Treating depression: Adding folate to SSRIs might be the answer

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Mental Health Awareness Month, which takes place every July in South Africa, elevates awareness of the stigma faced by those living with mental illness.  Activities during the month usually include a focus on education to increase understanding and to advocate for change, to show that mental illness is not something to be ashamed about and that getting help is possible.  The fear of stigma silences many, who avoid seeking help in the fear that others will think that they are crazy.

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Depression is common and has a significant impact on the lives of the affected individuals and those around them.   There is a need to address unmet treatment needs, as less than 40 % of people treated with Selective Serotonin Reuptake Inhibitors (SSRIs), the most commonly used antidepressant monotherapy, achieve full remission.  Although the strategy of adding a second antidepressant may enhance efficacy, it comes with the risk of reduced tolerability.

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Folate is a natural form of vitamin B9 that is found in food, especially leafy vegetables, and may be a useful addition to antidepressant treatment.  Patients with depression often have a folate deficiency, which correlates with the severity of depression, while low folate levels are associated with poor response to antidepressants.   Of interest are the findings of  a recent study which showed that vitamin D plus fluoxetine, a SSRI, showed better results than fluoxetine alone in controlling depressive symptoms. A further study concluded that vitamin B supplementation, given with antidepressants, significantly improved depressive symptoms in the group studied.

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