Harvard Medical School and Director of Center for Treatment-Resistant Depression, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Can J Psychiatry. 2012 Jul;57(7):406-13. doi: 10.1177/070674371205700703.
Interest in nonpharmaceutical supplements for treating major depressive disorder (MDD) has increased significantly, both among patients and among clinicians during the past decades. Despite the large array of antidepressants (ADs) available, many patients continue to experience relatively modest response and remission rates, in addition to a burden of side effects that can hinder treatment compliance and acceptability. In this article, we review the literature on folates and S-adenosylmethionine (SAMe), 2 natural compounds linked in the 1-carbon cycle metabolic pathway, for which substantial evidence supports their involvement in mood disorders. Background information, efficacy data, proposed mechanisms of action, and side effects are reviewed. Based on existing data, supplementation with SAMe, as well as with various formulations of folates, appears to be efficacious and well tolerated in reducing depressive symptoms. Compared with other forms of folates, 5-methyltetrahydrofolate (L-methylfolate or 5-MTHF) may represent a preferable treatment option for MDD given its greater bioavailability in patients with a genetic polymorphism, and the lower risk of specific side effects associated with folic acid. Although further randomized controlled trials in this area appear warranted, SAMe and L-methylfolate may represent a useful addition to the AD armamentarium.
在过去几十年中，人们对治疗重度抑郁症 (MDD) 的非药物补充剂的兴趣显著增加，无论是在患者还是临床医生中。尽管有大量的抗抑郁药 (AD) 可用，但许多患者继续经历相对适度的反应和缓解率，此外还有副作用的负担，这可能会阻碍治疗的依从性和可接受性。在本文中，我们回顾了叶酸和 S-腺苷甲硫氨酸 (SAMe) 的文献，这两种天然化合物在 1 碳循环代谢途径中相互关联，有大量证据表明它们与情绪障碍有关。我们回顾了背景信息、疗效数据、提出的作用机制和副作用。基于现有数据，SAMe 以及各种形式的叶酸补充剂似乎在减轻抑郁症状方面是有效且耐受良好的。与其他形式的叶酸相比，5-甲基四氢叶酸 (L-甲基叶酸或 5-MTHF) 可能代表 MDD 的更优治疗选择，因为它在具有遗传多态性的患者中具有更高的生物利用度，并且与叶酸相关的特定副作用风险更低。尽管在这一领域进一步的随机对照试验似乎是必要的，但 SAMe 和 L-甲基叶酸可能代表 AD 武器库中的有用补充。
