Vitamin Deficiencies and Mental Health: Depression

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Feelings of sadness, changes in appetite, changes in sleep patterns, low energy, fatigue, general feelings of malaise and lack of motivation – many of these symptoms can be traced to biological components. When symptoms become prolonged – it can become extremely challenging to find relief.

Even without meeting criteria for an official diagnosis, depression symptoms can quickly impact daily functioning and overall well-being. Depression, like anxiety, is very common throughout the world and there remains a need for effective and efficient treatments. While science has made leaps and bounds in recent years on identifying biological components to depression, helping to reduce the stigma surrounding it in many ways, there remains a lot to learn. While antidepressants and psychotherapy benefit many, there remains a large sect of people who continue to suffer.

Appetite changes that frequently occur with depression may play a role in the nutritional aspect related to the following research. Again, and this cannot be stressed enough, correlation does not equal causation. Relationships between vitamin deficiencies and depression symptoms have been found but this does not mean that one causes the other; there may be an alternative explanation that has not been identified.

That said, the appetite changes that frequently occur with depression can include overeating or undereating. Some will find themselves snacking all day or binge eating, commonly referred to as “emotional eating”, typically sweet or salty foods (which boost dopamine resulting in small bursts of feeling relief). Others may find it overwhelming to even consider eating, let alone think about cooking an actual meal. In either case, nutritional recommendations are frequently disobeyed.

The lack of consistent research into using supplements during treatment is lacking. There seems to be little attention paid to how treating vitamin deficiencies may improve mood symptoms. More experimental research is definitely warranted.

For the purpose of this post, meta-analysis and literature review articles were focused on. Meta-analysis involves looking at research that is currently available and conducting statistical analysis of the results. Literature reviews peruse available information and present findings, typically to call for additional research and identify gaps or similar findings.

So, without further ado:

Vitamin D

There is a lot of anecdotal evidence about treating Seasonal Affective Disorder (SAD) with Vitamin D supplements – the following studies did not particularly look at mood changes related to seasonal changes and this will be delved into further on another post. SAD is theorized to be caused from changes in light patterns due to changing seasons, with depression symptoms occurring because of not enough sunlight being available. Vitamin D is absorbed through our skin via sun exposure and SAD tends to occur more frequently in areas with harsh winters.

The research evidence on Vitamin D and depression symptoms tends to be conflicting, including whether there is even a relationship between Vitamin D and depression.

For example, while Bicikova and colleagues (2015) found lower levels of the Vitamin D precursor, called calcidiol, Karanova and his colleagues (2015) found no similar correlation between Vitamin D deficiency and depression symptoms; however, they did find a correlation between depression and age.

Black and colleagues (2013) found a correlation between depression and Vitamin D levels in a sample of males; however, Alatram (2015) found no similar correlation in his sample of 43 males.

Studies concerning the use of Vitamin D supplements for the treatment of depression do not appear to be as promising as one may think. One study found that Vitamin D supplements produced only a moderate effect for those with significant depressive symptoms and minor effect for those with less severe symptoms (Shaffer et al 2015). A meta-analysis found no reduction in depression symptoms after Vitamin D supplementation (Gowda et al 2015).

Again, none of these studies discussed SAD specifically.

Vitamin B

B vitamins are another supplement for which anecdotal evidence is common, and two studies showed some benefit to their use.

A study on “Max Stress B”, a Vitamin B supplement, showed significant improvements in depression symptoms when compared to a placebo (Lewis et al 2013).

Stough and colleagues (2011) were interested in reducing workplace stress and improving mood ratings of employees. They found that after taking a B supplement for 3 months, participants reported less workplace stress and strain when compared to those assigned to the placebo group.

Folate

The most research found pertained to the use of Folate as a supplemental treatment to augment antidepressant medications. Adding folate to a traditional depression treatment was found to reduce Hamilton Depression Rating Scale (HDRS) scores in a review of three randomized trials (247 total participants). The review also found reduction in HDRS scores with folate use alone, and no significant difference between using folate or trazodone; however, the research is unclear whether participants were folate deficient or not and the number of participants for each study is fairly small (Taylor et al 2004).

