A Placebo-Controlled Study of Physiologic Effects of L-methylfolate in Schizophrenia Patients

• Examine the change in DLPFC activation in patients receiving L-methylfolate 15 mg/d versus placebo as measured by fMRI using Sternberg's Iterm Recognition Paradigm. [ Time Frame: Week 12 ] [ Designated as safety issue: No ]
• Examine the relationship between MTHFR genotype, change in plasma homocysteine, and methionine concentration, and change in DLPC activation in subjects receiving L-methylfolate [ Time Frame: Weeks 2, 8, and 12 ] [ Designated as safety issue: No ]
• Examine the change in negative symptoms (SANS total score) after three months compared to placebo [ Time Frame: Weeks 2, 8, and 12 ] [ Designated as safety issue: No ]
• Examine the change in negative symptoms (SANS total score) in relation to change in plasma L-methylfolate levels [ Time Frame: Weeks 2, 8, and 12 ] [ Designated as safety issue: No ]
• Examine the change in MATRICS cognitive battery composite score after three months compared to placebo [ Time Frame: Weeks 2, 8, and 12 ] [ Designated as safety issue: No ]
• Examine the change in MATRICS cognitive battery composite score after three months in relation to change in plasma L-methylfolate concentration. [ Time Frame: Weeks 2, 8, and 12 ] [ Designated as safety issue: No ]
• Examine the change in psychotic symptoms as measured by the PANSS psychosis subscale score after three months compared to placebo [ Time Frame: Weeks 2, 8, and 12 ] [ Designated as safety issue: No ]
• Examine the change in psychotic symptoms (PANSS score) in relation to change in plasma L-methylfolate concentration. [ Time Frame: Weeks 2, 8, and 12 ] [ Designated as safety issue: No ]
• Examine the change in plasma homocysteine and methionine concentrations following a three-month trial of L-methylfolate 15 mg/d compared to placebo. [ Time Frame: Weeks 2, 8, and 12 ] [ Designated as safety issue: No ]

This study is a 12-week, double-blind, placebo-controlled trial of L-methylfolate 15 mg/d supplementation in schizophrenia patients with mild or greater negative symptoms. L-methylfolate, a prescription medical food, is the activated form of folate required for conversion of homocysteine to methionine and hence is the optimal form of folate for supplementation, since it eliminates the need for activation by MTHFR. The purpose of this study is to examine the change in plasma L-methylfolate concentrations following a three-month trial of L-methylfolate 15 mg/d compared to placebo.

Blood levels of L-methylfolate and biological activity will be evaluated by examining changes in plasma homocysteine concentrations, serum methionine concentrations and changes in brain activation as measured by fMRI.

• Other: Placebo
  Placebo once a day for 12 weeks
• Other: L-methylfolate
  L-methylfolate 15mg once a day for 12 weeks
  Other Name: Deplin

• Experimental: L-methylfolate
  L-methylfolate 15mg (a medical food)
  Intervention: Other: L-methylfolate
• Placebo Comparator: Placebo
  Placebo
  Intervention: Other: Placebo

Inclusion Criteria:

• Diagnosis of schizophrenia, any subtype
• Male of female
• Age 18-68 years
• Treated with an antipsychotic for at least 6 months at a stable dose for at least 6 weeks
• PANSS total score of at least 60, with at least 3 (moderate) on one negative symptom item or on one positive symptom item
• Simpson Angus Scale (SAS) for the EPS total score of 12 or less and
• A score of 2 (mild) or less on all items of the Calgary Depression Rating Scale (CDRS)
• Comprehension of English adequate to complete cognitive testing

Exclusion Criteria:

• Unable to provide informed consent
• CBC results consistent with megaloblastic anemia
• Serum creatinine concentration greater than 1.4
• Current use of folate supplementation > 400mcg folate
• Alcohol or other substance abuse within 3 months (nicotine allowed)
• Current use of any of the following medications: phenobarbital, phenytoin, carbamazepine, valproic acid, fosphenytoin, primidone or pyrimethamine
• Positive baseline urine toxic screen, (positive test for PCP, barbiturates, cannabinoids, amphetamines, benzodiazepines, opiates, or cocaine)
• Unstable medical illness (exclusionary lab values are listed in Appendix A)
• Unstable psychiatric illness
• Seizure disorder
• Pregnant or nursing, or planning/trying to get pregnant within the next 6 months, and
• DSM-IV diagnosis of major depressive disorder