Folate for depressive disorders

 

Abstract

Background

There are a number of effective interventions for the treatment of depression. It is possible that the efficacy of these treatments will be improved further by the use of adjunctive therapies such as folate.

Objectives

1. To determine the effectiveness of folate in the treatment of depression
2. To determine the adverse effects and acceptability of treatment with folate.

Search methods

The Cochrane CENTRAL Register of Controlled Trials (CENTRAL), and the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Registers (CCDANCTR-Studies and CCDANCTR-References - carried out on 12/5/2005) were searched. Reference lists of relevant papers and major textbooks of affective disorders were checked. Experts in the field and pharmaceutical companies were contacted regarding unpublished material.

Selection criteria

All randomised controlled trials that compared treatment with folic acid or 5'-methyltetrahydrofolic acid to an alternative treatment, whether another antidepressant medication or placebo, for patients with a diagnosis of depressive disorder (diagnosed according to explicit criteria).

Data collection and analysis

Data were independently extracted from the original reports by two reviewers. Statistical analysis was conducted using Review Manager version 4.1.

Main results

Three trials involving 247 people were included. Two studies involving 151 people assessed the use of folate in addition to other treatment, and found that adding folate reduced Hamilton Depression Rating Scale scores on average by a further 2.65 points (95% confidence interval 0.38 to 4.93). Fewer patients treated with folate experienced a reduction in their HDRS score of less than 50% at ten weeks (relative risk (RR) 0.47, 95% CI 0.24 to 0.92) The number needed to treat with folate for one additional person to experience a 50% reduction on this scale was 5 (95% confidence interval 4 to 33). One study involving 96 people assessed the use of folate instead of the antidepressant trazodone and did not find a significant benefit from the use of folate. The trials identified did not find evidence of any problems with the acceptability or safety of folate.

Authors' conclusions

The limited available evidence suggests folate may have a potential role as a supplement to other treatment for depression. It is currently unclear if this is the case both for people with normal folate levels, and for those with folate deficiency.

 

Plain language summary

Folate for depression

This systematic review was undertaken to see if giving folate to people with depressive disorders reduced their depressive symptoms. Three randomized trials were identified, involving a total of 247 people. In all three trials, folate was well tolerated. In two of these trials, folate was added to other antidepressant drug treatment and there was limited evidence that folate helped. In the third trial, folate was compared to trazodone, an antidepressant drug. No difference was found. There is therefore limited evidence that adding folate to other antidepressant may be helpful, but larger trials are needed before patients and clinicians can be confident that it will be helpful.

 

摘要

背景

葉酸用於憂鬱症治療

憂鬱症有許多有效治療.若輔用葉酸則可能可以增加療效

目標

1.確認葉酸用於憂鬱症是否可增加療效2.檢視使用葉酸的副作用和接受度

搜尋策略

搜尋The Cochrane CENTRAL Register of Controlled Trials (CENTRAL), 和the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Registers (CCDANCTRStudies and CCDANCTRReferences  carried out on 12/5/2005).檢察相關文章的文獻清單和情感障礙的主要教科書.連絡領域專家和藥廠取得未發表資料.

選擇標準

所有隨機對照試驗比較使用葉酸或5′methyltetrahydrofolic acid 與替代療法(其他抗憂鬱藥物或安慰劑),用於抑鬱症確診病人(依特別條件診斷).

資料收集與分析

兩個檢閱者由原始報告獨立擷取資料,統計分析使用Review Manager version 4.1.

主要結論

納入3試驗包含247受試者.2個試驗包含151受試者,評估使用其他治療時加上葉酸, 發現可減少漢氏憂鬱量表平均得分達2.65分(95% CI 0.38 to 4.93). 較少使用葉酸受試者10週後的漢氏憂鬱量表得分減少不到50% (RR0.47, 95% CI 0.24 to 0.92). 每額外葉酸受試者得分減少50%的需要治療人數為 (95% CI 4 to 33). 1個有96名受試者的試驗評估使用葉酸替代抗憂鬱藥trazodone,發現使用葉酸並沒有顯著效益.試驗沒有發現任何葉酸接受度或安全性的證據

作者結論

現有證據有限,但顯示葉酸可能有潛力扮演其他憂鬱症治療的輔助藥物.目前不清楚是否對葉酸正常或葉酸缺乏病人皆有相同作用.

翻譯人

本摘要由成功大學附設醫院尹子真翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

本系統回顧欲研究葉酸是否減少憂鬱症病人的憂鬱症狀.納入3試驗包含247受試者.3試驗中葉酸皆耐受良好.其中兩試驗於其他抗憂鬱藥物中加入葉酸,得到有限證據證明葉酸有效.第3試驗中比較葉酸和抗憂鬱藥trazodone.沒有顯著差異.故有有限證據於其他抗憂鬱藥物中加入葉酸可能有幫助,但需要更大規模試驗確定葉酸有幫助.