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Dr. Bob is Robert Hsiung, MD,
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Posted by SLS on January 13, 2008, at 12:21:13
In reply to Re: Deplin is a drug, not a nutritional supplement, posted by Jamal Spelling on January 13, 2008, at 9:36:13
> (1) What is the relationship between Deplin (L-methylfolate), L-5-methyl-tetrahydrofolate, and 5-formyl-tetrahydrofolate?
>
> and
>
> (2) I've seen claims that Deplin only works concomitant with prescriptions ADs. If Deplin helps synthesise neurotransmitters, why can it not work by itself?
--------------------------------------
Hi.I don't know. Not to be a wise-guy, but if it doesn't, then it just doesn't.
I find questions like this to be esoteric and of heuristic value only. My simple answer is to just report clinical observations without trying to account for them. Scientists cannot account for them either.
For the sake of heuristics: It is possible that increasing the synthesis of presynaptic neurotransmitter is kept in check by MAO. I guess one idea of treating depression with drugs is to increase the concentration of neurotransmitter in the synaptic cleft. Apparently, this does not happen in the absence of an MAOI or reuptake inhibitor or a presynaptic receptor antagonist. L-methylfolate, thus it increases the supply of neurotransmitter, but does not stimulate its action-potential induced release.
Just a few esoteric thoughts...
My recommendation is to experiment with Deplin in combination with varioius psychotropic drugs. At the moment, clinicians don't have enough experience with Deplin in order to use it so selectively.
For the sake of increasing one's success at finding a treatment that works, I recommend that one not take too seriously their armchair psychopharmacologist ideas such that they make clinical decisions based upon them. We don't even know how lithium performs physiologically. There is an incredible array of data relating to it properties, but none has yet emerged as the singular psychotropic mechanism of action. It probably performs or affects multiple physiological processes to exert its therapeutic effects.
This post has not been conceived in an effort to identify the behaviors of anyone in particular.
I'll just continue taking my Deplin. It works for me. I don't know why.
Currently:Nardil 90mg
nortriptyline 150mg
Lamictal 200mg
Abilify 20mg
Deplin 7.5mg
- Scott
Posted by Phillipa on January 13, 2008, at 12:29:10
In reply to Re: Deplin is a drug, not a nutritional supplement » Jamal Spelling, posted by Larry Hoover on January 13, 2008, at 12:15:25
I just got a script for Deplin suggested by my pdoc 7.5mg. She referred to it as brain food and that it was also explained by the drug rep that it was being used in Alzheimers too. She wasn't left literature to pass out to patients and when ordering the med the drug sheet that came with it did not as yet contain a side effect or mode of action profile was referred on the drug sheet to www.deplin.com. Also a coupon which my husband did can be printed out to save on Deplin first prescription and then they send a card to show for future purchases. Since I have not good insurance medicaire the coupon saved me about a third off the med. But shouldn't someone have a side effect profile available to read if it is a drug and what if the person doesn't have a computer. I did go to deplin and couldn't find that info. Phillipa ps cost with coupon for a month 40 some odd dollars at a major pharmacy chain.
Posted by Phillipa on January 13, 2008, at 12:38:21
In reply to Re: Deplin is a drug, not a nutritional supplement, posted by Phillipa on January 13, 2008, at 12:29:10
Scott and Larry not being anywhere good at neurotransmitters it will maybe work with any ad and dose does not matter of the ad as not on an MAO or is MAO in all antideressants. I truly don't know. My head sort of doesn't understand all the intellectual stuff. Thanks Phillipa and the first deplin website gives no side effects Scott I think you said some anxiety first two weeks and 4-6 weeks to show an ad effect?
Posted by your#1fan on January 13, 2008, at 12:39:48
In reply to Re: Deplin is a drug, not a nutritional supplement » Racer, posted by Jamal Spelling on January 13, 2008, at 12:02:01
i take Deplin 7.5mg
it helps, with energy and stuff. Not exactly the mood.
Posted by SLS on January 13, 2008, at 12:41:51
In reply to Re: Deplin is a drug, not a nutritional supplement, posted by Phillipa on January 13, 2008, at 12:38:21
> Scott and Larry not being anywhere good at neurotransmitters it will maybe work with any ad and dose does not matter of the ad as not on an MAO or is MAO in all antideressants. I truly don't know. My head sort of doesn't understand all the intellectual stuff. Thanks Phillipa and the first deplin website gives no side effects Scott I think you said some anxiety first two weeks and 4-6 weeks to show an ad effect?
