Research Critique of “Vitamin D Supplementation Affects the Beck Depression Inventory, Insulin Resistance, and Biomarkers of Oxidative Stress in Patients with Major Depressive Disorder: A Randomized, Controlled Clinical Trial”

Alexandra Grossano

September 24, 2018

Vitamin D is produced in the skin by sun exposure and has many important functions in the human body. These functions include: calcium maintenance for bone health, as well as roles in brain development and function CITATION Jor08 l 1033 (1). Vitamin D is said to have a profound impact on neurotransmitters and, it has also shown in research to have antidepressant properties CITATION Par17 l 1033 (2). Studies have suggested that the brain has specialized receptors for vitamin D that contribute to mood and depressive disorders CITATION Par11 l 1033 (3). Low serum levels of 25-hydoxyvitamin D [25(OH)D], the storage form of vitamin D, have been associated with reduced cognitive function as well as anxiety and depression CITATION Jor08 l 1033 (1). Vitamin D deficiency has been associated with an 8-14% increase in the prevalence of depression and a 50% increase in the prevalence of suicide CITATION Sep16 l 1033 (4). There is evidence to support the hypothesis that low vitamin D status is associated with mood disorder, including major depressive disorder and seasonal affective disorder CITATION Cho18 l 1033 (5). Major Depressive Disorder (MDD) is defined as a mental disorder that is characterized by persistent low mood, accompanied by loss of interest or pleasure in normally enjoyable activities CITATION Sep16 l 1033 (4). One study showed that 95 % of patients with MDD had a serum-hydroxyvitamin D concentration below 30 micrograms per liter CITATION Sep16 l 1033 (4). Vitamin D has shown to improve depressive symptoms through its effects on neurotransmitters such as serotonin CITATION Cho18 l 1033 (5), inflammatory markers, calcium homeostasis in the brain and nerve growth factor synthesis CITATION Sep16 l 1033 (4).

A one-month, randomized, double blind, placebo-controlled clinical trial done by Sepehrmanesh, Z., and Kolahdooz, F., et. Al. examined 40 patients between the ages of 18 and 65 who had been diagnosed with MDD based on the disease criteria from the Diagnostic and Statistical Manual of Mental Disorders CITATION Sep16 l 1033 (4). Exclusion criteria included: a history of coronary artery infarction, angina pectoris, stroke, renal stone disease, pregnant or lactating women, smokers and those with liver problems or substance abuse problems, those having non-normal creatinine concentrations or taking dietary supplements during the previous two months CITATION Sep16 l 1033 (4). Participants were randomly assigned to received either a single capsule of Vitamin D, or a placebo every week for eight weeks. Fasting blood samples were taken before and after the study. Both Primary and secondary outcomes were assessed; Primary measures included the Beck Depression Inventory (BDI) which is a self-compiled questionnaire in multiple-choice format that examines depressive symptoms CITATION Sep16 l 1033 (4). Secondary measures included: glucose homeostasis variables, lipid profiles, hs-CRP, and biomarkers of oxidative stress CITATION Sep16 l 1033 (4). Patients were asked to not change their routine physical activity or dietary intake for the duration of the study CITATION Sep16 l 1033 (4). Participants provided three dietary records and three physical activity records both were obtained at two, four, and six weeks of the study CITATION Sep16 l 1033 (4). Physical activity was expressed in metabolic equivalents (hours/day) by multiplying the time reported for physical activity by the relevant metabolic equivalent coefficients found in standard tables CITATION Sep16 l 1033 (4). A trained nutritionist obtained anthropometric measurements both pre and postintervention. In addition to short reminder messages, participants were asked to return empty medication packages to ensure compliance CITATION Sep16 l 1033 (4). Nutritionist IV software, modified for Iranian foods, was used to obtain nutrient intake for the participants CITATION Sep16 l 1033 (4).

