Double Blind Controlled Study of Adding Folic Acid to Fluoxetine in the Treatment of Ocd

Abstract

Background: Folate is important for the synthesis of serotonin the neurotransmitter which plays a main role in OCD. We, therefore, explored the efficacy of folic acid as add on treatment to fluoxetine in a double blind study among patients with OCD. Subjects and methods: A double blind, 12-week study comparing the efficacy of folic acid as add on treatment and placebo in patients with OCD was conducted on thirty six (36) patients. Patients were randomly assigned to folic acid (5 mg/day) or placebo group in addition to fluoxetine (40 mg/day). After the baseline assessment, on week 2, 4, 6, 8 and 12 assessments were performed by using YBOCS, HAM-D, HAM-A and CGI-S. Serum folate, erythrocyte folate, serum homocysteine and B 12 levels were measured both baseline and the end of study. Results: A mixed model repeated measures ANCOVA on Y-BOCS scores were used to determine the difference between folic acid and placebo groups. No significant differences were found in the ratios of gender or in the mean age, serum folic acid level, erythrocyte folate level, serum homocysteine level and serum B 12 level between the treatment groups at the baseline. Consecutively scores collected over six measurements on YBOCS, HAM-D, HAM-A and CGI showed non-significant differences between folic acid and placebo groups. Conclusion: None of the biological markers of one carbon metabolism were associated with the change in YBOCS scores. It may be assumed that there is no beneficial effect of folic acid addition to fluoxetine in the treatment of OCD.

Mitochondrial modulators for obsessive–compulsive and related disorders: a systematic review and meta-analysis

“…Table 1 lists the characteristics of each study and the characteristics of patients included in each study. Eicosapentaenoic acid (1 study) [ 41 ], folic acid (1 study) [ 43 ], lithium (1 study) [ 55 ], N -acetylcysteine (10 studies) [ 44 – 47 , 49 – 54 ], inositol (3 studies) [ 39 , 40 , 48 ], and silymarin (1 study) [ 42 ] were the mitochondrial modulators studied. Twelve studies included individuals with OCD [ 39 – 41 , 43 – 47 , 50 , 51 , 53 , 55 ], four others included individuals with trichotillomania [ 42 , 48 , 52 , 54 ], and the remaining study included individuals with excoriation disorder [ 49 ].…”

“…Eicosapentaenoic acid (1 study) [ 41 ], folic acid (1 study) [ 43 ], lithium (1 study) [ 55 ], N -acetylcysteine (10 studies) [ 44 – 47 , 49 – 54 ], inositol (3 studies) [ 39 , 40 , 48 ], and silymarin (1 study) [ 42 ] were the mitochondrial modulators studied. Twelve studies included individuals with OCD [ 39 – 41 , 43 – 47 , 50 , 51 , 53 , 55 ], four others included individuals with trichotillomania [ 42 , 48 , 52 , 54 ], and the remaining study included individuals with excoriation disorder [ 49 ]. Thirteen studies included adults [ 39 – 41 , 43 , 44 , 47 – 51 , 53 – 55 ], three others included children [ 45 , 46 , 52 ], and one included both adults and children [ 42 ].…”

“…Twelve studies included individuals with OCD [ 39 – 41 , 43 – 47 , 50 , 51 , 53 , 55 ], four others included individuals with trichotillomania [ 42 , 48 , 52 , 54 ], and the remaining study included individuals with excoriation disorder [ 49 ]. Thirteen studies included adults [ 39 – 41 , 43 , 44 , 47 – 51 , 53 – 55 ], three others included children [ 45 , 46 , 52 ], and one included both adults and children [ 42 ]. In all studies except one of inositol [ 39 ], the investigators assessed mitochondrial modulator add-on to conventional treatment, such as pharmacotherapy (in most studies, serotonin reuptake inhibitors) or psychotherapy.…”

“…For the two inositol studies, data from the first treatment phase could be used to analyze efficacy outcomes, although the data were from a complete analysis. Except for one study of folic acid [ 43 ], none of the trials was sponsored by pharmaceutical companies. The methodological quality of most studies was high (Fig.…”

The Role of Antioxidants in the Management of Obsessive‐Compulsive Disorder

“…Adding folic acid to fluoxetine did not significantly change the Y-BOCS total scores and response rate. The authors concluded that adding folic acid to fluoxetine had no benefits for OCD treatment [91]. In the end, five of 12 were assessed "much" or "very much improved" on the clinician-rated CGI, six were "minimally improved," and one showed "no change."…”