Question

: Have you ever heard of taking folic acid to help with depression? I read about it in a health magazine.

Answer: Some research evidence links low folic-acid levels to depression. Some research also suggests that taking folic-acid supplements along with antidepressants, particularly the SSRIs (Lexapro, Zoloft, Prozac, Paxil), can augment the antidepressant response in some people. But the research gets a bit muddy because it turns out that 10 percent of the general population possesses a gene defect that eliminates the enzyme needed to properly break down folic acid into its active form, L-methylfolate. An additional 40 percent of folks have only a limited ability to convert consumed folic acid into L-methylfolate.

To determine if you're wasting time taking folic-acid supplements, lab clues include a low serum or red blood cell folic-acid level, or both, (although the range of what's normal is wide) and an elevated homocysteine level. A prescription L-methylfolate supplement, Deplin, for folks with a suboptimal folic-acid level can help boost the levels of serotonin, norepinephrine, and dopamine when taken with antidepressants.

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Sundowner's syndrome and how to manage it

Q:

Do you have any suggestions on how best to manage someone with sundowner's syndrome?

A: For readers unfamiliar with the term, sundowner's syndrome describes agitated, disruptive, or anxious behavior, typically in an Alzheimer's or other demented patient, in the late evening as the sun goes down.

Causes for sundowner's syndrome include: sensory overload during the day; fatigue and stress at the end of the day; anxiety due to a gradual loss of visual cues as the room gets dark; and drugs that can further impair cognition.

The first steps in dealing with sundowner's syndrome are to anticipate it and keep the individual safe from injury, continually orienting the person to surroundings during evening hours.

Other suggestions include taking naps during the day to help reduce daytime fatigue; Alzheimer's drugs like Aricept or Exelon; and antidepressants like Zoloft or Lexapro. You can also schedule activities earlier in the day; avoid caffeine and sweets after lunch; and expose the person to light in the evening hours and in the early morning to help maintain the body's internal sleep-wake clock. Regular toileting in the evening and use of a nightlight may help. For information, check out www.sundownerfacts.com.

Mitchell Hecht is a physician specializing in internal medicine. Send questions to him at: "Ask Dr. H.," Box 767787, Atlanta, Ga. 30076.