Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, USA.
BSN, Psychiatric NP - Class of 2019, Regis College, School of Nursing, 235 Wellesley Street Weston, MA 02493, USA.
J Psychiatr Res. 2017 Dec;95:48-53. doi: 10.1016/j.jpsychires.2017.07.021. Epub 2017 Jul 22.
Bipolar depression is difficult to treat. Vitamin D supplementation is well tolerated and may improve mood via its neurotransmitter synthesis regulation, nerve growth factor enhancement and antioxidant properties. Vitamin D adjunct reduces unipolar depression, but has not been tried in bipolar depression.
18-70yos with DSM IV bipolar depression and Vitamin D deficiency (<30 ng/ml) were randomized in a controlled double blind trial of 5000IU Vitamin D po qday supplementation versus placebo for twelve weeks. Change in Montgomery-Åsberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HAM-A), Young Mania Rating Scale (YMRS), medication, and tolerance were assessed q2weeks.
16 VitD vs 17 placebo subjects did not differ in baseline characteristics (mean = 44 yo, SD = 13), VitD level (19.2 ± 65.8 g/ml vs 19.3 ± 5.5 ng/ml respectively) or mood ratings (MADRS 21.3 ± 6.4 vs 22.8 ± 6.9 respectively). At 12wks, the placebo group VitD levels remained unchanged, while the VitD group levels increased to 28 ng/ml. MADRS score decreased significantly in both placebo (mean = 6.42 (95% CI [2.28 to 10.56]) and VitD groups (mean = 9.54 (95% CI[3.51 to 15.56]) (p = 0.031), but there were no differences between treatment groups (time by treatment interaction estimate: 0.29, t = 0.14, p = 0.89); VitD and placebo groups had similar reductions in YMRS and HAM-A. Vitamin D was well tolerated.
In this small study, despite a greater rise in Vitamin D levels in the VitD supplementation group, there was no significant difference reduction in depressive symptoms. However both groups' VitD levels remained deficient. Vitamin D supplementation vs placebo did not improve reduction in mood elevation or anxiety symptoms.
双相情感障碍的治疗较为困难。维生素 D 补充剂具有良好的耐受性，可能通过调节神经递质合成、促进神经生长因子、发挥抗氧化作用来改善情绪。维生素 D 辅助治疗可改善单相抑郁，但尚未在双相抑郁中进行尝试。
18-70 岁、符合 DSM-IV 双相情感障碍诊断标准且存在维生素 D 缺乏（<30ng/ml）的患者，参与了一项为期 12 周的对照双盲试验，随机接受每日 5000IU 维生素 D 口服补充剂或安慰剂治疗。每 2 周评估一次蒙哥马利-阿斯伯格抑郁评定量表（MADRS）、汉密尔顿焦虑量表（HAM-A）、杨氏躁狂评定量表（YMRS）评分、药物使用情况和耐受性。
16 名接受维生素 D 治疗和 17 名接受安慰剂治疗的患者在基线特征（平均年龄 44 岁，标准差 13 岁）、维生素 D 水平（分别为 19.2±65.8ng/ml 和 19.3±5.5ng/ml）或情绪评分（MADRS 分别为 21.3±6.4 和 22.8±6.9）方面无差异。12 周时，安慰剂组的维生素 D 水平保持不变，而维生素 D 组的水平增加到 28ng/ml。安慰剂组（平均变化值 6.42[95%CI[2.28 至 10.56]]）和维生素 D 组（平均变化值 9.54[95%CI[3.51 至 15.56]]）的 MADRS 评分均显著降低（p=0.031），但两组间无差异（治疗时间交互作用估计值：0.29，t=0.14，p=0.89）；维生素 D 组和安慰剂组的 YMRS 和 HAM-A 评分均有相似的降低。维生素 D 具有良好的耐受性。
在这项小型研究中，尽管维生素 D 补充组的维生素 D 水平升高幅度更大，但抑郁症状的缓解程度无显著差异。然而，两组的维生素 D 水平仍存在不足。与安慰剂相比，维生素 D 补充剂并未改善情绪升高或焦虑症状的缓解。