What I indicated is that it might be activating (more mental energy), but not necessarily anxiogenic. This is a question that I'm sure will soon be answered as people post their experiences with it.
- Scott
Posted by Racer on January 13, 2008, at 12:43:09
In reply to Re: Deplin is a drug, not a nutritional supplement » Racer, posted by Jamal Spelling on January 13, 2008, at 12:02:01
> > I haven't tried Deplin myself, and I know it's higher in methylfolate than Metan-X is.
>
> Yes, about 10x higher it seems. I suppose Metan-X is like poor man's Deplin, lol. Except, even the OTC stuff is prohibitively expensive. So maybe just better to go straight for Deplin, I don't know.Metan-X is not OTC -- it's a "medical food," like Deplin, and available by prescription. The "medical food" label is apparently the new thing -- I'm taking another, Limbrel, for a hip problem, as well as the Metan-X.
I agree with Scott -- if it works, it works, and sometimes the why of the how is not so clear-cut as A therefore B resulting in C. (And I must be feeling obsessive again, after stopping EMSAM, since I'm really loving that phrase, "the why of the how..." Sad, isn't it, when we miss our symptoms?)
Posted by Jamal Spelling on January 13, 2008, at 13:34:42
In reply to Re: Deplin is a drug, not a nutritional supplement, posted by SLS on January 13, 2008, at 12:21:13
> I find questions like this to be esoteric and of heuristic value only. My simple answer is to just report clinical observations without trying to account for them. Scientists cannot account for them either.
Sure. No problem. I suppose the reason I was asking is because I might be interested in using something like Deplin, but at this stage, I don't want to go back on ADs. So I was just curious whether I might benefit from Deplin on its own. But like you say, this is not yet known.
Posted by bleauberry on January 13, 2008, at 14:06:09
In reply to Deplin is a drug, not a nutritional supplement., posted by SLS on January 13, 2008, at 8:05:29
I suspect a majority of folks with mood disorders have some sort of malfunction associated with it in the folate-homocysteine pathways. Folate may not be able to convert properly all the way through its stages and may convert to other substances that are of no good or maybe even of harm. Whether it be a genetic defect, a part of the overall disease, or a defect caused by undiagnosed lead or mercury burden, Deplin sounds like a good way to bypass any malfunctions.
It is cheap enough probably everyone should have some onhand to try with each med trial. I mean, there are lots of things in the health food store that cost more than this stuff. Though it is early, it appears that even people without defects in folate metabolism get benefits from Deplin.
Worth a try in my vote.
Zyprexa upregulates over 20 genes and downregulates over 30 genes. Some of those genes are involved in mood disorders, some are involved in metabolic processes. What I am saying is that regardless of the whole dopamine-serotonin theory thing, there are tons of other things going on with all the drugs we take. Deplin probably has some mysterious mechanisms too in my opinion.
Posted by Phillipa on January 13, 2008, at 14:11:05
In reply to Re: Deplin is a drug, not a nutritional supplement., posted by bleauberry on January 13, 2008, at 14:06:09
Here's the site. Phillipa. Can anyone find side effects? Thanks.
Deplin® enables anti-depressants to be more effective. : Deplin®
Life With Depression
About Depression
Causes & Treatment
Partial Response
Low Folate Levels
Deplin® Facts
How Deplin® Works
Deplin® vs. Folic Acid
What To Expect
ValueCardRx ProgramPrice Quote
Pharmacy Availability
Get a ValueCardDeplin® is a novel anti-depressant augmentation therapy with 7.5mg of L-methylfolate.
L-methylfolate aids in the synthesis of neurotransmitters associated with mood.
Deplin® tablets contain 7.5mg of L-methylfolate
Deplin® is the first medical food product indicated for the distinct nutritional requirements of persons with low plasma and/or low red blood cell folate with particular emphasis for those individuals who have a major depressive disorder that has not fully responded or may not fully respond to antidepressant therapy.
Deplin® is available by prescription onlyLife With Depression
About Depression
Causes & Treatment
Partial Response
Low Folate Levels
Deplin® Facts
How Deplin® Works
Deplin® vs. Folic Acid
What To Expect
ValueCardRx ProgramPrice Quote
Pharmacy Availability
Get a ValueCard
Healthcare Professionals
Folate Deficiency
Mechanisms of Action
Clinical Trials & References
Deplin® vs. Folic Acid
Safety Profile
Posted by SLS on January 13, 2008, at 14:41:00
In reply to Re: Deplin is a drug, not a nutritional supplement., posted by bleauberry on January 13, 2008, at 14:06:09
Hi BB.
