Journal: Integrative Medicine: A Clinician's Journal

Article Title: L-Methylfolate as a Monotherapy for Treatment-Resistant Depression: A Case Study

doi:

Figure Lengend Snippet: Table 2.

Article Snippet: Date Summaries from Initial and Follow-up Visits Diagnostic Testing Interventions 10/1/18 Initial visit: CC: daytime sleepiness and depression PE revealed enlarged tongue Stop-Bang score: 2 (low) Epworth Scale: 11 (moderate excessive) PHQ-9 score: 17 (moderately severe) CBC Ferritin Hcy MMA CMP TSH Exercise, 150 minutes weekly Happy Light use, 30 min, qam Omega-3 fish oil, 2 g/d Sleep study ordered 10/8/18 Follow-up: Pt reports no change in sxs Lab review (WNL) Genomind Genecept buccal swab genetic testing Continue with prior recommendations Sleep study pending 10/29/18 Follow-up: Reports no change in sxs Genetic testing revealed decreased enzymatic activity of MTHFR N/A Initiated 2 mg L-methylfolate for 1 week; increased by 1-2 mg/week until 15 mg daily dosage qas achieved Continue with prior recommendations Sleep study pending 11/29/18 Phone call: Pt reported sx improvement with supplementation and requested Rx for 10 mg strength of L-methylfolate N/A Rx provided for higher dose L-methylfolate Continue with prior recommendations Sleep study pending 12/10/18 Follow-up: Pt reached dose of 10 mg L-methylfolate and reported improvement in symptoms PHQ-9: 12 (moderate) GAD-7: 11 (moderate) Sleep study scheduled for 2/2019 N/A Continue with prior recommendations 1/7/19 Follow-up: Pt reported continued sx improvement with 15 mg daily L-methylfolate PHQ-9 score: 0 N/A Continue with prior recommendations 1/14/19 Follow-up: Pt reported mild insomnia and anxiety with 15 mg daily dosage N/A Alternate dosing of 15 mg with 10 mg qod 2/4/19 Follow-up: Well-woman exam Pt reported fatigue with lower dose of supplementation Reported anxiety and insomnia related to potential home relocation to Mexico for Peace Corps Cervical cytology with HPV co-testing (WNL) Return to 15 mg daily dosage of L-methylfolate Initiate PS for sleep support: 250 mg qhs for 3 nights; increase to 500 mg qhs thereafter 3/11/19 Follow-up: Pt reported improved sleep and decreased anxiety with PS 375 mg qhs and denied depression N/A Continue with prior recommendations 4/2019 Patient continued 15 mg daily supplementation with L-methylfolate and reported stable mood and energy with treatment.

Techniques: Diagnostic Assay, Activity Assay