MTHFR Gene Mutation and Its Repercussion in the Genesis and Treatment of Depression: Case Report
Downloads
This study aims to report the correlation of MTHFR gene mutation with the genesis of depression and antidepressants non-response in a patient, highlighting the importance of genetic investigation and indicating the replacement of L-methylfolate as an effective treatment adjuvant. This is a case report of a patient diagnosed with major depressive disorder, refractory to pharmacological therapies, in monotherapy or combination therapy, and psychotherapy. After 1 year and 4 months of persistent residual symptoms, genetic testing of the MTHFR gene was requested with confirmation of a heterozygous double mutation of MTHFR. This gene polymorphism can result in deficiency of L-methylfolate, which is related to psychiatric diseases and refractoriness to antidepressant therapy. With the introduction of l-methylfolate 15mg, the patient reported remission of depressive symptoms in 4 months of follow-up. MTHFR gene mutations influence the action of folate, favoring depression and leading to refractory response to conventional treatment.
Downloads
Jiang, W., Xu, J., Lu, X. J., & Sun, Y. (2016). Association between MTHFR C677T polymorphism and depression: a meta-analysis in the Chinese population. Psychology, health & medicine, 21(6), 675–685. https://doi.org/10.1080/13548506.2015.1120327
Jha, S., Kumar, P., Kumar, R., & Das, A. (2016). Effectiveness of add-on l-methylfolate therapy in a complex psychiatric illness with MTHFR C677 T genetic polymorphism. Asian journal of psychiatry, 22, 74–75. https://doi.org/10.1016/j.ajp.2016.05.007
Do Prado CM, Dieckmann LHJ, Dieckmann PM. Farmacogenética na psiquiatria: entendendo os princípios e a aplicabilidade clínica. Rio de Janeiro: DOC Content; 2018.
Oberg, E., Givant, C., Fisk, B., Parikh, C., & Bradley, R. (2015). Epigenetics in Clinical Practice: Characterizing Patient and Provider Experiences with MTHFR Polymorphisms and Methylfolate. Journal of nutrigenetics and nutrigenomics, 8(3), 137–150. https://doi.org/10.1159/000440700
Mech, A. W., & Farah, A. (2016). Correlation of clinical response with homocysteine reduction during therapy with reduced B vitamins in patients with MDD who are positive for MTHFR C677T or A1298C polymorphism: a randomized, double-blind, placebo-controlled study. The Journal of clinical psychiatry, 77(5), 668–671. https://doi.org/10.4088/JCP.15m10166
Bjelland, I., Tell, G. S., Vollset, S. E., Refsum, H., & Ueland, P. M. (2003). Folate, vitamin B12, homocysteine, and the MTHFR 677C->T polymorphism in anxiety and depression: the Hordaland Homocysteine Study. Archives of general psychiatry, 60(6), 618–626. https://doi.org/10.1001/archpsyc.60.6.618
Wan, L., Li, Y., Zhang, Z. et al. Methylenetetrahydrofolate reductase and psychiatric diseases. Transl Psychiatry 8, 242 (2018). https://doi.org/10.1038/s41398-018-0276-6
Gabriela Nielsen, M., Congiu, C., Bortolomasi, M., Bonvicini, C., Bignotti, S., Abate, M., Milanesi, E., Conca, A., Cattane, N., Tessari, E., Gennarelli, M., & Minelli, A. (2015). MTHFR: Genetic variants, expression analysis and COMT interaction in major depressive disorder. Journal of affective disorders, 183, 179–186. https://doi.org/10.1016/j.jad.2015.05.003
Papakostas, G. I., Shelton, R. C., Zajecka, J. M., Etemad, B., Rickels, K., Clain, A., Baer, L., Dalton, E. D., Sacco, G. R., Schoenfeld, D., Pencina, M., Meisner, A., Bottiglieri, T., Nelson, E., Mischoulon, D., Alpert, J. E., Barbee, J. G., Zisook, S., & Fava, M. (2012). L-methylfolate as adjunctive therapy for SSRI-resistant major depression: results of two randomized, double-blind, parallel-sequential trials. The American journal of psychiatry, 169(12), 1267–1274. https://doi.org/10.1176/appi.ajp.2012.11071114
Copyright (c) 2021 International Journal of Scientific Research and Management
This work is licensed under a Creative Commons Attribution 4.0 International License.