Abstract
BackgroundBipolar disorder (BD) is a major psychiatric illness, however its physiopathology is unclear. The role of folate in the physiopathology of BD is controversial. We conducted this systematic review and meta-analysis to investigate the effect of folate in BD patients.MethodsWe performed a thorough literature study of the PubMed, Embase, ScienceDirect, ClinicalKey, Cochrane Library, ProQuest, Web of Science, and ClinicalTrials.gov databases until December 21st, 2018. Random effects meta-analysis was conducted.ResultsSix articles involving 481 patients with BD and 760 controls were included. The meta-analysis results suggested that serum folate levels in the patients with BD were significantly lower than those in the controls (Hedges’ g = − 0.211, 95% confidence interval = − 0.391 to − 0.031, p = 0.021).ConclusionThe current meta-analysis show it might be association between lower serum folate levels and patient with BD. However, we could not distinguish the potentially confounding effects of mood states on the folate levels. Further prospective studies including subjects with different mood states and possible physiopathology are warranted to investigate the association between folate deficiency and the etiology of BD.
Highlights
Bipolar disorder (BD) is a major psychiatric illness, its physiopathology is unclear
Folate is a key element in neurotransmitter synthesis and had been found to be abnormally synthesized in numerous psychiatric diseases
The current meta-analysis showed that serum folate levels in individuals with bipolar disorder (BD) were lower than in healthy controls
Summary
Bipolar disorder (BD) is a major psychiatric illness, its physiopathology is unclear. Folate has been reported to be involved in the synthesis of neurotransmitters and many other metabolic pathways, which may be associated with exacerbations of psychiatric disorder [24, 25]. Folate is essential for deoxyribonucleic acid (DNA) repair, and it has been intimately associated with methylation and the formation of neurotransmitters in the central nervous system, such as serotonin [26,27,28]. Another study including patients with manic episodes demonstrated no significant differences in folate level between the patients and healthy control [30]. A clinical trial on biomedical predictors of treatment response in patients with bipolar depression found no significant difference in folate level between patients who received lamotrigine and controls [31]
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