After the eight weeks, changes in serum 25-hydroxyvitamin D concentrations were greater in the vitamin D group than in the placebo group CITATION Sep16 l 1033 (4). A trend in a greater decrease of BDI score was observed in those who took the vitamin D supplements compared to those in the placebo group CITATION Sep16 l 1033 (4). There were no significant differences in height, weight, physical activity, or baseline BMI between the vitamin D group and the placebo CITATION Sep16 l 1033 (4). There were no statistically significant differences seen between groups in terms of dietary intake of energy, carbohydrates, proteins, fats, cholesterol, dietary fiber, vitamin D, calcium, etc. CITATION Sep16 l 1033 (4). Patients who took the vitamin D supplement had significant decreases in the serum insulin concentrations, HOMA-IR, and HOMA-B compared to the placebo group CITATION Sep16 l 1033 (4). MDD is linked to complications such as morbidity, mortality, increased risk of cardiovascular disease, dyslipidemia, and impaired insulin function CITATION Sep16 l 1033 (4).

Low serum 25-hyrdroxyvitamin D levels have been seen in overweight and obese subjects, individuals with depression as well as those with seasonal affective disorder (SAD) CITATION Jor08 l 1033 (1). There is an apparent relationship between 25-hydroxyvitamin D levels and symptoms of depression CITATION Jor08 l 1033 (1). Many studies on the relation between blood 25-hydroxyvitamin D levels and incidence of depression have been limited by physical activity, body mass index, length of study as well as other factors that may be associated with depression CITATION Ber12 l 1033 (6). There is room for further research on the effects of supplementation of vitamin D and depression symptoms in otherwise healthy adults for longer periods of time CITATION Cho18 l 1033 (5). Other exploration into the effects of vitamin D supplementation on patients without a deficiency may help to distinguish how supplementation impacts those with and without deficiency CITATION Sep16 l 1033 (4). One study focused on vitamin D levels and their relationship to depression disorders in a population with musculoskeletal pain (MSP), this study found that supplementation with vitamin D improved MSP and other associated disorders CITATION Abd18 l 1033 (7).

Vitamin D is essential for calcium homeostasis as well as neurodevelopment and function CITATION Anj18 l 1033 (8). Low vitamin D status is linked to a range of different mood disorders such as major depressive disorder (MDD) and other problems such as dementia, depression, diabetes mellitus, autism and schizophrenia CITATION Cho18 l 1033 (5). MDD is characterized by persistent low mood with a loss of interest or pleasure in normally enjoyable activities CITATION Sep16 l 1033 (4). Supplementation with vitamin D in patients with MDD has a beneficial impact on BDI scores, markers of glucose metabolism an oxidative stress CITATION Sep16 l 1033 (4). Vitamin D supplementation with high doses alleviates symptoms of depression indicating a casual relationship between vitamin D levels and depression CITATION Jor08 l 1033 (1).

Bibliography

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2. Vitamin D and Depression. Parker, G.B., Brotchie, H., Graham, R. K. 15, 2017, Journal of Affective Disorders, Vol. 208, pp. 56-61.

3. ‘D’ for depression: any role for vitamin D? Parker, G., Brotchie, H. 4, 2011, Acta Psychiatrica Scandinavica, Vol. 124, pp. 243-249.

4. Vitamin D Supplementaion Affects Becks Depression Inventory, Insulin Resistance, and Biomarkers of Oxidative Stess in Patients with Major Depressive Disorder: A Randomized, Controlled Clinical Trial. Sepehrmanesh, Z., Kolahdooz, F., Abedi, F., et al. 2, 2016, The Journal of Nutrition, Vol. 146, pp. 243-248.

5. Effect of Vitamin D Supplementation on depressive symptoms and psychological wellbeing in healthy adult women : a double-blind radomised conrtolled clinical trial. Choukri, M.A., Conner, T.S., Haszard, J.J., et al. s.l. : Journal of Nutritional Science, 2018, Vol. 7.

6. Vitamin D Supplementation and Depression in the Womens Health Initiative Calcium and Vitmain D Trial. Bertone-Johnson, E. R., Powers, S. I., Spangler,L. Et. Al. 1, 2012, American Journal of Epidemiology, Vol. 176, pp. 1-13.

7. Vitamin D as potential antidepressant in outpatients with musculoskeltal pain. Abdul-Razzak, K.K, Mayyas, F.A., Al-Farras, M.I. s.l. : Int. Jounral of Clinical Pharmacology and Therapeutics, 2018, Vol. 56, pp. 400-410.

8. The Role of Vitamin D in Brain Health: A Mini Lierature Review. Anjum, I., Jaffery, S., Fyyaz, M., et al. 7, s.l. : Cureus, 2018, Vol. 10.