When it is recommended to treat MTHFR mutations?

[SpongeBob DoctorPants]

I can't remember where I saw it, and I don't think it came from an authoritative source anyway, but I read something somewhere that recommended treatment with l-methylfolate when there are homozygous C677T mutations, or heterozygous mutations of both C677T and A1298C. Sometimes I see l-methylfolate being prescribed whenever there is any mutation, homozygous or heterozygous. Is there any official guideline on this?

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[splik]

this is pure quackery. There is never a reason to check these genes. elevated homocysteine level is sufficient. Its highly questionable whether l-methylfolate is even the correct treatment

Edit to add: In addition l-methylfolate can be helpful in depression regardless of MTHFR status

 

[whopper]

this is pure quackery. There is never a reason to check these genes. elevated homocysteine level is sufficient. Its highly questionable whether l-methylfolate is even the correct treatment

Edit to add: In addition l-methylfolate can be helpful in depression regardless of MTHFR status

The homocysteine levels are only pathologically elevated in the homozygous mutation persons, not in heterozygous persons where there would be some mitigated L-Methylfolate production.

But what you said above about L-Methylfolate is true in regards that it could help regardless of the MTHFR status. Add to the equation that it's cheap OTC (if you know where to buy the right type, some brands are very expensive) so it'd be more practical to suggest to people to simply give it a try instead of getting a test that if done at the wrong place could cost hundreds of dollars.

The gene test, however, I wouldn't say is "pure quackery." Aside that the lab method is CLIA approved and in and of itself a completely legit test. One might want to know their status to see if they pass this on to their children, or out of curiosity for themselves. There is also a plethora of data linking MTHFR mutations with depression. Don't believe me just put in "MTHFR" and "depression" into a pubmed search. Plenty of interesting articles.

So is a test needed? No, but it can add more insight for both the clinician and the patient, hence the words "pure quackery" IMHO are excessive.

 

[wolfvgang22]

Most of my patients drink, anyways.

 

[hamstergang]

So is a test needed? No, but it can add more insight for both the clinician and the patient, hence the words "pure quackery" IMHO are excessive.

What insight does it add? Regardless of genotype, you're not going to change treatment. Also, it doesn't aid in the making of any psychiatric diagnosis. If there's no reason to get the test, then it sounds like quackery to me.

 

[nexus73]

The homocysteine levels are only pathologically elevated in the homozygous mutation persons, not in heterozygous persons where there would be some mitigated L-Methylfolate production.

But what you said above about L-Methylfolate is true in regards that it could help regardless of the MTHFR status. Add to the equation that it's cheap OTC (if you know where to buy the right type, some brands are very expensive) so it'd be more practical to suggest to people to simply give it a try instead of getting a test that if done at the wrong place could cost hundreds of dollars.

The gene test, however, I wouldn't say is "pure quackery." Aside that the lab method is CLIA approved and in and of itself a completely legit test. One might want to know their status to see if they pass this on to their children, or out of curiosity for themselves. There is also a plethora of data linking MTHFR mutations with depression. Don't believe me just put in "MTHFR" and "depression" into a pubmed search. Plenty of interesting articles.

So is a test needed? No, but it can add more insight for both the clinician and the patient, hence the words "pure quackery" IMHO are excessive.

wheres a good price on l-methylfolate?

 

[whopper]

So if the person has high homocysteine levels you know the likely cause of it. MTHFR might not be the only factor going on. The patient could tell if this is linked to a familial situation. If the person has the mutation there's the argument to be made that instead of other augmentation strategies that one could get prioritized higher.

 

[whopper]

wheres a good price on l-methylfolate?

Best one I know if is for 15 mg, 90 pills
$37.99 with free shipping.

That's the cheapest I've seen. I can't point out where to get it or the brand name because it violates SDN rules.

 

[downwithDTB]

Am I missing something, or is there just one RTC with 75 people with TRD who weren't selected based on any biomarker?

 

[birchswing]

If you go with almost any non-big-brand multivitamin (basically any multivitamin for vitamin enthusiasts) they switched over to l-methyfolate a good while ago, along with methylated versions of all or most of the B vitamins. There are tons of brands out there. Like with APIs for prescription medications, I would guess they're probably all made in a handful of factories and don't vary much in quality (or lack of quality as we see with prescription medications lately). There is one brand I saw being advertised in doctor's offices which was methylpro.com. But again, if you're shopping anything other than Centrum etc, it's almost hard not to find l-methylfolate in your vitamins these days.

 

[tr]

So if the person has high homocysteine levels you know the likely cause of it. MTHFR might not be the only factor going on. The patient could tell if this is linked to a familial situation. If the person has the mutation there's the argument to be made that instead of other augmentation strategies that one could get prioritized higher.

But there are dozens of different possible MTHFR mutations, and the potential effects of each type are poorly described.
So knowing the genetics doesn't tell you much about the function. Homocysteine gives you a downstream readout on whether there is a functional consequence to guide treatment.