The effect of folate supplementation on inflammatory markers in individuals susceptible to depression: a systematic review

Background & objectives: Folate has been proposed to be an efficacious treatment strategy for depression. The mandatory fortification of flour with synthetic folic acid (FA) in over 80 countries has yielded improvements in folate intake; however, depression is still a considerable public health concern. While there are established benefits of FA fortification in reducing risk of Neural Tube Defects, the implications regarding depression are unclear, especially in individuals with certain genetic polymorphisms. Therefore, a systematic review was conducted to examine the effects of folate to treat depression. Methods: Following PRISMA guidelines, a systematic review was conducted of electronic databases (PUBMED, Scopus, CINAHL, and Cochrane Library) to identify human clinical trials examining the effects of folate (including FA) supplementation in the management or prevention of depression, the impact on inflammatory markers and if genetic polymorphisms were considered. Results: Ten trials met the inclusion criteria. Seven trials examined effects of either adjunctive FA or L-methylfolate (L-MTHF) supplementation with antidepressants in the management of depression and three examined effects of FA supplementation alone for prevention of depression. No benefit of FA was found compared to placebo (all, p>0.05). The single L-MTHF trial explored the interplay of genetic polymorphisms and methylation status found benefit in the Hamilton Depression Rating Scale from adjunctive treatment with 15mg/day of L-MTHF compared with placebo (-6.8±7.2 vs. -3.7±6.5; p=0.017), and improvement with L-MTHF for most genetic markers. Conclusions: Currently there is no evidence to support FA supplementation for the management or prevention of depression. More research is required to determine the efficacy of L-MTHF and folinic acid in certain clinical populations.