Anemia and macrocytosis in the prediction of serum folate and vitamin B12 status, and treatment outcome in major depression.
BACKGROUND
Folate and B12 deficiencies may result in macrocytic anemia, and are common in major depression; hypofolatemia may result in poorer antidepressant response. We wished to determine whether anemia or macrocytosis predict hypofolatemia, low B12, or refractoriness to antidepressants.


METHODS
After obtaining serum folate, B12, and hematological indices, 213 depressed adults were treated with fluoxetine 20 mg/day. Amelioration of depressive symptoms was measured.


RESULTS
Neither macrocytosis nor anemia predicted low serum folate/B12, or antidepressant refractoriness. Among 39 patients with hypofolatemia, none had macrocytosis; 28% had low HCT; 41% had low RBC. Among 25 patients with low B12, none had macrocytosis; 24% had low HCT; 28% had low RBC. Among non-responders, 3% had macrocytosis; 24% had low HCT; 25% had low RBC.


CONCLUSIONS
Anemia and macrocytosis should not be used to predict folate or B12 deficiencies, or refractoriness to antidepressants. Measurement of folate and B12 should be considered when evaluating treatment refractoriness.
Mischoulon
D
D
Department of Psychiatry, Depression Clinical and Research Program, Massachusetts General Hospital, 15 Parkman St., WAC-812, Boston, MA 02114, USA. dmischoulon@partners.org
Burger
J K
JK
Spillmann
M K
MK
Worthington
J J
JJ
Fava
M
M
Alpert
J E
JE
D000328:Adult; D000748:Anemia, Macrocytic / Q000097:blood* / Q000523:psychology*; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000097:blood* / Q000188:drug therapy*; D004361:Drug Tolerance; D004906:Erythrocyte Count; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use; D005494:Folic Acid Deficiency / Q000097:blood / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D016896:Treatment Outcome; D014806:Vitamin B 12 Deficiency / Q000097:blood / Q000523:psychology*
D018687:Antidepressive Agents, Second-Generation; D005473:Fluoxetine