healthy diet for everyone should include three servings a week of these fish.

Flax seed is the second best source of omega-3s. Whole flax seeds can be ground and added to food and it's found in some cereals. Flax seed meal or flax seed oil (one tablespoon/day) can be added to food. Flax seed oil capsules can be taken two to three times a day. Omega 3 fatty acids in flax seed are not as easily processed by the body as those in fish. People with mood disorders should supplement their dietary requirements with fish oil capsules containing DHA and EPA for a daily dosage of 6000 mg/day, which contains 2000 mg/day of EPA. Take two to three capsules three times a day, 30 minutes before meals, if possible, with water. Do not skip a dose if you missed taking it with a meal. If you use a brand concentrated for EPA, you would take fewer pills to equal 2000 mg EPA. Do not use cod liver oil as your source of omegas. It contains too much vitamin D.

Possible side effects include a fishy aftertaste. (Eating a piece of citrus fruit afterward can help or you can buy a flavored version of fish oil.) Burping may also occur. It helps to keep pills in the freezer, which makes them release more slowly and thus farther down in your intestine. Omega-3 fatty acids can also cause stomach irritation, and may affect blood clotting in persons with bleeding disorders.

Fish oil supplements are not FDA approved as a treatment of mood disorders. Dr. Francisco Fernandez, chairman of the department of psychiatry at Loyola University Medical Center, says that fish oil is effective and well tolerated, but points out that no drug company is likely to put resources into further study for approval, because it cannot be patented, and therefore cannot produce profit.


St. Johns Wort

A popular and controversial treatment for depression

St Johns Wort is one of the most popular, and controversial, medicinal herbs used to treat depression. It has been shown to be effective for mild to moderate symptoms, but not for major depression.

St. John's wort is available by prescription in Europe and is widely used to treat anxiety and depression. European studies suggest that St. John's Wort may work as well as some antidepressants in mild depression and with fewer side effects for short-term use.

St. John's Wort is generally well tolerated. In less than one percent of users, side effects have been found to be mild and included dry mouth, dizziness, digestive problems, sunburn, allergic reaction and sexual problems.

A frequently cited study disclaiming its effectiveness has been discredited due to flaws in the study's methods. A 3-year federal study is underway.

The Food and Drug Administration issued a Public Health Advisory in 2000.warning that St. John's Wort can cause serious interactions with prescription drugs, herbs or supplements. As with any herbal supplement, you should consult with your prescribing doctor before combining treatments.

For more information about individual herbs, including safety and side effects, go to MedlinePlus, a service of the U.S. National Library of Medicine and the National Institutes of Health | Department of Health & Human Services or the University of Maryland Medical Center.


medical foods Omega 3 fatty acids St.Johns Wort