Abstract
Objectives Partial response to pharmacotherapy is common in major
depressive disorder (MDD) and many patients require alternative pharmacotherapy
or augmentation, including adjunctive L-methylfolate. Given that L-methylfolate
augmentation is rarely included in major clinical practice guidelines, we sought
to systematically review evidence for L-methylfolate augmentation in adults with
MDD and to examine its efficacy meta-analytically.
Methods We systematically searched PubMed for articles up to December 31,
2020, following the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) recommendations. Included studies were published in
peer-reviewed, English-language journals and examined L-methylfolate adjunctive
therapy in depressive disorders or its effect on antidepressant response. A
fixed- and random-effects meta-analysis and risk of bias assessment using the
Cochrane Risk of Bias Tool were conducted.
Results Qualitative assessment of nine articles (N=6,707
patients) suggests that adjunctive L-methylfolate improved antidepressant
response. In the meta-analysis of categorical Hamilton Rating Scale for
Depression-17 response, (three studies, N=483) adjunctive
L-methylfolate was associated with a small effect versus antidepressant
monotherapy (relative risk: 1.25, 95% confidence interval
[CI]=1.08 to 1.46, p=0.004). A meta-analysis of four
studies (N=507) using a continuous measure of depressive symptoms
showed a similar effect of adjunctive L-methylfolate (standardized mean
difference=− 0.38, 95%
CI=− 0.59 to−0.17, p=0.0003).
Conclusion Adjunctive L-methylfolate may have modest efficacy in
antidepressant-treated adults with MDD.