You are depressed and taking a medication. You feel somewhat better but not all the way well. Should you switch antidepressants or have another major psychotropic medication added to your existing antidepressant? Before you do this, consider whether you may have low central nervous system (CNS) folate levels. Folate is a critical vitamin needed by your brain to transform amino acids (from dietary protein) into key brain chemicals (neurotransmitters) such as serotonin, dopamine, norepinephrine, and acetylcholine. If your brain folate levels are low, you cannot make sufficient neurotransmitters. If so, not even the best antidepressant will work optimally. You may get better, but will you get well? Find out what the signs (fatigue, inflammation, pain, being overweight, and other sickness behaviors), causes (diet, inflammation, environmental toxins, lifestyle, genetic mutations), and risk factors (age, depression, medications, other medical conditions) for low folate. Won’t the folic acid in your current multi-vitamin or B vitamin complex take care of this? Probably not. For many people with depression, they cannot convert this synthetic form of folate (or for that matter, they cannot convert dietary folate from green leafy vegetables) into the only form of folate – L-methylfolate - that can get through the blood-brain-barrier (BBB) and into their brains. You may be one of those. For that reason, I (Dr. Dave) only use that specific form of folate: L-methylfolate. But be careful, not all L- methyfolate is the same. The two that I trust and use the most often, depending on your insurance coverage and whether I’m your personal physician or your health consultant, are Deplin and our own IP Formula’s Methyl Esssentials. Deplin, a medical food, requires a prescription from your clinician, and if not covered by your insurance may make it unaffordable. It is of high quality made by a superb company supported by topnotch sales and marketing team. You cannot buy it directly, however. I also trust our over-the-counter form of L-methyfolate: Methyl Essentials. It too is of very high quality, is competitively priced, is ideally dosed, and combines with it the most bio-active form of Vitamin B12 (methylcobalamin). This is particularly important in our elder patients and clients. Here are the specs on Methyl Essentials: IP Formulas Methyl Essentials L 5 MTHF 6.5 mg & B12 2mg contains the most bio active form of L 5-Methyl folate and methylcobalamin-vitamin B12 and is the only form that crosses the blood brain barrier. Increases production of dopamine, melatonin, serotonin, and DNA It can be ordered online here: http://www.integrativepsychiatry.net/ip-formulas-methyl-essentials-l-five-mthf-btwelve.html Or you can click on the link in the slide presentation.

2. You’re are on an
antidepressant
and it puzzles
you that YOU
ARE STILL NOT
WELL.

3. Increase dose?
Switch Medication?
nd Medication?
Add A 2
Change Clinicians?
Go Natural?
What Should You Do?

8. So What If You Are Inflamed?
Inflammation
Decreases the rate
at which you make
new
neurotransmitters
Low Serotonin
Low Dopamine
Low Norepinephrine
Low Acetylcholine
Inflammation
Is associated with
low levels of CNS
folate.
All of which leads to:
Increases the rate at
which you burn
through your brain
chemicals:
neurotransmitters
Inflammation
(And that
keeps you depressed!)

9. What Else Causes
Low Folate?
• Overweight
• Elevated hs-CRP (a
measure of systemic
inflammation
• Age (especially > 70)
• Medications such as
Lamictal, Tegretol,
Depakote,
methotrexate, Prozac,
metformin, birth
control pills, niacin
• Excess alcohol/smoking
and poor nutrition
• Genetics

10. Genetics?
Get Tested Here!
T/T
Polymorphism
30%
If you suffer from depression, you
have a 70% chance of having a
genetic in-born error impairing
your ability to make Lmethylfolate from dietary folate
(green leafy vegetables) or from
C/C the synthetic folic acid that is in
your multi-vitamin.
Normal
30%
• If you have this genetic error (formally
referred to as a single nucleotide
polymorphism (SNP) of the enzyme –
C/T Polymorphism
MTHFR – that converts dietary folate
56%
into L-methylfolate) then you will have
low levels of L-methylfolate in your
central nervous system (CNS).
• If you have low CNS L-methylfolate levels you will have low levels of the key
neurotransmitters serotonin, norepinephrine, and dopamine.

13. When to consider taking L-methylfolate:
• Mild to moderate depressive symptoms
for those who don’t want medications;
• At initiation of new antidepressant
therapy;
• Inadequate response to antidepressant
therapy:
• Before raising/maximizing does
• Before switching to a different agent
• As a first-line augmentationcombination strategy.

14. Where Do You Get L-methylfolate?
Methyl Essentials from IP Formulas

15. 1) Buy Methyl Essentials from IP Formulas online
2) Visit us online at Integrativepsychiatry.net
3) Arrange for an individual consultation:
(800) 385-7863
info@integrativepsychiatry.net
(Not actual patients; artist’s rendering)
You’ll Be Glad You Did!