Researchers found no overall benefit of adjuvant vitamin B12, B6 and folic acid on symptoms and neurocognition in first-episode psychosis, according to study findings.
However, secondary analyses revealed that B-vitamins may benefit attention/vigilance in women and patients with elevated homocysteine and affective psychosis.
“We know that B-vitamins (particularly B6, B12 and folate) are important for brain health,” Kelly Allott, DPsych, from Orygen, The National Centre of Excellence in Youth Mental Health, and The University of Melbourne, Australia, told Healio Psychiatry. “Previous research involving people with long-term schizophrenia has shown that B-vitamin supplementation can improve symptoms of psychosis. However, no previous study had investigated whether B-vitamins could improve symptoms following a first episode of psychosis. Early effective treatments have the potential to prevent longer-term illness and functional difficulties.”
The researchers conducted a randomized, double-blind, placebo-controlled trial to evaluate whether homocysteine-lowering agents — folic acid, vitamin B12 and B6 — could lower homocysteine levels and improve symptomatology and composite neurocognition in 120 patients with first-episode psychosis.
Participants were randomized to receive once-daily adjunctive B-vitamin supplement (containing folic acid 5 mg, B12 0.4 mg, and B6 50 mg) or placebo for 12 weeks. Along with change in symptoms and neurocognition, researchers examined change in additional psychopathology measures (ie, symptoms, neurocognition, functioning, tolerability and safety).
Allott and colleagues found that B-vitamin supplementation had no significant effects on symptomology as measured by the Positive and Negative Syndrome Scale, or neurocognition. In addition, the results showed no significant group differences in secondary symptom domains.
However, over the 12 weeks, the B-vitamin group showed a greater average decrease in homocysteine levels (effect size = –0.65; P = .003). Furthermore, analysis revealed a significant group difference in the attention/vigilance domain (effect size = 0.49; P = .024) indicating that the B-vitamin group remained stable while the placebo group declined in performance.
Overall, 14% of the sample had high homocysteine levels at baseline, which was tied to greater improvements in attention/vigilance after taking B vitamins, according to the results.
“B-vitamin (B6, B12, folate) supplementation can aid concentration skills in young people with first-episode psychosis,” Allott told Healio Psychiatry. “People with psychosis who have elevated homocysteine levels (>15 mcmol/L) have a stronger response to B-vitamin supplementation than those who have normal homocysteine levels. This indicates that B-vitamin supplementation personalized to those with elevated homocysteine may be particularly beneficial.”
In addition, being female and having affective psychosis was linked to better neurocognition in select domains in patients taking B vitamins, according to the study.
“Given the high tolerability and low side-effect profiles of nutritional supplements, future research could explore using targeted multi-nutrient interventions for synergistic action in [first-episode psychosis],” Allott and colleagues wrote in Biological Psychiatry. “Individuals who have abnormal homocysteine or blood vitamin levels may be the most responsive to adjuvant vitamin treatment, strongly supporting a precision medicine or biomarker-guided treatment approach.” – by Savannah Demko
Disclosure: The authors report no relevant financial disclosures.
Editor’s note: This article was updated 1/30 with comments from the author.