> Zyprexa upregulates over 20 genes and downregulates over 30 genes.Wow. I had no idea.
Can you summarize what you've discovered?
You might want to check out the "methyl trap" and its relationship to vitamin B12 levels. Also, iron deficiency can mask *blood* folate deficiency. Normal blood folate levels can occur while the system is deficient in L-methylfolate. Vitamin B12-folate interrelationships are still not well understood or agreed upon.
Be well.
- Scott
Posted by Jamal Spelling on January 13, 2008, at 16:10:15
In reply to Re: Deplin is a drug, not a nutritional supplement, posted by Phillipa on January 13, 2008, at 12:29:10
> But shouldn't someone have a side effect profile available to read if it is a drug and what if the person doesn't have a computer.
I think you make a good point, Phillipa. I wonder what the reason was for making methylfolate prescription only, when it used to be an OTC supplement.
It seems like going against public interest to "prescriptionize" a substance like methylfolate, unless they found some medical issue with it that warranted making it prescription only. If there *is* some important side-effect or contra-indication or whatever, then what is it?
If, on the other hand, there are no serious side-effects or contra-indications, which I suspect is the case, then why did methylfolate suddenly become a prescription-only substance?
Who decides which substances are prescription anyway, and what are the criteria?
The only potential issue that I can think of, is that folic acid may mask the signs of vitamin B12 deficiency, so there may possibly be a similar issue with methylfolate, but I'm not sure of that.
Posted by bulldog2 on January 13, 2008, at 16:42:44
In reply to Re: Deplin is a drug, not a nutritional supplement, posted by Jamal Spelling on January 13, 2008, at 16:10:15
> > But shouldn't someone have a side effect profile available to read if it is a drug and what if the person doesn't have a computer.
>
> I think you make a good point, Phillipa. I wonder what the reason was for making methylfolate prescription only, when it used to be an OTC supplement.
>
> It seems like going against public interest to "prescriptionize" a substance like methylfolate, unless they found some medical issue with it that warranted making it prescription only. If there *is* some important side-effect or contra-indication or whatever, then what is it?
>
> If, on the other hand, there are no serious side-effects or contra-indications, which I suspect is the case, then why did methylfolate suddenly become a prescription-only substance?
>
> Who decides which substances are prescription anyway, and what are the criteria?
>
> The only potential issue that I can think of, is that folic acid may mask the signs of vitamin B12 deficiency, so there may possibly be a similar issue with methylfolate, but I'm not sure of that.I've read in the Life Extension Magazine the Pharm companies want to make all vitamins and minerals etc..prescription items..Probably ppl staying well with supps cuts into their profits. So someday we'll have to buy all our supplements from them.
Posted by linkadge on January 13, 2008, at 17:27:06
In reply to Deplin is a drug, not a nutritional supplement., posted by SLS on January 13, 2008, at 8:05:29
>To think of using folic acid as a replacement >does not normally correspond to remission. >Deplin does.
Ok? I don't even know what that means. There are studies suggesting that folic acid added to AD's can improve response rates.
While deplin may have advantages in certain cases, thats no reason to suggest that folic acid is not helpful for many patients.
Again, a "drug"... What's that supposed to mean?
Linkadge
Posted by SLS on January 13, 2008, at 17:46:46
In reply to Re: Deplin is a drug, not a nutritional supplement., posted by linkadge on January 13, 2008, at 17:27:06
> > To think of using folic acid as a replacement does not normally correspond to remission. Deplin does.
> Ok? I don't even know what that means. There are studies suggesting that folic acid added to AD's can improve response rates.
What percentage?
My recommendation is to try Deplin first if you prefer to enhance your chances of responding to it as an augmentor.
> While deplin may have advantages in certain cases,
Exactly which cases, and why?
> thats no reason to suggest that folic acid is not helpful for many patients.
I guess we'll see the clinical separation between these two substances as clinical usage increases.
> Again, a "drug"... What's that supposed to mean?
I think I've addressed this issue in a few of my posts along different threads.
How do *you* define the word "drug"?
For what it is worth, I have tried mega-doses of folic acid before. I experienced only flatulence. I have tried Deplin. I am responding much better 2 months subsequent to its introduction. That's good enough for me to indicate there is something special about taking Deplin over folic acid.
