The proper dose of methylfolate is 15 milligrams a day, and patients can now get it for about $5 a month. Response is more likely with a BMI over 30 or an hs-CRP of three or more, and we do not recommend testing for a deficit. Valproate tends to deplete folate, so giving folic acid with it makes sense.
When we reach for it
Studies have found that response is more likely with a BMI over 30, or with inflammation: a high-sensitivity C-reactive protein (hs-CRP), an inexpensive test, of three or more.
“Studies have found that if you have a BMI over 30, you're more likely to respond to it. And if you have inflammation, which can be measured through an inexpensive test of high sensitivity C-reactive protein, HSCRP. And if that marker of inflammation is three or more, you're more likely to respond to methylfolate”
29:23The Deficit Model in Psychiatry & Difficult to Treat Depression with Dr. Chris Aiken | Episode 18Mar 2025Guest episode Valproate (Depakote) tends to deplete folate, and a study showed it works better in mania when given with folic acid, so it makes sense to give folic acid with it.
“There's a study showing that Depakote works better in mania if given with folic acid. And we know that Depakote tends to deplete folate, so it makes sense to give it”
31:13The Deficit Model in Psychiatry & Difficult to Treat Depression with Dr. Chris Aiken | Episode 18Mar 2025Guest episode
Dosing and testing
The proper dose is 15 milligrams a day. Several products on Amazon sell it for about $5 a month, so patients can now afford it, where that used to be difficult.
“The proper dose is 15 milligrams a day, which is available through several products on Amazon for just about $5 a month. So your patients can now afford it where it used to be difficult”
26:34The Deficit Model in Psychiatry & Difficult to Treat Depression with Dr. Chris Aiken | Episode 18Mar 2025Guest episode We do not recommend testing for any of these deficits. That is in some ways where the deficit hypothesis falls apart, and the other hole in it is that most trials enrolled people without testing for a deficit.
“I don't recommend testing for any of these. And that's in some ways where the hypothesis falls apart. And the other hole in this hypothesis is that most of the trials, in fact, nearly, well, most of the trials have enrolled people without testing for a deficit”
11:59The Deficit Model in Psychiatry & Difficult to Treat Depression with Dr. Chris Aiken | Episode 18Mar 2025Guest episode
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From these episodes
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.