Underlying Causes of Depression

As physicians, we see depressed patients in our practices every day. Add the numbers who have been diagnosed with anxiety and bipolar disorder, and we begin to feel a little anxious ourselves! In Integrative Medicine, (as it should be in all medicine), we look for potential underlying causes of depression instead of choosing which SSRI (selective serotonin reuptake inhibitor) to use. One interesting cause is MTHFR deficiency.

As physicians, we see depressed patients in our practices every day. Add the numbers who have been diagnosed with anxiety and bipolar disorder, and we begin to feel a little anxious ourselves! In Integrative Medicine, (as it should be in all medicine), we look for potential underlying causes of depression instead of choosing which SSRI (selective serotonin reuptake inhibitor) to use. One interesting cause is MTHFR deficiency.

MTHFR stands for methylene tetra hydro folate reductase. Say that five times fast! Basically, MTHFR is the enzyme needed to process folate (also called folic acid, a B vitamin found in many vegetables, grains and supplements) and allow it into the brain. Folate in the brain is the necessary building block for many neurotransmitters (including serotonin), which helps regulate our MOODS!


As many as 20% of the population has inherited a defective copy of the gene that makes this MTHFR, a condition that makes it harder for folate to get into the brain. These patients have an increased risk of depression, anxiety, bipolar disorder and schizophrenia; it also predisposes them to be resistant to medical treatment. Usually, they have a strong family history of psychiatric disorders as well.

Fortunately, the treatment is easy once the defect is found, which can be done by simple blood testing. Patients can be prescribed folate which is already processed! After 2-4 weeks, patients usually feel much better, and can often be weaned from their antidepressant, or the dose can be decreased.

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