Vitamins

Vitamins are organic micronutrients that are required for normal growth and function. This includes brain function as well and therefore mood! It is hard to find rock-solid scientific evidence to support vitamins for the treatment of depression, but I did a dive into the literature and found what I could. Most of the vitamins and minerals seem to have a “Goldilocks” effect. Too little of a vitamin or mineral is bad, but too much can be bad as well. Staying in the middle is just right for optimal health.

Thiamine (Vitamin B-1)

Background:

Thiamine deficiency is seen in alcoholics and leads to lesions in the brain. These lesions were seen on autopsy of 12.5% of alcohol abusers. This is called Wernicke-Korsakoff syndrome. The symptoms include confusion and balance issues but can progress all the way to severe memory loss and psychosis.

Evidence:

A review of 1,587 Chinese men and women aged 50 to 70 found an association between poor thiamine nutritional status and depression.

Foods with Thiamine:

Whole grains, yogurt, seafood, lean meat, eggs, beans and seeds (via the National Institutes of Health, Office of Dietary Supplements)

Riboflavin (Vitamin B-2)

Background:

Riboflavin deficiency can cause depression, but there is no evidence that I could find that supports that taking Riboflavin helps with depression.

Evidence:

98 nurses (45 depressed and 53 were non-depressed) were analyzed for Riboflavin deficiencies. The study found a marginal prevalence of Riboflavin deficiency in the depressed nurses.

Foods with Riboflavin:

Eggs, organ meat, lean meats, milk and green vegetables (via the National Institutes of Health, Office of Dietary Supplements)

Niacin (Vitamin B-3)

Background:

Niacin deficiency can cause depression. Niacin is needed for the process that converts the amino acid, tryptophan, into serotonin. I could not find any specific trials that supported its use for treating depression but it makes sense how deficiencies could be detrimental in mood.

Foods with Niacin:

Meat, poultry, fish, pumpkin, tempeh, peanuts, tofu, beans, eggs

Pyridoxine (Vitamin B-6)

Background:

Pyridoxine is needed by your body to convert food into energy and to produce red blood cells. Pyridoxine is also a cofactor in the tryptophan to serotonin pathway.

Evidence:

A study looked at 140 individuals pyrixidone levels and depression score using the Major Depression Inventory. 13% of the individuals were depressed and a significant association was found between low pyridoxine levels and depression score.

Foods with Pyridoxine:

Chickpeas, beef, tuna, salmon, chicken breast, fortified breakfast cereal, potatoes, banana (via the National Institutes of Health, Office of Dietary Supplements)

Folate (Vitamin B-9)

Background:

Folate levels are on average 25% lower in depressed people than non-depressed people. Folate has long been known to prevent certain fetal abnormalities and is in prenatal vitamins. Folate can also be helpful in mood. The body converts Folate to L-methylfolate which then helps in the production of Serotonin, Norepinephrine, and Dopamine.

Evidence:

A trial in Wales looked at adding 5mg of folic acid to the patient’s antidepressant medication regimen. 475 patients were included in the study. The trial did not find that folic acid was clinically effective for treating depression. This might be a case of not enough Folate can cause depression, but adding more once you already have enough doesn’t do much.

A study was conducted to assess if folic acid supplementation would help to prevent mood disorders in young people with a family history of mood disorders. There were 112 participants, half of which took folic acid 2.5mg daily and half took a placebo. The incidence of mood disorders was 14.3% in the folic acid group and 17.9% in the placebo group. Folic acid may have delayed the time to onset of mood disorder as well. The results were not statistically significant.

Your body converts Folate into L-methylfolate. Some people have a type of genetic makeup that has trouble with that conversion. These people (or anyone) can take L-methylfolate directly. A study combined two trials that investigated adding L-methylfolate or placebo to antidepressant medications. The first trial had 148 patients. The patients received various doses of L-methylfolate (7.5 – 15mg daily) or placebo. The first trial showed no significant difference. The second trial compared just the 15mg dose of L-methylfolate to placebo. The second trial did show an advantage in response rate and depression scores.

Foods with Folate:

Beef liver, spinach, black-eyed peas, fortified breakfast cereals, asparagus, Brussels sprouts, romaine lettuce, avocado (via the National Institutes of Health, Office of Dietary Supplements)

Vitamin B-12

Background:

Vitamin B-12 is used by the body to create red blood cells and is needed for proper neurological function and DNA synthesis.

Evidence:

A trial screened 199 depressed patients. 73 had low normal B-12 levels. 34 were randomized to the treatment group (antidepressant and 1000mcg weekly B-12 injection) while 39 were randomized to the control arm (antidepressant alone). At three months follow up, 100% of patients in the B-12 group showed a 20% reduction in their depression score! Only 69% in the control arm showed a 20% reduction.

Foods with Vitamin B-12:

Clams, beef liver, fortified breakfast cereal, trout, salmon, tuna, milk, yogurt, cheese (via the National Institutes of Health, Office of Dietary Supplements)

How I found and addressed my own dietary issues

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References:

1. Torvik A, Lindboe CF, Rogde S. Brain lesions in alcoholics. A neuropathological study with clinical correlations. J Neurol Sci. 1982;56(2-3):233.

2. Zhang G, Ding H, Chen H, et al. Thiamine Nutritional Status and Depressive Symptoms Are Inversely Associated among Older Chinese Adults. J Nutr. 2013 Jan; 143(1): 53–58.

3. Naghashpour M, Amani R, Nutr R, et al. Riboflavin status and its association with serum hs-CRP levels among clinical nurses with depression. J Am Coll Nutr. 2011 Oct;30(5):340-7.

4. Hvas AM, Juul S, Bech P, et al. Vitamin B6 level is associated with symptoms of depression. Psychother Psychosom. 2004 Nov-Dec;73(6):340-3.

5. Bedson E, Bell D, Carr D, et al. Folate Augmentation of Treatment–Evaluation for Depression (FolATED): randomised trial and economic evaluation. Health Technol Assess. 2014 Jul;18(48).

6. Sharpley AL, Hockney R, McPeake L, et al. Folic acid supplementation for prevention of mood disorders in young people at familial risk: a randomised, double blind, placebo controlled trial. J Affect Disord. 2014;167:306-11.

7. Papakostas GI, Shelton RC, Zajecka JM, et al. L-methylfolate as adjunctive therapy for SSRI-resistant major depression: results of two randomized, double-blind, parallel-sequential trials. Am J Psychiatry. 2012 Dec;169(12):1267-74.

8. Syed E, Wasay M, Awan S. Vitamin B12 Supplementation in Treating Major Depressive Disorder: A Randomized Controlled Trial. Open Neurol J. 2013; 7: 44–48.