This week is not just about one article, because just one article did not provide enough evidence to convince me. There is a lot of biased information out there, a lot of people trying to sell products, and a lot of people with very little education/expertise who tout being “experts” in this subject. Even after researching this, I’m still left with a lot of questions and this is because there is still research that needs to be done in regards to vitamins and their link to mental illness. See below for information reviewed for this post.
Since there was not just one article, I will pick my favorite of the ones listed below, titled “Dubious MTHFR Gene Mutation Testing.” While reading this article, I assumed it was written by someone in the medical field; however, I was very surprised to find the author, Jann Bellamy, is actually an attorney. I greatly appreciate her writing and valid points. If you have time, please read it.
This (horribly time-consuming) rabbit hole started after being contacted by a pharmaceutical company trying to promote their medication (a $150/month multivitamin) for prevention and treatment of depression in pregnancy. After our discussion, I was convinced this was a great medication. The “pharm rep,” as they’re typically called, said this medication is ideal for women who want to get off of antidepressants during pregnancy and take a more “natural” approach to treatment. The pharm rep said recent research was done by a Harvard psychiatrist showing that, in women trying to become pregnant or in pregnant women <28 weeks gestation, this medication prevented depression symptoms from occurring in those with a history of depression, and significantly decreased symptoms in those who already were experiencing depression. One concerning piece of this study though, and there were several, is it only followed these women for 12 weeks, and did not look at the time that women are most vulnerable for depression relapse - in postpartum. The pharm rep followed up by sending me the other peer-reviewed journal articles referenced in our discussion, but after reading these articles, I realized they actually didn’t provide any evidence for using that particular multivitamin.
So I began my own search of the scientific literature, and looked to my frienemy, “Dr. Google,” to help me figure out whether or not this medication is worth the cost since most insurances don’t cover it. I discovered that a woman can get the same benefits for much less money by taking a prenatal vitamin and some l-methylfolate over the counter. My next quest was to find out if genetic testing for MTHFR (which this pharm company conveniently sells a kit for, as well) was necessary.
Through this, I learned that MTHFR gene mutation testing is essentially pointless, unless there is concern for homocystinuria - a rare and potentially fatal genetic disorder. Otherwise, testing homocysteine levels will provide just as much information. I won’t go into the boring biochemistry, but checking for elevated homocysteine levels is actually more accurate, and cheaper, than testing for a genetic mutation in MTHFR. This is because, carrying a variant of the MTHFR gene (or two), doesn’t necessarily mean the MTHFR enzyme is not functioning adequately. Some variant mutations function just fine and do not necessarily affect the enzyme’s ability to process dietary folic acid.
If serum homocysteine is elevated, it means folic acid and/or homocysteine are not being properly broken down. This could be either because of a defective MTHFR enzyme, or it could be due to malnutrition. Either way, the “cure” is to take vitamins. All of the vitamins necessary for this reaction are actually found in the majority of prenatal vitamins (+DHA). The only one missing is l-methylfolate (rather than folic acid). Just pick up 10-15 mg of l-methylfolate from a local pharmacy, add it to a DHA prenatal vitamin, and viola! it’s essentially a DIY version of their medication for a fraction of the cost. It’s important to point out this medication does not have all of the components of a prenatal vitamin. So, although the inventor told me it can be used in leu of a prenatal vitamin, I highly disagree. Furthermore, I personally would be concerned about using this in addition to a prenatal vitamin, since some vitamins are in both and would be above the recommended upper limit in pregnancy. I also want to point out that the inventor argues this medication is superior to prenatal vitamins because the components are all in their “reduced” forms, meaning they do not need to be metabolized. While this is helpful for a very small portion of the population, this is not necessary for the majority of patients.
I haven’t really answered the initial question of whether or not vitamins can treat depression. For that, I could not find consistent evidence in scientific literature. Bottom line, we need better research studies to give us this answer. Eating healthy food though, will generally improve mood (not clinical depression) without any associated risk. When Deplin, an expensive prescription form of l-methylfolate, is used by itself, we do not see the robust effect we had anticipated. Like most illnesses though, the cause of depression is multifactorial. Those who use just one approach to treat it, typically don’t see the same positive results that are seen by people using multiple modalities. So while everyone would love an “all-natural” pill that cures depression, I just don’t think that will ever exist. Moderate to severe mental illness, like most biological illness, needs medication, a healthy diet, exercise, and meditation/therapy to treat it.
1. About MTHFR by EnBraceHR
2. Overview of homocysteine and folate metabolism by Blom et al
3. Reprotox.org for researching effects of different dosages of vitamins on fetal and infant development when ingested by the mother.
4. PubChem Compound Database to review various vitamin compounds
5. Prenatal Vitamins by WebMD
6. Dietary Supplement Fact Sheet by NIH
7. B vitamins and homocysteine by Harvard
8. Various pages from Ben Lynch’s website, MTHFR.net
9. MTHFR Mutation Test by Medline Plus
10. Blog post by 23andMe
11. MTHFR gene overview by NIH’s Genetics Home Reference website
12. MTHFR gene variant by NIH’s Genetic and Rare Disease Information Center website
13. A Genetic Test you Don’t Need by Cleveland Clinic Health Essentials
14. Dubious MTHFR Gene Mutation Testing by Science Based Medicine