Summary: New research indicates that supplements containing vitamins B12, B6 and folic acid (vitamin B9) may help preserve concentration and attention in young people experiencing a first episode of psychosis.
Source: Orygen
B-group vitamins and concentration in first-episode psychosis
Researchers from Orygen, the National Centre of Excellence in Youth Mental Health, report that supplementation with B-group vitamins may help maintain attention and concentration abilities in people after a first episode of psychosis. The clinical trial investigated whether increasing intake of vitamin B12, vitamin B6 and folic acid could reduce levels of the amino acid homocysteine and have measurable benefits for cognition and symptoms.
Background and rationale
Previous studies in people with chronic schizophrenia found that higher intake of certain B-vitamins can lower homocysteine levels and in some cases improve symptoms. Elevated homocysteine has been linked to greater illness severity in schizophrenia and may be associated with cognitive difficulties. Given that a first episode of psychosis can be an early stage of schizophrenia or related to bipolar disorder or severe depression, researchers sought to test whether B-vitamin supplementation soon after onset would affect biochemical markers, clinical symptoms and neurocognitive functioning.
Study design and participants
The randomized, double-blind, placebo-controlled trial enrolled young people attending Orygen Youth Health’s Early Psychosis Prevention and Intervention Centre (EPPIC). Participants were randomly assigned to receive either a daily B-vitamin supplement (containing folic acid 5 mg, vitamin B12 0.4 mg and vitamin B6 50 mg) or a matched placebo for 12 weeks. Researchers assessed homocysteine levels, psychiatric symptoms, and a range of cognitive domains including attention, memory, language and learning at baseline and across the treatment period.
Key findings
The trial found that B-vitamin supplementation significantly reduced homocysteine concentrations. While the supplementation did not lead to a broad improvement in overall psychiatric symptoms or global neurocognition across the whole sample, there was a clear benefit in the attention and vigilance domain. Participants who received the B-vitamins maintained their performance on attention tasks over 12 weeks, whereas the placebo group showed a decline in performance during the same period.
Notably, individuals with elevated homocysteine at baseline appeared to derive the greatest benefit in attention measures from B-vitamin treatment. Additional subgroup analyses indicated that women and people diagnosed with affective forms of psychosis showed improvements in selected cognitive areas following supplementation. Genetic variation measured in the study did not predict response to B-vitamins.
Interpretation
These results suggest that B-group vitamins may exert a neuroprotective effect on attention and vigilance in the early stages of psychosis. Rather than producing broad cognitive enhancement, the supplementation appeared to prevent decline in specific attention-related abilities, especially among those who started the trial with higher homocysteine levels.
The findings support a move toward a more personalised approach to nutritional supplementation in early psychosis care: screening for elevated homocysteine could help identify patients most likely to benefit from targeted B-vitamin therapy.
Clinical implications and next steps
Clinicians and services working with young people after a first episode of psychosis may consider biochemical screening and, where appropriate, targeted B-vitamin supplementation as an adjunctive strategy to protect attention and concentration. Larger and longer trials will be needed to confirm these effects, determine optimal dosing and duration, and evaluate longer-term functional outcomes such as social and occupational recovery.
Funding: The study was funded by the Stanley Medical Research Institute, the University of Melbourne, the National Health and Medical Research Council, Blackmores Institute and the Colonial Foundation.
Source and publication: The trial results were published in Biological Psychiatry. The published study is titled “The Vitamins in Psychosis Study: A randomized, double-blind, placebo-controlled trial of the effects of vitamin B12, B6 and folic acid on symptoms and neurocognition in first-episode psychosis” and lists the research team including Divna Lazic, Abhay P. Sagare, Angeliki M. Nikolakopoulou, Kelly Allott, Patrick D. McGorry, Hok Pan Yuen, Joseph Firth, Tina-Marie Proffitt, Gregor Berger, Paul Maruff, Michaela K. O’Regan, Alicia Papas, Timothy C.B. Stephens and Colin P. O’Donnell. DOI: 10.1016/j.biopsych.2018.12.018.
Abstract (concise)
Background: Elevated homocysteine is seen in schizophrenia and is associated with greater illness severity. This trial assessed whether supplementation with folic acid, vitamin B12 and vitamin B6 reduces homocysteine and improves symptoms and neurocognition in first-episode psychosis.
Methods: In a randomized, double-blind, placebo-controlled design, approximately 120 patients with first-episode psychosis received either a daily B-vitamin supplement (folic acid 5 mg, B12 0.4 mg, B6 50 mg) or placebo for 12 weeks. Primary outcomes included changes in overall symptoms (PANSS) and composite neurocognition; secondary outcomes assessed specific cognitive domains, functioning, tolerability and safety.
Results: B-vitamin supplementation reduced homocysteine levels. No significant effects were observed on total symptom scores or composite neurocognition for the whole sample. However, the attention/vigilance domain showed a significant group difference: the B-vitamin group remained stable while the placebo group declined. Approximately 14% of participants had elevated baseline homocysteine, and these individuals showed greater attention gains with B-vitamins. Female participants and those with affective psychosis also experienced improvements in select neurocognitive domains. Genetic variation did not alter treatment response.
Conclusion: Twelve weeks of B-vitamin supplementation may not change overall psychopathology or global cognition but appears to offer specific neuroprotective benefits for attention and vigilance, particularly in patients with elevated homocysteine, affective psychosis, or female sex. The results support targeting supplementation to subgroups most likely to benefit.
Image source: public domain image used in the original report.