Department of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, 45147, Essen, Germany.
Research Institute for the Prevention of Allergies and Respiratory Diseases in Childhood, Department of Pediatrics, Marien-Hospital Wesel, Wesel, Germany.
Eur J Nutr. 2020 Dec;59(8):3415-3424. doi: 10.1007/s00394-020-02176-6. Epub 2020 Feb 27.
While observational studies revealed inverse associations between serum vitamin D levels [25(OH)D] and depression, randomized controlled trials (RCT) in children and adolescents are lacking. This RCT examined the effect of an untreated vitamin D deficiency compared to an immediate vitamin D supplementation on depression scores in children and adolescents during standard day and in-patient psychiatric treatment.
Patients with vitamin D deficiency [25(OH)D ≤ 30 nmol/l] and at least mild depression [Beck Depression Inventory II (BDI-II) > 13] (n = 113) were 1:1 randomized into verum (VG; 2640 IU vitamin D/d) or placebo group (PG) in a double-blind manner. During the intervention period of 28 days, both groups additionally received treatment as usual. BDI-II scores were assessed as primary outcome, DISYPS-II (Diagnostic System for Mental Disorders in Childhood and Adolescence, Self- and Parent Rating) and serum total 25(OH)D were secondary outcomes.
At admission, 49.3% of the screened patients (n = 280) had vitamin D deficiency. Although the intervention led to a higher increase of 25(OH)D levels in the VG than in the PG (treatment difference: + 14 ng/ml; 95% CI 4.86-23.77; p = 0.003), the change in BDI-II scores did not differ (+ 1.3; 95% CI - 2.22 to 4.81; p = 0.466). In contrast, DISYPS parental ratings revealed pronounced improvements of depressive symptoms in the VG (- 0.68; 95% CI - 1.23 to - 0.13; p = 0.016).
Whereas this study failed to show a vitamin D supplementation effect on self-rated depression in adolescent in- or daycare patients, parents reported less depressive symptoms in VG at the end of our study. Future trials should consider clinician-rated depressive symptoms as primary outcome.
"German Clinical Trials Register" ( https://www.drks.de ), registration number: DRKS00009758.
虽然观察性研究显示血清维生素 D 水平[25(OH)D]与抑郁呈负相关，但儿童和青少年的随机对照试验（RCT）却缺乏。本 RCT 研究了未经治疗的维生素 D 缺乏症与立即补充维生素 D 对接受标准日间和住院精神病治疗的儿童和青少年的抑郁评分的影响。
将维生素 D 缺乏症[25(OH)D≤30 nmol/l]且至少有轻度抑郁[贝克抑郁量表第二版（BDI-II）>13]的患者（n=113）按 1:1 比例随机分为真（VG；2640 IU 维生素 D/d）或安慰剂组（PG），进行双盲治疗。在 28 天的干预期间，两组均额外接受常规治疗。BDI-II 评分作为主要结局，DISYPS-II（儿童和青少年精神障碍诊断系统，自我和家长评定）和血清总 25(OH)D 为次要结局。
在入院时，49.3%的筛选患者（n=280）患有维生素 D 缺乏症。尽管干预措施使 VG 的 25(OH)D 水平升高幅度明显高于 PG（治疗差异：+14ng/ml；95%CI 4.86-23.77；p=0.003），但 BDI-II 评分的变化无差异（+1.3；95%CI -2.22 至 4.81；p=0.466）。相比之下，DISYPS 家长评定显示 VG 组的抑郁症状明显改善（-0.68；95%CI -1.23 至 -0.13；p=0.016）。
本研究未能显示青少年日间或住院患者补充维生素 D 对自我报告的抑郁有影响，但在研究结束时，父母报告 VG 组的抑郁症状较少。未来的试验应将临床医生评定的抑郁症状作为主要结局。
“德国临床试验注册”（https://www.drks.de），注册号：DRKS00009758。
