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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Dr. XXXXXXX it s been a couple of weeks. This

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Dr. Ashok Kumar

Psychiatrist

Practicing since :2000

Answered : 3001 Questions

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Posted on Wed, 19 Dec 2018 in Mental Health
Question: Dr. XXXXXXX it's been a couple of weeks. This is XXXXXXX Your email address would not go through. As you remember I am on folate and vitamin D but as yet no antidepressant at the moment after 40 years of chemical depression. I should finally have the saliva test done this week. Again isn't it necessary that I be on something?? I'm still not feeling quite right and feel that this is necessary. I still have had no follow up blood test to get current levels of folate and vitamin D. Isn't that important? XXXXXXX
doctor
Answered by Dr. Ashok Kumar 1 hour later
Brief Answer:
Consultation

Detailed Answer:
Dear XXXXXXX
Thanks for following up.

First of all, I'd like to state that if the symptoms are not severe enough it is not necessary to remain on medications despite 40 years of clinical depression. In addition, since most of the antidepressants did not work for you probably your psychiatrist is planning something which requires washout period of few weeks (MAO inhibitors often need washout period before we can use them). Thirdly since you have planned saliva test I do not think any addition for a few days, before we can make out a suitable choice, will make any difference in the final decision.

Regarding folate and vitamin D you will need a follow-up serum determination but after three months. It often takes time to restore the reserves and I think the time is absolutely necessary before we can go for further testing.

I hope this helps you.
Thanks and regards.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Ashok Kumar 24 hours later
Dr. XXXXXXX ......please tell me if you did not receive my last inquiry. Does it really take 3 months before I can check my folate and vitamin D levels again? I still don't feel quite right. XXXXXXX
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Follow up: Dr. Ashok Kumar 3 minutes later
I wrote an inquiry earlier today and apparently the system didn't put it through. Please let me know.. XXXXXXX
doctor
Answered by Dr. Ashok Kumar 14 hours later
Brief Answer:
Follow up

Detailed Answer:
Dear XXXXXXX
Thanks for follow up.

I have received your query but only what you can read on this page only.

No it does not take 3 months to correct the deficiency but testing is indicated after three months or once there is symptomatic improvement. It is ideal to continue folate for long time as it is completely harmless.

Regarding vitamin D I need to know the levels which you received from your laboratory. That will determine the time required to correct the deficiency as well as dose of supplements.

Regarding not feeling alright we need to understand that folate and vitamin D are just contributing factors and not the final cause for depression. In my opinion finding a better solution with use of saliva test may help you in coming out of depression.

I hope this assists you further.
Thanks and regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ashok Kumar 2 days later
Dr. XXXXXXX .....three weeks ago my levels were as follows: folate was 23.9, vitamin D was 25, and B12 was 366. Now as you know I'm on folate and vitamin D supplements. What do you think? Am I doing the right thing? Since I feel better, should I have another blood test? XXXXXXX
doctor
Answered by Dr. Ashok Kumar 18 hours later
Brief Answer:
Yes it is right thing to use supplements

Detailed Answer:
Hell,
Thanks for follow up.

Since both the folate and vitamin D were significantly low it is important to take supplements. There is no question of doing wrong as it is essential to correct the deficiency.

Regarding next blood levels it is appropriate to wait for 10-12 weeks before next testing. The timing is important as all supplements do not directly affect the reserves and it takes time to reach equilibrium in body.

I also like to draw your kind attention that feeling better after use of supplements is most important indicator of nutritional deficiency playing significant role.

I hope this helps you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Ashok Kumar 25 hours later
I FINALLY got my saliva test yesterday and the results will take a week. My mind still feels like I need an antidepressant or to build up the reserves on folate and vitamin D or both. Does that make sense? Do you feel like I do and both are needed?
doctor
Answered by Dr. Ashok Kumar 15 hours later
Brief Answer:
I think waiting is best thing at this time

Detailed Answer:
Hello,
Thanks for follow up.

Since the saliva test is already done and there is one week before you get the results I feel waiting is best thing that we can do at this moment of time.

This is very important from another part of depression cause as you have shown some response with vitamin D and folate. This strategy will allow more time to observe effect of nutritional supplements.

I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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