Vitamin D deficiency: Result, not cause of depression!

 A clinical study seems to suggest that Vitamin D- deficiency  is NOT the “cause” of depression, but may often be a consequence… thus: it’s really important to have your Vitamin D level checked when you are depressed!
 
 
 

Vitamin D Supplementation Does Not Relieve Depressive Symptoms CME

News Author: Megan Brooks
CME Author: Hien T. Nghiem, MD

CME Released: 07/31/2012; Valid for credit through 07/31/2013

 
 

This article is intended for primary care clinicians, psychiatrists, and other specialists who provide care for patients with low levels of vitamin D who may be at risk for depression.

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

Upon completion of this activity, participants will be able to:

  1. Report the association between low levels of vitamin D and certain medical conditions.
  2. Determine the effect of vitamin D supplementation on depression scores in people with low levels of serum 25-hydroxyvitamin D.

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As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.

Megan Brooks

 

Megan Brooks is a freelance writer for Medscape.

Disclosure: Megan Brooks has disclosed no relevant financial relationships.

Brande Nicole Martin, MA

CME Clinical Editor, Medscape, LLC

Disclosure: Brande Nicole Martin, MA, has disclosed no relevant financial relationships.

Hien T. Nghiem, MD

 

Hien T. Nghiem, MD, is a freelance writer for Medscape.

Disclosure: Hien T. Nghiem, MD, has disclosed no relevant financial relationships.

Sarah Fleischman

CME Program Manager, Medscape, LLC

Disclosure: Sarah Fleischman has disclosed no relevant financial relationships.

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Faculty and Disclosures

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.

Author(s)

Megan Brooks

 

Megan Brooks is a freelance writer for Medscape.

Disclosure: Megan Brooks has disclosed no relevant financial relationships.

Editor(s)

Brande Nicole Martin, MA

CME Clinical Editor, Medscape, LLC

Disclosure: Brande Nicole Martin, MA, has disclosed no relevant financial relationships.

CME Author(s)

Hien T. Nghiem, MD

 

Hien T. Nghiem, MD, is a freelance writer for Medscape.

Disclosure: Hien T. Nghiem, MD, has disclosed no relevant financial relationships.

CME Reviewer(s)

Sarah Fleischman

CME Program Manager, Medscape, LLC

Disclosure: Sarah Fleischman has disclosed no relevant financial relationships.

 
 

From Medscape Education Clinical Briefs

Vitamin D Supplementation Does Not Relieve Depressive Symptoms CME

News Author: Megan Brooks
CME Author: Hien T. Nghiem, MD

Faculty and Disclosures

CME Released: 07/31/2012; Valid for credit through 07/31/2013

 
 

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Clinical Context

During the past decade, vitamin D deficiency has gained much attention. Low levels of vitamin D have been associated with the development of cardiovascular disease, hypertension, neurodegenerative disease, diabetes, metabolic syndrome, and cancer. However, the function of vitamin D in the brain is not fully understood. Vitamin D receptor has been found in areas of the brain that are involved in the development of depression; hence, vitamin D has been associated with depressive symptoms and other psychiatric conditions. Several population-based studies have investigated the relationship between depression and vitamin D, but results have been conflicting.

The aim of this study by Kjærgaard and colleagues is to compare depressive symptoms in participants with low and high serum 25-hydroxyvitamin D (25[OH]D) levels and to examine whether supplementation with vitamin D3 would alleviate symptoms in those with low serum 25(OH)D levels.

Study Synopsis and Perspective

Low serum vitamin D is linked to depression, but treating with high doses of the supplement does not appear to ease depressive symptoms, new research suggests.

A randomized controlled trial conducted by investigators from the Medical Clinic, University Hospital of North Norway, in Tromsø, showed that participants with low vitamin D levels had significantly higher depression scores than participants with high vitamin D levels (P < .05) but that high-dose vitamin D supplementation for 6 months had no significant effect on depressive symptom scores when compared with placebo.

"This implies that vitamin D deficiency is the result of depression and not the cause of depression," first author Marie Kjærgaard, PhD, told Medscape Medical News.

"The take-home message," she said, is that clinicians "should not try to treat depression with vitamin D, but they must be aware that this patient population is at risk of vitamin D deficiency."

The study was published online July 12 in the British Journal of Psychiatry.

Clear Negative Result

There have been a number of cross-sectional studies linking low vitamin D to depression, including 1 published in Mayo Clinic Proceedings in November 2011 and reported by Medscape Medical News at that time.

