25257064
BACKGROUND	Depression is common and the efficacy of antidepressants is suboptimal .
BACKGROUND	High plasma homocysteine has been consistently associated with depression , and treatment with certain B vitamins demonstrably reduces its concentration .
OBJECTIVE	To determine whether vitamins B6 , B12 and folic acid enhance response to antidepressant treatment over 52 weeks .
METHODS	Randomised , double-blind , placebo-controlled trial of citalopram ( 20-40 g ) together with 0.5 mg of vitamin B12 , 2 mg of folic acid and 25 mg of vitamin B6 for 52 weeks ( Australian and New Zealand Clinical Trials Registry : 12609000256279 ) .
METHODS	Participants were community-dwelling adults aged 50 years or over with DSM-IV-TR major depression .
METHODS	We measured severity of symptoms with the Montgomery-sberg Depression Rating Scale ( MADRS ) .
METHODS	The primary outcome was remission of the depressive episode after 12 , 26 and 52 weeks .
METHODS	Secondary outcomes included reduction of MADRS scores over time and relapse of major depression after recovery by week 12 .
METHODS	Results In total , 153 people were randomised ( 76 placebo , 77 vitamins ) .
METHODS	Remission of symptoms was achieved by 78.1 and 79.4 % of participants treated with placebo and vitamins by week 12 ( P = 0.840 ) , by 76.5 and 85.3 % at week 26 and 75.8 and 85.5 % at week 52 ( effect of intervention over 52 weeks : odds ratio ( OR ) = 2.49 , 95 % CI 1.12-5 .51 ) .
METHODS	Group differences in MADRS scores over time were not significant ( P = 0.739 ) .
METHODS	The risk of subsequent relapse among those who had achieved remission of symptoms at week 12 was lower in the vitamins than placebo group ( OR = 0.33 , 95 % CI 0.12-0 .94 ) .
CONCLUSIONS	B vitamins did not increase the 12-week efficacy of antidepressant treatment , but enhanced and sustained antidepressant response over 1 year .
CONCLUSIONS	Replication of these findings would mandate that treatment guidelines adopt the adjunctive use of B vitamins as a safe and inexpensive strategy to manage major depression in middle-aged and older adults .

