Medical Perspectives | Others

July 13, 2020



John Jiao, MD

National information on mental health services in the Philippines is not given enough attention. Perhaps one of the barriers to it is the prevailing stigma inappropriately given to individuals suffering from mental health issues. Problems and lapses, primarily in providing proper mental health care to patients, arise from the previous neglect of this issue.

 

There is little epidemiological evidence on mental disorders in the Philippines. At least 14% of a population of 1.4 million Filipinos with disabilities were identified to have a mental disorder (Philippines Statistics Authority, 2010). The National Statistics Office identified that mental illness is the third most prevalent form of morbidity, however the finding that only 88 cases of mental health problems were reported for every 100 000 of the population (DOH, 2005) is likely an underestimate of the true extent of these issues.1

 

The recently passed Philippine Mental Health Act (Republic Act no. 11036) seeks to establish access to comprehensive and integrated mental health services, while protecting the rights of people with mental disorders and their family members.1 However, mental health remains poorly resourced. Only 3–5% of the total health budget is spent on mental health and 70% of this is spent on hospital care (WHO & Department of Health, 2006). Accordingly, majority of mental healthcare is provided in hospital settings with underdeveloped community mental health services.1

 

Depression is one of the mental health disorders encountered in primary care. According to the Department of Health (DOH), depressive disorder is characterized by either depressed mood or markedly diminished interest or pleasure in most activities of the day. Genetics and stressful life events play the primary or principal roles in depression.2

 

Symptoms of depression may include: significant weight loss or weight gain, difficulty in sleeping or oversleeping, fatigue or loss of energy, psychomotor agitation and slowness, diminished ability to think or concentrate, indecisiveness, and recurrent thoughts of deaths and suicidal ideations.2

 

Currently, managing mental health problems such as depression require medications such as antidepressants, anxiolytics, mood stabilizers, and antipsychotics. These can be coupled with proper psychiatric counselling to provide support for their mental health needs. Aside from the usual treatment regimens given to these cases, there are recent studies that elucidate possible positive effects of vitamin B complex and folic acid supplementation in mental health disorders.3-5

 

A recent study has evaluated the efficacy of a vitamin B complex nutritional supplement for improving depressive and anxiety symptoms in 60 adults diagnosed with major depression according to the Beck Depression and Anxiety Inventories (BDI and BAI). Secondary outcomes included quality of life according to the SF-36.4

 

Participants in the said study were assessed at baseline, at 30, and at 60 days. Those taking vitamin B complex showed significant and more continuous improvements in depressive and anxiety symptoms, compared to placebo. Additionally, there was significant improvement on the mental health scale with the SF-36 compared to placebo. Thus, modest utility of vitamin B complex can improve mood symptoms and mental health quality of life in adults with depression.4

 

A study used combination of folic acid and vitamin B-12 supplementation to lower the risk of cognitive decline in patients with depressive symptoms.6 Such an intervention is inexpensive and the preventive effect may be considerable at the population level.4

 

The prospect of using dietary supplements of folic acid and vitamin B-12 to prevent cognitive decline appears promising. More studies are needed to determine whether the benefits of folic acid and vitamin B-12 supplementation found in this trial could be replicated in other populations of older adults with increased risk of developing significant cognitive impairment.6

 

Coppen, A et al in 2005 found that both low folate and low vitamin B12 status have been found among depressed patients compared to the general population. Low plasma or serum folate has also been found in patients with recurrent mood disorders treated by lithium. Low folate levels are furthermore linked to a poor response to antidepressants, and treatment with folic acid is shown to improve response to antidepressants.3

 

The same study by Coppen and colleagues found that high vitamin B12 status may be associated with better treatment outcome for depression. On the basis of current data, the study suggests that oral doses of both folic acid (800 micrograms daily) and vitamin B12 (1 mg daily) should be tried to improve treatment outcome in depression.3

 

Adjuncts such as vitamin B12 and folic acid, as supported by multiple studies, can be used with traditional or conventional regimens for mental disorders. Tantamount to managing mental disorders with medications and supplements s educating society and raising awareness on mental health to better accept and address issues related to it.

 

References:

  • Lally J, Tully J, Samaniego R. Mental Health Services in the Philippines. BJPsych Int. 2019 Aug; 16(3): 62–64.doi: 10.1192/bji.2018.34
  • Department of Health (DOH), Depressive Disorders, Health Advisory. Accessed at: https://www.doh.gov.ph/Health-Advisory/Depressive-Disorders.
  • Coppen A, Bolander-Gouaille C, Treatment of Depression: Time to Consider Folic Acid and Vitamin B12. J Psychopharmacol. 2005 Jan;19(1):59-65.
  • Lewis JE, Tiozzo E, Melillo AB, Leonard S, Chen L, Mendez A, Woolger JM, Konefal J. The effect of methylated vitamin B complex on depressive and anxiety symptoms and quality of life in adults with depression. ISRN Psychiatry. 2013 Jan 21;2013:621453. doi: 10.1155/2013/621453. Print 2013.
  • Walker JG, Batterham PJ, Mackinnon AJ, Et al. Oral Folic Acid And Vitamin B-12 Supplementation To Prevent Cognitive Decline In Community-Dwelling Older Adults With Depressive Symptoms - The Beyond Ageing Project: A Randomized Controlled Trial. The American Journal of Clinical Nutrition. 2012;95:194–203.
  • Balk EM, Raman G, Tatsioni A, Chung M, Lau J, Rosenberg I. Vitamin B6, B12 and folic acid supplementation and cognitive function: a systematic review of randomized trials. Arch Intern Med 2007;167:21–30. 

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