Maybe its just a placebo effect. :-)
- Scott
Posted by Phillipa on January 13, 2008, at 18:55:55
In reply to Re: Deplin is a drug, not a nutritional supplement » Phillipa, posted by SLS on January 13, 2008, at 12:41:51
Scott thanks so far no side effects. Nothing at all I can feel or experience. So we'll see. Phillipa
Posted by Phillipa on January 13, 2008, at 18:59:58
In reply to Re: Deplin is a drug, not a nutritional supplement, posted by bulldog2 on January 13, 2008, at 16:42:44
Bulldog 2 that was going on when I was involved with a vitamin or supplement company. Who knows but a lot of people sure take supplements. Cars in the parking lots and filled baskets with supplemants Phillipa
Posted by clipper40 on January 13, 2008, at 20:37:07
In reply to Re: Deplin is a drug, not a nutritional supplement » bulldog2, posted by Phillipa on January 13, 2008, at 18:59:58
I'm sure there's something very special about it because there are too many wonderful responses for it to be a placebo. Still, that in itself doesn't make it a drug.
As I said in a thread above, it used to be sold in health food stores. In my opinion, calling it a drug is arbitrary in this case.
Whatever you call it, I'm very glad it's out there and that so many people are getting such good results with it!
Posted by linkadge on January 13, 2008, at 20:43:46
In reply to Re: Deplin is a drug, not a nutritional supplement » linkadge, posted by SLS on January 13, 2008, at 17:46:46
>What percentage?
I don't know, but I don't think that data is securely established for deplin either.
>My recommendation is to try Deplin first if you >prefer to enhance your chances of responding to >it as an augmentor.
I'm not saying don't try it. I'm just saying that a number of studies have linked low serum folate to antidepressant resistance. If deplin is not an option for you, it folic acid might be worth a try.
>I guess we'll see the clinical separation >between these two substances as clinical usage >increases.
Well thats the idea. However, the issue of patentability with undoubtedly cloud matters.
>For what it is worth, I have tried mega-doses of >folic acid before. I experienced only >flatulence. I have tried Deplin. I am responding >much better 2 months subsequent to its >introduction. That's good enough for me to >indicate there is something special about taking >Deplin over folic acid.
Perhaps. Deplin also has a name and a specific indication. Folic acid is just a $2 vitamin.
Linkadge
Posted by SLS on January 13, 2008, at 21:13:24
In reply to Re: Deplin is a drug, not a nutritional supplement, posted by linkadge on January 13, 2008, at 20:43:46
> > What percentage?
> I don't know, but I don't think that data is securely established for deplin either.What would you need to see before declaring Deplin something more therapeutic than folic acid?
> >My recommendation is to try Deplin first if you >prefer to enhance your chances of responding to >it as an augmentor.
> I'm not saying don't try it.
>
> I'm just saying that a number of studies have linked low serum folate to antidepressant resistance. If deplin is not an option for you, it folic acid might be worth a try.Why would Deplin not be an option? Is it prohibitively expensive or just certified not to be effective enough as to indicate that folic acid should be the first choice?
I know what I know. Deplin works for me. Folic acid does not. I am somewhat familiar with the bioavailability of L-methylfolate and its participation in methionine metabolic cycles in the brain as well as its pharmacokinetics. If you prefer more detailed explanations as to what are the differences between Deplin and folic acid, Google makes a wonderful resource to find them. Certainly, your own research will be more convincing than my words. I would suggest using Google to learn more about folic acid and L-methylfolate dynamics.
What do you think about the "methyl trap" theory?
> > I guess we'll see the clinical separation >between these two substances as clinical usage increases.
> Well thats the idea. However, the issue of patentability with undoubtedly cloud matters.
Who cares? The stuff exists. I don't care either how or why other than to secure its continued availability.
> > For what it is worth, I have tried mega-doses of >folic acid before. I experienced only >flatulence. I have tried Deplin. I am responding >much better 2 months subsequent to its >introduction. That's good enough for me to >indicate there is something special about taking >Deplin over folic acid.
>
> Perhaps. Deplin also has a name and a specific indication. Folic acid is just a $2 vitamin.Again, I would encourage you to do your own investigation. The answers to your questions are available and quite simple - even for a layman like me.
