Department of Endocrinology, Creighton University School of Medicine, Omaha NE, United States.
Department of Endocrinology, Creighton University School of Medicine, Omaha NE, United States.
J Steroid Biochem Mol Biol. 2018 Apr;178:60-64. doi: 10.1016/j.jsbmb.2017.10.025. Epub 2017 Nov 2.
Depression is a common problem affecting millions, usually treated with selective serotonin uptake inhibitors. Interest in vitamin D as a co-therapy was stimulated by some association studies that correlated depression with low serum 25OHD levels. There are few longitudinal studies of vitamin D and depression and most are single doses of vitamin D. In this study we examined the effect of one-year treatment with several doses of vitamin D on the Geriatric depression score (GDS) in older Caucasian and African American women. The clinical trial was a study of seven daily oral doses of vitamin D (400-4800IU/d) in Black and White older women. The trial was a double blind, randomized and placebo controlled lasting 12-months. The main inclusion criterion was serum 25 hydroxyvitamin D (25OHD)≤20ng/mL (50nmol/L). Calcium supplements were given to maintain calcium intake 1000mg/day in young people and 1200-1400mg/day in older women. Data on Geriatric depression (GDS) was collected using the validated long form at baseline and 12-months. The change in serum 25OHD was the primary outcome and GDS was one of the secondary outcomes. Adjustments were made for relevant covariates. Analysis of vitamin D effect was by dose low, medium and high compared to placebo or by quintiles. Serum 25OHD increased as a quadratic curve function to a mean of 46ng/mL (115nmol/L) in white women and 49ng/mL (122.5nmol/L) in black women on the highest dose of 4800 IU. In older women mean GDS scores changed from 3.8 (SD±4.2) at baseline to 3.6 (SD±4.1) at 12 months in whites and from 3.0 (SD±3.7) to 3.02 (SD±4.2) in Blacks. (p=0.790 in whites; p=0.958 in blacks). After 12-months there was no effect of dose on change in GDS score in women treated with different doses of vitamin D (p=0.507 in whites and p=0.340 in blacks). When both Caucasians and African Americans were divided into 3 dose groups, low (400-800 IU), medium (1600-3200 IU) and high (4000-4800 IU) doses, the change in score was 0.8 on low dose, -0.30 on medium dose and -0.31 on high dose compared to 0.11 on placebo (p=0.546). In summary, there was no improvement in GDS scores in Caucasians or African Americans on either increasing doses of vitamin D or quintiles of achieved response in serum 25OHD. The changes were small and not significant perhaps because of the relatively lower numbers of depressed women in the groups. Further studies should recruit larger numbers, 3 dose groups covering a serum25OHD range of 20-60ng/mL and more subjects with clinical depression in order to fully address the question of vitamin D effects on depression.
抑郁症是一种影响数百万人的常见问题，通常采用选择性 5-羟色胺再摄取抑制剂进行治疗。一些关联研究表明，抑郁症与低血清 25 羟维生素 D 水平有关，这激发了人们对维生素 D 作为辅助治疗的兴趣。关于维生素 D 和抑郁症的纵向研究很少，而且大多数都是单次给予维生素 D。在这项研究中，我们研究了一年中多次给予维生素 D 治疗对白种人和非裔美国老年女性的老年抑郁评分（GDS）的影响。该临床试验是一项对黑人和白人老年女性进行为期 12 个月的 7 天口服维生素 D（400-4800IU/d）的双盲、随机、安慰剂对照研究。主要纳入标准为血清 25 羟维生素 D（25OHD）≤20ng/mL（50nmol/L）。给予钙补充剂以维持年轻人每日钙摄入量 1000mg，老年女性每日 1200-1400mg。基线和 12 个月时使用经过验证的长表收集老年抑郁症（GDS）的数据。血清 25OHD 的变化是主要结局，GDS 是次要结局之一。对相关协变量进行了调整。分析维生素 D 效果是通过与安慰剂相比低、中、高剂量或通过五分位数进行的。血清 25OHD 呈二次曲线函数增加，白人女性最高剂量 4800IU 时平均增加至 46ng/mL（115nmol/L），黑人女性平均增加至 49ng/mL（122.5nmol/L）。在老年女性中，GDS 评分从基线时的 3.8（SD±4.2）变化至 12 个月时的 3.6（SD±4.1），白人女性为 3.0（SD±3.7）至 3.02（SD±4.2），黑人女性为 3.0（SD±3.7）至 3.02（SD±4.2）。（白人女性 p=0.790；黑人女性 p=0.958）。12 个月后，不同剂量维生素 D 治疗的女性 GDS 评分变化与剂量无关（白人女性 p=0.507；黑人女性 p=0.340）。当白人和非裔美国人都分为 3 个剂量组（低剂量 400-800IU、中剂量 1600-3200IU 和高剂量 4000-4800IU）时，低剂量组评分变化为 0.8，中剂量组为-0.30，高剂量组为-0.31，安慰剂组为 0.11（p=0.546）。总之，无论是增加维生素 D 剂量还是血清 25OHD 达到治疗反应的五分位数，白人和非裔美国人的 GDS 评分都没有改善。变化很小，没有统计学意义，可能是因为各组抑郁女性人数相对较少。为了充分探讨维生素 D 对抑郁症的影响，进一步的研究应该招募更多的患者，包括 3 个剂量组，涵盖血清 25OHD 范围为 20-60ng/mL，以及更多有临床抑郁的患者。