This study and others have fueled suggestions that vitamin D supplementation might help alleviate depressive symptoms. Yet "very few" randomized controlled trials have been done, Dr. Kjærgaard said, "and these have all been on selected populations [and] have shown diverging results. It has not yet been established if there is a causal relationship between vitamin D and depression," she added.

For the study, investigators recruited 344 healthy volunteers. At baseline, 230 had low serum 25(OH)D levels (< 55 nmol/L), and 114 had high 25(OH)D levels (> 70 nmol/L).

Participants with low vitamin D levels were randomly assigned to receive either placebo or 40,000 IU of vitamin D3 per week for 6 months. Participants with high vitamin D levels served as nested controls.

Depressive symptoms were evaluated with the Beck Depression Inventory, Hospital Anxiety and Depression Scale, Seasonal Pattern Assessment Scale, and Montgomery-Åsberg Depression Rating Scale.

There was no significant effect of vitamin D supplementation regardless of whether the data were analyzed per-protocol, as intent-to-treat, or when only participants with very low (< 25 nmol/L) and low (< 40 nmol/L) baseline vitamin D levels were included, the researchers say. Analyses stratified for sex, age, body mass index, and smoking status did not alter the results.

"Our study," said Dr. Kjærgaard, "is the first RCT [randomized controlled trial] on a general population with a clear negative result, indicating that there is no causal relationship." Nonetheless, "our study is only a small piece in the puzzle, and more studies most be performed to support our results."

Laura Tripkovic, RD, from the Institute of Biosciences and Medicine, University of Surrey in Guildford, United Kingdom, who was not involved in the study, agrees that more research is needed. In the meantime, "it's beneficial to maintain healthy levels of vitamin D, if not to prevent depression, then to most certainly help protect bone health," she told Medscape Medical News.

The study was supported by a grant from the Northern Norway Regional Health Authority. The authors and Dr. Tripkovic have disclosed no relevant financial relationships.

Br J Psychiatry. Published online July 12, 2012. Abstract

Study Highlights

  • Between October 2009 and November 2010, participants with low 25(OH)D levels were randomly assigned to receive either placebo or 40,000 IU of vitamin D3 per week for 6 months.
  • Eligible participants were adults 30 to 75 years old who were found to have serum 25(OH)D levels below the 20th percentile (55 nmol/L) or above the 75th percentile (70 nmol/L).
  • Individuals with high serum 25(OH)D levels were used as nested control participants.
  • Depressive symptoms were evaluated with the Beck Depression Inventory, the Hospital Anxiety and Depression Scale, the Seasonal Pattern Assessment Scale, and the Montgomery-Åsberg Depression Rating Scale.
  • At baseline, there were no differences between the placebo and vitamin D groups.
  • Participants with low 25(OH)D levels (n = 230) at baseline were more depressed (P < .05) than participants with high 25(OH)D levels (n = 114).
  • In the intervention study, no significant effect of high-dose vitamin D was found on depressive symptom scores vs placebo.
  • No significant differences were found in delta values (score at 6 months minus score at baseline) between the placebo and vitamin D groups when stratified according to sex, age, body mass index, serum 25(OH)D levels at baseline, or smoking status.
  • No differences in effect were found when stratified according to depression scores and other subgroups.
  • No significant adverse events occurred in the placebo and vitamin D groups.
  • This study included the following limitations:
    • 6 months may have been a short time frame to investigate depression.
    • Participants were informed before the study that they had either high or low serum 25(OH)D levels, which may have biased their self-report of depressive symptoms.
    • The study was performed in a general population where the majority of participants had no or only mild depressive symptoms.

Clinical Implications

  • Low levels of vitamin D have been associated with the development of cardiovascular disease, hypertension, neurodegenerative disease, diabetes, metabolic syndrome, and cancer.
  • Low levels of serum 25(OH)D are associated with depressive symptoms, but vitamin D supplementation appears to have no effect on depressive symptoms.

 

CME Test

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Questions answered incorrectly will be highlighted.

A 45-year-old woman presents to you for follow-up on her laboratory results. The only significant abnormal result was that her vitamin D level was found to be below normal. You tell her that low levels of vitamin D are linked to which of the following medical conditions?

Cardiovascular disease
Diabetes
Hypertension
All of the above

The patient described in the first question has a history of depression. She reports that her symptoms of depression have returned in the past 2 months. According to this study by Kjærgaard and colleagues, what can you tell her about vitamin D and depression?

Serum 25(OH)D levels have no effect on depressive symptoms
High levels of serum 25(OH)D are linked with depressive symptoms
Low levels of serum 25(OH)D are linked with depressive symptoms
Vitamin D supplementation significantly alleviates depressive symptoms

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