Role of Adjunctive L-Methylfolate with Selective Serotonin Reuptake Inhibitor in Depressed Patients at a Tertiary Care Centre

Abstract

Background: Present study was aimed to determine clinical outcome and tolerability in patients receiving combination of LMTF plus Escitalopram at the initiation of treatment compared with Escitalopram monotherapy. Methods: Patients aged 21- 60 years, newly diagnosed as Depression, having moderate to severe severity as per ICD-10 criteria were taken for the study after informed consent. 31 Patients taking supplemental folic acid, having current or a history of psychotic episodes, history of bipolar disorder, patient with suicidal tendencies or the patients having significiant physical and neurological illness were excluded from the study. Semi structured proforma and HDRS (Hamilton depression rating scale) was administered. Patients were divided in two groups based on the observation, one group was of L-MTF plus Escitalopram and other was of Escitalopram alone. The score was calculated for both the groups. The assessment on HDRS was done again in the follow up at 2,4,6,8 weeks. 50% or more reduction in HDRS was considered as response. Results: The sample consisted of 70 patients, 35 in each group. No significant sex differentiation was observed as well as average duration of illness was comparable in both groups. The present study demonstrated that by adding L-MTF to Escitalopram at the initiation of treatment led to greater number of responders comparison to Escitalopram monotherapy. LMTF plus Escitalopram did not demonstrate any significant decrease in HDRS on 2 weeks. Further, L-MTF plus Escitalopram group demonstrated significant decrease in HDRS (p<0.001) at 4,6,8 weeks compared with Escitalopram monotherapy group. As per table 3 nausea, constipation & somnolence were reported more in combination group while dizziness, agitation in Escitalopram group. Conclusions: Greater efficacy was observed with lmethylfolate when used as an adjunct to Escitalopram from initiation. Our present analyses establishes the relative superiority of l-methylfolate plus Escitalopram versus Escitalopram alone in MDD patients during initiation of treatment. More studies with other SSRI’s and other classes are required to validate the findings.