Posted by Ron Hill on October 31, 2007, at 6:19:32
In reply to Re: One Deplin® 7.5mg tablet is bioequivalent to . » Ron Hill, posted by tecknohed on October 30, 2007, at 16:49:05
Hi Teck,
> Just wondering, did you have any tests for L-methylfolate blood cencentrations
No, I didn't ask my p-doc for any test scripts. On the one hand, it would be fun to pull blood samples before and after Deplin tx, and analyze the samples for folate and homocysteine.
On the other hand, why does it really matter what the pre and post concentrations were and are? The med will either work or not work, regardless of what the test data are. The only times I ask for pre and/or post testing is if there is a health risk associated with the med trial, or if testing is required to monitor blood levels so as to hit a targeted therapeutic blood level.
I'm sure my insurance company is already wishing they could get rid of me. They pay more than $1000 per month just for my meds. So, I try to constrain my testing occasions to those times when it is truly necessary.
Plus, I hate needles and blood draws. ;-)
Finding a p-med that helps in the tx of my disorder is, by and large, a process of educated trial-and-error. My med trial selection process comes down to this: Read a ton of journal articles about the med, search the archives of this site for anecdotal response reports to the med, paying particular attention to the posters with my dx, and/or the posters that typically respond to various meds in the same way that I do.
Then, if I decide the med is worthy of a trial, I take copies of four or five of the best journal articles and show them to my p-doc. During the appointment, I use the articles to explain my rationale for wanting to conduct the trial.
So far, over the years that I have been working with Dr. O, he has never found it necessary to refuse any of my med trial requests. I'm very lucky to have a great working relationship with such an excellent p-doc. We are a very good team.
I've said all of this only to encourage all of us to do our homework, and go to our p-doc appointments with information in hand.
> were you found to have difficulty in the conversion from standard folate, before you were put onto Deplin?
For clarification of your question for subsequent readers of the archives, your question refers to the fact that many psychiatric patients (pts), especially those with depression or schizophrenia, are homozygous for the 677C --> T mutation in the MTHFR enzyme. MTHFR stands for methylenetetrahydrofolate reductase. MTHFR is a regulating enzyme in the folate-dependant remethylation of homocysteine, because it catalyzes the reduction of 5,10 methylenetetrahydrofolate to 5-methylenetetrahydrofolate (5-MTHF, a.k.a.,L-methylfolate).
This will make a lot more sense if you look at the nice pics located on page 5 of this pdf file:
http://www.metafolin.com/pdfs/Scientific_Review_13.12.pdf
The pics are not addressing the subject of genetic impairment of MTHFR. However, just look at the pic and figure out what would happen if MTHFR is functioning poorly, or perhaps not at all.
Now back to your question, Teck. Who knows what it would cost to conduct this kind of testing and analysis. I'd think it would probably involve some type of DNA testing, but I don't know. So, my answer to your question is that it would be nice to know if I have this genetic problem, but it's not all that important since the genetic problem can't be fixed anyway.
So, for me, it comes back to the same old, same old: The med is either going to work or not work. The proof is in the pudding.
I know I have written way too much, but there is one more topic I want to mention and it is VERY VERY important. In fact, I need to start a thread to warn people that it is absolutely essential for all pts that are taking Deplin, or high doses of folic acid, it is vital that the pt also take B12.
Please pull up the document that you opened earlier, and read the text that is in the same section as the pics. The document explains the reason much better than I can. Here is the same link again, Please read it, Teck.
http://www.metafolin.com/pdfs/Scientific_Review_13.12.pdf
One more issue regarding the administration of B12. There are two main types of B12 available. First, there is cyanocobalamin, the more common type. This type of B12 is not "brain ready". What I mean is that it must first go to the liver (I think it's the liver) where the cynanide (yuck) group on cyanocobalamin molecule is replaced by a methyl group to form methylcobalamin (methyl-B12).
Methyl-B12 if the activated form of B12 that the brain cells can use directly. It crosses the blood brain barrier readily and it is ready for use by the brain cells just as it is. Therefore, it makes a lot of good sense to just take methyl-B12 to begin with. It is analogous to taking Deplin instead of folic acid.
Another issue is that if B12 is swallowed, as is usually the case, only about 1% of the oral dose is passed through the intestinal wall and into the blood stream. The rest of it goes out with your, ah, well you know what I mean. This why you hear of people getting B12 shots.
However, if the B12 is a sublingual tablet, when the tablet is placed under the tongue, the B12 goes directly to the blood stream via the thin membrane in the bottom of the mouth under the tongue. Any portion of the B12 sublingual dose that is inadvertently swallowed with the build up of the saliva which accumulates in the mouth while the tablet is being administered sublingually, is lost via passing through the digestive system virtually unabsorbed.
Here's a link to some methyl-B12 sublingual products. Click on each product, read the Product Details tab and the Product Reviews tab. Then pick one ya like. If this is all you are buying, you are obviously better off to buy it at a local vitamin store because the shipping costs more that the cost of the product. On the other hand, however, if you have a large order, the shipping is free.
If this link automatically switches you to the home page when you click it, then just do a search for methylcobalamin.
http://www.iherb.com/Search.aspx?c=1&kw=Methylcobalamin
I also plead with psychiatric pts to take P-5-P, the biologically active form of B6.
Geeze, why don't I just give short concise answers to short questions. Sorry if I rambled too long.
Be well my friend.
-- Ron
Currently In Full Remission Since Addition of Deplin on 10/22/07.
Bipolar II, with ultra rapid cycling (15 day cycle), and mild Obsessive Compulsive Personality Disorder (OCPD)600 mg/day Trileptal
200 mg/day Lamictal
875 mg/day Keppra
90 mg/day Nardil
15 mg/day Deplin
poster:Ron Hill
thread:791850
URL: http://www.dr-bob.org/babble/20071027/msgs/792472.html