By Greg Arnold, DC, CSCS, June 7, 2014, abstracted from “Vitamin D and Depression: A Systematic Review and Meta-Analysis Comparing Studies with and without Biological Flaws” in April 11, 2014 issue of Nutrients
Depression affects 350 million people worldwide and is both the leading cause of disability and the fourth-leading cause of the global disease burden (1). An estimated 1 in 20 people worldwide reported having depression in the previous year (2), while in the United States that number is 1 in 10 (3).
Unfortunately, conventional treatments in the form of prescription medications demonstrate only minimal benefit over placebo (4). As a result, alternative treatments for depression such as vitamin D have been consistently suggested. Vitamin D deficiency is associated with an 8%–14% increase in depression (5) and a 50% increase in suicide (6). The study results on vitamin D for depression have been inconsistent, but this is thought to be due to serious flaws in the how the studies were done (called “biological flaws”), including failing to measure vitamin D blood levels and not giving high enough doses of vitamin D (at least 800 IU per day) (7).
Now a new review of the research (8) has taken pains to look at the studies without biological flaws and have found that vitamin D is not only statistically significant in depression but also just as effective as prescription medication. Using a method of identifying high-quality studies confirmed in previous research (9), researchers identified 15 randomized clinical trials without biological flaws. In one of the studies without biological flaws, a 2013 study (10) showed that 1,200 IU of vitamin D per day helped lower depression scores in 6 weeks (called the Beck Depression Scale) by 48.5% (32.45 to 16.73) when combined with a depression medication called fluoxetine (20 milligrams per day) compared to a 33.7% decrease with fluoxetine alone (31.65 to 21.00, p < 0.05).
When they included other studies that had biological flaws, the benefit of vitamin D on depression was actually negative, but they state this was due to flaws that included not taking vitamin D blood levels, not giving enough vitamin D, or giving too much vitamin D (500,000 IU per day (12)).
The researchers also specifically scrutinized the Women’s Health Initiative (13), a study of more than 160,000 women (more than all the other studies combined). This study had the highest methodological quality but also the most biological flaws (vitamin D dosage equaled 200 IU per day), leading to non-significant outcomes for both bone strength and mood. For the researchers, “due to its sheer size, the WHI has dominated previous meta-analysis leading to null results.”
Citing the optimal vitamin D blood levels to be between 50 and 85 nanomoles/Liter (14), the researchers concluded that “Traditional evidence, biological plausibility and epidemiological studies indicate Vitamin D has therapeutic effects in depression.”
Greg Arnold is a Chiropractic Physician practicing in Hauppauge, NY. You can contact Dr. Arnold directly by emailing him at PitchingDoc@msn.com or visiting his web site at www.PitchingDoc.com
1. Hyman, S.; Chisholm, D.; Kessler, R.; Patel, V.; Whiteford, H. Mental disorders. In Disease Control Priorities in Developing Countries, 2nd ed.; Jamison, D.T., Breman, J.G., Measham, A.R., Alleyne, G., Claeson, M., Evans, D.B., Jha, P., Mills, A., Musgrove, P., Eds.; Oxford University Press: New York, NY, USA, 2006; pp. 605–626.
2. “Depression: A Global Public Health Concern” posted on the World Health Organization website
3. “An Estimated 1 in 10 U.S. Adults Report Depression” posted on the CDC Website
4. Bracken, P.; Thomas, P.; Timimi, S. Psychiatry beyond the current paradigm. Br. J. Psychiat. 2012, 201, 430–434
5. Kjærgaard, M.; Joakimsen, R.; Jorde, R. Low serum 25-hydroxyVitamin D levels are associated with depression in an adult Norwegian population. Psychiatry Res. 2011, 190, 221–225
6. Umhau, J.C.; George, D.T.; Heaney, R.P.; Lewis, M.D.; Ursano, R.J. Low Vitamin D status and suicide: A case-control study of active duty military service members. PLoS One 2013, 8, e51543
7. Heaney, R.P. Vitamin D—Baseline status and effective dose. [Letters to the editor]. N. Engl. J. Med. 2012, 367, 1
8. Spedding S. Vitamin D and Depression: A Systematic Review and Meta-Analysis Comparing Studies with and without Biological Flaws. Nutrients 2014 Apr 11;6(4):1501-18. doi: 10.3390/nu6041501
9. Sherrington, C.; Herbert, R.D.; Maher, C.G.; Moseley, A.M. PEDro. A database of randomized trials and systematic reviews in physiotherapy. Man. Ther. 2000, 5, 223–226
10. Khoraminya, N.; Tehrani-Doost, M.; Jazayeri, S.; Hosseini, A.; Djazayery, A. Therapeutic effects of Vitamin D as adjunctive therapy to fluoxetine in patients with major depressive disorder. Aust. N.Z. J. Psychiatry 2013, 47, 271–275
11. Jorde R. Effects of vitamin D supplementation on symptoms of depression in overweight and obese subjects: randomized double blind trial. Jorde R. J Intern Med 2008 Dec;264(6):599-609. doi: 10.1111/j.1365-2796.2008.02008.x. Epub 2008 Sep 10
12. Sanders, K.M.; Stuart, A.L.; Williamson, E.J.; Jacka, F.N.; Dodd, S.; Nicholson, G.; Berk, M. Annual high-dose Vitamin D3 and mental well-being: randomised controlled trial. Br. J. Psychiatry 2011, 198, 357–364
13. Bertone-Johnson, E.R.; Powers, S.I.; Spangler, L.; Larson, J.; Michael, Y.L.; Millen, A.E.; Bueche, M.N.; Salmoirago-Blotcher, E.; Wassertheil-Smoller, S.; Brunner, R.L. Vitamin D supplementation and depression in the women’s health initiative calcium and Vitamin D trial. Am. J. Epidemiol. 2012, 176, 1–13
14. Maddock, J.; Berry, D.J.; Geoffroy, M.-C.; Power, C.; Hyppönen, E. Vitamin D and common mental disorders in mid-life: Cross-sectional and prospective findings. Clin. Nutr. 2013, 32, 758–764
Integrity Health is a franchise company residing in New Hampshire. We specialize in health coaching centers combining fitness with weight loss to optimize and promote optimal health. We are also the national purveyors of the EZCOACH Fitness Prescription System licensed by fitness professionals.