First-Episode Psychosis? Take Your Vitamins
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Reducing homocysteine levels with a vitamin cocktail has potential benefits.
Elevated homocysteine levels have been reported in schizophrenia, and homocysteine reduction by higher vitamin doses has been reported to improve symptoms in schizophrenia. In a 12-week, randomized, double-blind, placebo-controlled Australian study, researchers provided a single pill combining standard supplement doses of vitamin B6, vitamin B12, and folic acid to 100 patients with a first episode of any psychotic disorder. All patients continued their usual treatment, including antipsychotic drugs.
Vitamins, but not placebo, increased red cell folate levels and decreased homocysteine levels. At 12 weeks, the two groups showed no differences in positive and negative symptoms or overall neurocognition. However, attention/vigilance declined in placebo patients while remaining stable in vitamin patients. This benefit with supplementation was mainly evident in patients with baseline elevated homocysteine levels, patients with affective psychoses, and women, who also showed improved processing speed. In a test of four genetic variants in folate-metabolizing enzymes, no group differences were seen.
These results, combined with other earlier findings, suggest that this vitamin preparation could be helpful in higher doses to patients with elevated homocysteine levels, particularly in those with affective psychoses. The other health benefits of lowering homocysteine levels are already known. It is sometimes claimed that methylfolate is more beneficial than folate, but in this study, folate did at least enter red cells, and its effect was independent of alleles of folate-metabolizing enzymes. Little seems to be lost by suggesting the addition of supplements in high doses to patients with affective psychoses, especially women (because an effect could have been evident in men with higher doses).
Allott K et al. The vitamins in psychosis study: A randomized, double-blind, placebo-controlled trial of the effects of vitamin B12, B6 and folic acid on symptoms and neurocognition in first-episode psychosis. Biol Psychiatry 2019 Jan 9; [e-pub]. (https://doi.org/10.1016/j.biopsych.2018.12.018)
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