Srifuengfung Maytinee, Srifuengfung Somporn, Pummangura Chalermsri, Pattanaseri Keerati, Oon-Arom Awirut, Srisurapanont Manit
Department of Psychiatry, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Faculty of Pharmacy, Siam University, Bangkok, Thailand.
Nutrition. 2023 Apr;108:111968. doi: 10.1016/j.nut.2022.111968. Epub 2023 Jan 7.
This systematic review and meta-analysis synthesized the evidence from randomized controlled trials comparing vitamin D and placebo in reducing depressive symptoms and contributing to all-cause dropout rates.
Inclusion criteria were randomized controlled trials comparing reduced depression between depressed patients receiving vitamin D and those receiving placebo. We searched PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials through January 2022.
Eighteen trials (1980 participants, median age 39 y) were included in the meta-analysis. Vitamin D supplements were significantly superior to placebo in reducing depression (standardized mean difference = -0.49; 95% confidence interval [CI], -0.75 to -0.23; I = 81%). Depressed adults (standardized mean difference = -0.70; 95% CI, -1.09 to -0.31) responded to vitamin D significantly better than children and adolescents (standardized mean difference = 0.10; 95% CI -0.27 to 0.47). Vitamin D administered as bolus doses (oral intermittent high doses or intramuscular single high dose) appeared to be more effective than that taken daily by the oral route (P < 0.01). Patients with more severe depression tended to respond better than those with less severity (P = 0.053). We found no moderating effect of concurrent antidepressant use, presence of major depressive disorder diagnosis, physical comorbidity, sex, duration and doses of vitamin D supplement, serum 25-hydroxyvitamin D levels at baseline, and changes in serum 25-hydroxyvitamin D levels in the vitamin D group. Dropout rates were indifferent between the groups (17 trials; risk ratio = 0.84; 95% CI, 0.6-1.16; I = 0).
Heterogeneous data suggested that vitamin D supplements are effective and safe for depressed patients.
本系统评价和荟萃分析综合了来自随机对照试验的证据，比较维生素D和安慰剂在减轻抑郁症状及导致全因失访率方面的效果。
纳入标准为比较接受维生素D的抑郁症患者与接受安慰剂的患者抑郁症状减轻情况的随机对照试验。我们检索了截至2022年1月的PubMed、Embase、Web of Science和Cochrane对照试验中央注册库。
18项试验（1980名参与者，中位年龄39岁）纳入荟萃分析。维生素D补充剂在减轻抑郁方面显著优于安慰剂（标准化均数差=-0.49；95%置信区间[CI]，-0.75至-0.23；I²=81%）。抑郁的成年人（标准化均数差=-0.70；95%CI，-1.09至-0.31）对维生素D的反应明显优于儿童和青少年（标准化均数差=0.10；95%CI -0.27至0.47）。大剂量给药（口服间歇高剂量或肌肉注射单次高剂量）的维生素D似乎比每日口服给药更有效（P<0.01）。抑郁程度较重的患者往往比程度较轻的患者反应更好（P=0.053）。我们发现同时使用抗抑郁药、存在重度抑郁症诊断、身体合并症、性别、维生素D补充剂的持续时间和剂量、基线时血清25-羟维生素D水平以及维生素D组血清25-羟维生素D水平的变化均无调节作用。两组的失访率无差异（17项试验；风险比=0.84；95%CI，0.6-1.16；I²=0）。
异质性数据表明，维生素D补充剂对抑郁症患者有效且安全。
