Ask the Pharmacist: How popular medications wipe out folate and lead to depression

Suzy Cohen

What I’m about to tell you has been known for years; I’m just worried you don’t personally know. So I’m going to tell you about another ‘drug mugger,’ and this is a very important depletion because it has to do with a popular medication and an anti-cancer nutrient you need to avoid depression.

Prescription bottle on patient chart with medication bottles and supplies in background.

Carbamazepine is a popular anti-epilepsy drug and works by suppressing nerve impulses that trigger seizures. It’s quite effective for certain types of seizure disorders and sometimes used for diabetic neuropathy, bipolar disorder and trigeminal neuralgia, a facial pain syndrome.

According to a 2016 study published in the journal Clinical Laboratory, the drug seems to significantly reduce levels of both vitamin B12 (methylcobalamin) as well as natural folate, also called Vitamin B9.

Folate plays a huge role in cell and tissue growth. You have trillions of cells and the crystalline DNA strands in each cell are highly susceptible to harm. Folate encourages DNA synthesis and repair of ‘injured’ strands. Folate is needed for red blood cells, and to make iron in the body.

So if you take a drug mugger of folate like carbamazepine (and there are over 150 other medications) then you need to be aware of this depletion.  But I’m not saying to take folate supplements either; I’ll explain why at the end of this article.  Right now I want to make the case for what happens to you when you take a drug mugger of natural folate (B9).

When folate levels fall, especially in combination with B12 deficiency, homocysteine rises and this is a known risk factor for heart attacks. Homocysteine can also act as a neurotoxin causing brain fog.

Your body also requires folate to convert compounds in your brain into happy neurotransmitters and sleep hormones. In particular, folate is required to make more of your happy hormones like serotonin and dopamine. Folate deficiencies definitely play a role in depression and tearfulness, pre-menstrual moodiness and suicidal ideation. There’s even a drug version of folate called Deplin on the market, but it’s a stronger version of the same natural folate you can eat or supplement with.

By the way, natural folate is superior to “folic acid,” a synthetic form, at least in my opinion. I explain this, and give you other medications that deplete folate, if you go to my website and read the longer version of this article.

Be very careful because supplementing with folate vitamins because it can block the effect of your seizure medicine. The mechanism of action of anti-seizure drugs requires suppression of folate (in some cases) so don’t just go and supplement. Ask your doctor first and, if permitted, use very low doses and separate from the medication.  In some cases, you will not want to supplement at all with a dietary supplement; however, it might be okay to eat leafy greens, which are very high in natural folate.  Again, talk to your physician.

Suzy Cohen is a registered pharmacist. The information presented here is not intended to treat, cure or diagnose any condition. Visit SuzyCohen.com.