B vitamins play an important role within the central nervous system. They’re essential for optimal mental well-being, and they play an important role in psychiatric treatment as well. In this article, I’ll share more about B vitamins’ role in mood, the complex relationship that exists between psychotropic medication and B vitamin status, and one potential reason why your psych patients aren’t getting better.
The crucial role of B vitamins in brain function
B vitamins serve as cofactors in neurotransmitter production. For example, folate, vitamin B6, and vitamin B12 are essential in converting homocysteine to methionine within the central nervous system. Later in this pathway, methionine is converted into s-adenosylmethionine (SAMe). By acting as a methyl donor, SAMe plays a critical role in the eventual production of neurotransmitters, including dopamine and serotonin. These neurotransmitters play vital roles in mood regulation.
Genetics play an important role in this process. For example, patients with single nucleotide polymorphisms in their MTHFR C677T genes may have impaired homocysteine metabolism, leading to an increased risk for mental health concerns.
Mental health concerns and B vitamins
In addition to the fact that the body needs B vitamins for neurotransmitter production, there is a clear association between mental health concerns like depression and schizophrenia and lower levels of B vitamins. [1-2] To make a point, I want to zoom in on depression. We know there’s a link between depression and B vitamin deficiency, but it’s still unclear whether the vitamin deficiency leads to the depression or whether the brains and bodies of depressed individuals require more B vitamins leading to the stores being depleted more quickly. There is, however, evidence to support that administering B vitamins to depressed patients may lead to improvements in mood in the long run. A systematic review and meta-analysis of randomized placebo-controlled trials found that maintaining optimal folate and vitamin B12 levels in the long term led to decreased risk of depression relapse.
The complex relationship between psychotropic drugs and B vitamins
When we consider the available treatment options, the relationship between B vitamins and psychiatric disorders becomes even more complex. We know that chronic use of some psychotropic medications can lead to nutrient depletion. For starters, chlorpromazine and the tri-cyclic anti-depressants imipramine and amitriptyline are known to inhibit riboflavin metabolism both in-vivo and in-vitro. This is problematic because riboflavin is necessary for cellular energy production and pyridoxine activation, the conversion of tryptophan into niacin, and glucose metabolism, among other things.
In some cases where a psychotropic medication is associated with decreased stores of a specific nutrient, replenishing stores of that nutrient may actually lead to increased efficacy of the drug. For example, lithium carbonate has been demonstrated to deplete folic acid levels in some cases, and pre-clinical trials demonstrate that administering lithium and folic acid to animals exhibiting methamphetamine-induced manic-like behavior led to reversal of the behavior. Clinical trials also corroborate this finding. Research demonstrates that folic acid may be an effective adjunct treatment in addressing mania in humans, and that its effect may be partially due to changes that occur in the melatonin profile.
We also know that low levels of certain B vitamins may affect the efficacy of some psychotropic medications. For example, low folate levels has been linked to poor response to antidepressants. Furthermore, research also suggests that having a high vitamin B12 status may be associated with better treatment outcomes. In other words, it may be more difficult to treat our patients with psychiatric concerns if their levels of B vitamins are sub-optimal, but if they have optimal levels, they may be more likely to respond to treatment.
An approach to improving the efficacy of available treatment options in mental health
To summarize, patients who are dealing with psychiatric concerns need to make sure they have an abundant supply of B vitamins available within their bodies. This is one of the reasons why many providers are now incorporating B vitamins into the treatment plans of their patients with psychiatric concerns. If you have a patient who has been diagnosed with a psychiatric concern and who has seen minimal improvement with your recommendations, consider checking homocysteine levels, since higher levels are suggestive of sub-optimal B12 and/or folate levels, and possibly B vitamin levels as well. If the lab values come back outside of the optimal range, consider recommending oral or intravenous nutrient therapy. Oral nutrient therapy of active forms of the vitamins are sufficient to improve homocysteine levels in most people; however, intravenous nutrient therapy may be more beneficial for patients with very low levels, those with severe symptoms, or those with impaired gastrointestinal function.
If you would like to learn more about how to incorporate IV nutrient therapy into your practice as well as the business of running an IV therapy practice, click here.
1. Bender, A., Hagan, K. E., & Kingston, N. (2017). The association of folate and depression: A meta-analysis. Journal of psychiatric research, 95, 9–18. https://doi.org/10.1016/j.jpsychires.2017.07.019
2. Saedisomeolia, A., Djalali, M., Moghadam, A. M., Ramezankhani, O., & Najmi, L. (2011). Folate and vitamin B12 status in schizophrenic patients. Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences, 16 Suppl 1(Suppl1), S437–S441.
3. Almeida, O. P., Ford, A. H., & Flicker, L. (2015). Systematic review and meta-analysis of randomized placebo-controlled trials of folate and vitamin B12 for depression. International psychogeriatrics, 27(5), 727–737. https://doi.org/10.1017/S1041610215000046
4. Pinto, J. T., & Rivlin, R. S. (1987). Drugs that promote renal excretion of riboflavin. Drug-nutrient interactions, 5(3), 143–151.
5. Menegas, S., Dal-Pont, G. C., Cararo, J. H., Varela, R. B., Aguiar-Geraldo, J. M., Possamai-Della, T., Andersen, M. L., Quevedo, J., & Valvassori, S. S. (2020). Efficacy of folic acid as an adjunct to lithium therapy on manic-like behaviors, oxidative stress and inflammatory parameters in an animal model of mania. Metabolic brain disease, 35(2), 413–425. https://doi.org/10.1007/s11011-019-00503-3
6. Modabbernia, A., Ashrafi, M., Rahiminejad, F., Akhondzadeh, S. (2011). Fc22-04 Effect of folic acid add-on treatment in patients with acute mania on clinical symptoms and urinary 6-sulfatoxymelatonin: double blind placebo-controlled trial. European Psychiatry, 26(1), 1937.
7. Coppen, A., & Bolander-Gouaille, C. (2005). Treatment of depression: time to consider folic acid and vitamin B12. Journal of psychopharmacology (Oxford, England), 19(1), 59–65. https://doi.org/10.1177/0269881105048899