- Scott
Posted by Phillipa on January 13, 2008, at 23:47:26
In reply to Re: Deplin is a drug, not a nutritional supplement » linkadge, posted by SLS on January 13, 2008, at 21:13:24
Scott. You may not be a scientist but could be but you have studied for so many years for your depression to me you are very knowledgeable about medications. That's how I feel about you. Love Phillipa
Posted by star008 on January 14, 2008, at 7:54:36
In reply to Deplin is a drug, not a nutritional supplement., posted by SLS on January 13, 2008, at 8:05:29
I think it is a matter of how you look at it. I don't think that Deplin is a drug.. Deplin is classifed as a medical food. I guess it depends on what you view a drug as. Folic acid converts to L-methylfolate in the body..Deplin is already converted L-methylfolate.. Matter of opinion.
Deplin doesn't work for me.. I have not noticed any improvement at all with it..It does work well for some people but not me.
Posted by star008 on January 14, 2008, at 8:01:22
In reply to Deplin is a drug, not a nutritional supplement., posted by SLS on January 13, 2008, at 8:05:29
http://www.cnsspectrums.com/aspx/articledetail.aspx?articleid=1267
check out this article.. the fda classifies dephlin as neither a drug or a supplement.. so according to them we are both wrong
Posted by star008 on January 14, 2008, at 9:30:16
From The INTERNATIONAL JOURNAL OF PHYSICIATRIC MEDICINE MTHF is marketed in the United States as a medical food also called Deplin, which contains 7.5 mg L-methylfolate and is available by prescription only. According to the Food and Drug Administration, a medical food is different both from a drug and from a food, and is defined as a food that is formulated to be consumed orally
...under the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation.57
Medical foods are required when dietary management cannot achieve the specific nutrient requirements. Treatment with MTHF seems to be safe, apparently has few if any side effects, and is generally less expensive than augmenting with a second antidepressant. Further research is necessary to determine the exact priority this approach should be given in treatment algorithms for major depression. HERE IS THE LINK>>>>>
http://www.cnsspectrums.com/aspx/articledetail.aspx?articleid=1267
There are more links but they basically say the same thing.
Posted by SLS on January 14, 2008, at 9:35:44
In reply to CNS research Deplin Link » SLS, posted by star008 on January 14, 2008, at 8:01:22
> http://www.cnsspectrums.com/aspx/articledetail.aspx?articleid=1267
>
> check out this article.. the fda classifies dephlin as neither a drug or a supplement.. so according to them we are both wrong
My motivation for starting this thread was to diffuse the notion that Deplin is nothing more than an expensive folic acid. My calling it a drug would hopefully change people's perspectives regarding the physiological and clinical advantages of Deplin when compared to folic acid supplements. To the best of my knowledge, L-methylfolate is not found in human foodstuffs. I imagine there are good reasons for the FDA to establish the category of "medical food" such that a prescription is required for its dispensation. If someone takes a dozen 7.5mg pills, are there any untoward effects? One 7.5mg pill of Deplin produces many times the biological availability in the brain as folic acid such that one would need to ingest a hundreds of folic acid to equal 1 pill of Deplin. Besides being the biologically active metabolite of folic acid, it readily crosses the blood-brain barrier.Regardless of the semantics, Deplin has pharmacological actions to induce the rate of synthesis of the monoamine neurotransmitters. Folic acid does not do that.
How much different is the relationship between folic acid and Deplin versus primidone and phenobarbital? Both are metabolized by the body before becoming biologically active.
- Scott
Posted by SLS on January 14, 2008, at 9:39:56
In reply to deplin is neither a drug or a supplement, posted by star008 on January 14, 2008, at 9:30:16
Hi star008.
Thanks for this...
- Scott------------------------------------
> From The INTERNATIONAL JOURNAL OF PHYSICIATRIC MEDICINE MTHF is marketed in the United States as a medical food also called Deplin, which contains 7.5 mg L-methylfolate and is available by prescription only. According to the Food and Drug Administration, a medical food is different both from a drug and from a food, and is defined as a food that is formulated to be consumed orally
>
> ...under the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation.57
>
> Medical foods are required when dietary management cannot achieve the specific nutrient requirements. Treatment with MTHF seems to be safe, apparently has few if any side effects, and is generally less expensive than augmenting with a second antidepressant. Further research is necessary to determine the exact priority this approach should be given in treatment algorithms for major depression. HERE IS THE LINK>>>>>
> http://www.cnsspectrums.com/aspx/articledetail.aspx?articleid=1267
>
>
> There are more links but they basically say the same thing.
>
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Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
[email protected]
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
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