Peter Roy-Byrne, MD reviewing Mech AW and Farah A. J Clin Psychiatry 2016 May.

A proprietary compound shows promise, but many questions remain.

Once metabolized, B vitamins (i.e., “reduced B vitamins”) are important cofactors in neurotransmitter synthesis. Genetic polymorphisms can impair reduction of B vitamins, and reduced B vitamins (particularly methylfolate) may be effective adjunctively for treatment-resistant depression although the evidence is not strong (NEJM JW Psychiatry Jun 2016 and Am J Psychiatry 2016; 173:575). This manufacturer-sponsored, placebo-controlled study examined the 8-week efficacy of a proprietary formulation of multiple reduced B vitamins (EnLyte) as monotherapy for major depression in medication-free patients who had one of three MTHFR polymorphisms associated with impaired ability to reduce folate.

Compared with placebo, the formula was associated with significantly greater reduction in depression-rating scores beginning at week 2, with a large effect size by week 8. Remission rate was 42% with the formula; no rate with placebo was provided. By week 8, only the treated patients showed lower homocysteine levels, consistent with B-vitamin effects on homocysteine.

CITATION(S):

Mech AW and Farah A.Correlation of clinical response with homocysteine reduction during therapy with reduced B vitamins in patients with MDD who are positive for MTHFR C677T or A1298C polymorphism: A randomized, double blind, placebo-controlled study. J Clin Psychiatry 2016 May; 77:668. 

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