The Carlat Psychiatry Podcast Folate, Valproate, and Lamotrigine
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Apr 21, 2025 Delve into the vital role of folate in treating mood disorders and its complex relationship with anticonvulsants in bipolar disorder. Discover the groundbreaking research on anemia among pregnant women and its historical context. Uncover the nuances of folic acid's effects on mental health, along with surprising interactions with medications like lamotrigine. The podcast also discusses the genetic factors that can influence treatment outcomes, highlighting the importance of personalized care in psychiatric settings.
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Lucy Wills' Folate Discovery Anecdote
- Lucy Wills discovered that poor pregnant women in Bombay with anemia improved after she gave them liver and Marmite, rich in folate.
- This vitamin supplementation breakthrough corrected anemia similar to pernicious anemia but from folate deficiency, not B12 deficiency.
Folate vs. Folic Acid Insight
- Folate is the natural vitamin crucial for brain monoamine production, while folic acid is its synthetic form needing conversion.
- Confusing these forms causes misunderstandings in psychiatry medication and supplementation.
Folic Acid Cancels Lamotrigine Effects
- Folic acid supplements may cancel lamotrigine's benefits in bipolar depression, especially in patients with low-activity COMT genes.
- This interaction may involve disrupted homocysteine and glutathione pathways related to mood stabilization.