Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Bulfinch 351, Boston, MA 02114, USA.
J Clin Psychiatry. 2009;70 Suppl 5:12-7. doi: 10.4088/JCP.8157su1c.03.
Supplementation with folate may help reduce depressive symptoms. Folate, a naturally occurring B vitamin, is needed in the brain for the synthesis of norepinephrine, serotonin, and dopamine. Three forms of folate are commonly used: folic acid, 5-methyltetrahydrofolate (5-MTHF) (also known as methylfolate and L-methylfolate), and folinic acid. Some forms may be more bioavailable than others in patients with a genetic polymorphism and in those who take particular medications or use alcohol. Folic acid augmentation in depressed patients may reduce residual symptoms. The 5-MTHF formulation indicated efficacy as adjunctive therapy or monotherapy in reducing depressive symptoms in patients with normal and low folate levels, improving cognitive function and reducing depressive symptoms in elderly patients with dementia and folate deficiency, and reducing depressive and somatic symptoms in patients with depression and alcoholism. Adjunctive folinic acid reduced depressive symptoms in patients who were partially responsive or nonresponsive to a selective serotonin reuptake inhibitor. Evidence for the efficacy of folate in improving cognitive symptoms is equivocal, but most studies used folic acid. Although the studies reviewed have limitations and, historically, concerns have been raised about the role of folate in increasing cancer risk, masking B(12) deficiency, and worsening depressive symptoms, folate is generally well tolerated, and 5-MTHF may be less likely to incur some of these risks. Several forms of folate appear to be safe and efficacious in some individuals with major depressive disorder, but more information is needed about dosage and populations most suited to folate therapy.
补充叶酸可能有助于减轻抑郁症状。叶酸是一种天然存在的 B 族维生素，是大脑中合成去甲肾上腺素、5-羟色胺和多巴胺所必需的。叶酸有三种常见形式：叶酸、5-甲基四氢叶酸（5-MTHF）（也称为甲基叶酸和 L-甲基叶酸）和亚叶酸。在存在基因多态性的患者以及服用特定药物或饮酒的患者中，某些形式可能比其他形式更具生物利用度。在抑郁患者中补充叶酸可能会减轻残留症状。5-MTHF 制剂作为辅助治疗或单药治疗在降低正常和低叶酸水平的抑郁患者的抑郁症状方面显示出疗效，改善认知功能并减少痴呆和叶酸缺乏老年患者的抑郁症状，以及减少抑郁和酒精中毒患者的抑郁和躯体症状。辅助亚叶酸可减轻对选择性 5-羟色胺再摄取抑制剂部分反应或无反应的患者的抑郁症状。叶酸改善认知症状的疗效证据存在争议，但大多数研究都使用了叶酸。尽管所审查的研究存在局限性，并且历史上人们对叶酸在增加癌症风险、掩盖 B(12) 缺乏和加重抑郁症状方面的作用提出了担忧，但叶酸通常耐受良好，5-MTHF 可能不太可能产生其中一些风险。几种形式的叶酸似乎在某些患有重度抑郁症的个体中是安全有效的，但需要更多关于剂量和最适合叶酸治疗的人群的信息。