Coppen and Bolander-Gouaille (2005) found through a literature review of current research a correlation between low folate and recurrent mood disorders, as well as a link between poor antidepressant treatment outcomes and low folate levels. They suggest, based on their review, that oral supplements of folic acid and vitamin B12 be used in addition to antidepressants for those who continue to experience depression symptoms.

In another literature review, short term use of folate and Vitamin B12 symptoms did not improve depression symptoms in adults with major depression who were already being treated with an antidepressant medication. However, prolonged consumption of the supplements may decrease relapse of symptoms for people at risk of recurrence (Almeida et al 2015). This may further support the use of these supplements as an addition to medication treatment, rather than a replacement.

Omega 3 Fatty Acids

Bloch and Hannestad (2012) conducted a meta-analysis of 13 randomized trials (731 participants total) and found there to be no significant benefit of Omega-3 fatty acid treatment compared to a placebo. They further suggested that studies demonstrating any benefits were biased, poorly designed experiments or comprised of participants with greater baseline symptoms.

In critique of this meta-analysis, Martins and colleagues (2012) conducted their own meta-analysis and suggested that EPA (eicosapentaenoic acid), a component of omega-3 fatty acid supplements, is really the key to treatment. They found that regimes with lower than 60% EPA content had no effect; however, supplements with 60% or greater content did demonstrate improvements with depression symptoms. They criticized Bloch and Hannestad for suggesting that all Omega-3 treatments are the same and called for further research to focus on dosages of supplements.

Another meta-analysis of 13 studies found that omega-3 may be a potential depression treatment but not for mania (Kraguljac et al 2009).

Zinc

Swardfager et al (2013) found in a meta-analysis of 17 studies that depression is associated with lower levels of zinc. However, this analysis did not include using zinc as a potential treatment protocol.


Further research, particularly strong experimental designs with large sample sizes, are needed to help identify the link and role of vitamin deficiencies and depression symptoms. The more biological components to mental health symptoms are studied, the more understanding is gained and the more effective treatment can be.

  • I am not a medical doctor or a nutritionist. This information is only being presented as a broad overview based off of previous academic studies. I encourage you to read the studies for yourself and discuss with your physician before taking ANY supplements. Many supplements can be toxic at the wrong dose or potentially worsen symptoms

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Works Cited:

  1. Alatram, A. (2015). The Relationship Between Vitamin D Deficiency, Anxiety, and Depression. The FASEB Journal, 29(1 Supplement), LB310.
  1. Akbaraly, T., Brunner, E., Ferrie, J., Marmot, M., Kivimaki, M., &  Singh-Manoux, A. 2009. Dietary Pattern and Depressive Symptoms in Middle Age. The British Journal of Psychiatry, 195 (5) 408-413; DOI: 10.1192/bjp.bp.108.058925
  1. Almeida, O. P., Ford, A. H., & Flicker, L. (2015). Systematic review and meta-analysis of randomized placebo-controlled trials of folate and vitamin B12 for depression. International psychogeriatrics27(5), 727-737.
  2. Bicíková, M., Dusková, M., Vítku, J., Kalvachová, B., Rípová, D., Mohr, P., & Stárka, L. (2015). Vitamin D in anxiety and affective disorders. Physiological Research, 64, S101-S103.
  3. Black, L. J., Jacoby, P., Allen, K. L., Mori, T. A., Beilin, L. J., Adams, L. A., & Oddy, W. H. (2013). Low vitamin D levels are associated with symptoms of depression, anxiety and stress in young adult males. The FASEB Journal, 27(1 Supplement), lb264-lb264.
  1. Bloch, M. H., & Hannestad, J. (2012). Omega-3 fatty acids for the treatment of depression: systematic review and meta-analysis. Molecular psychiatry17(12), 1272.
  1. Coppen, A., & Bolander-Gouaille, C. (2005). Treatment of depression: time to consider folic acid and vitamin B12. Journal of Psychopharmacology19(1), 59-65.
  2. Gowda, U., Mutowo, M. P., Smith, B. J., Wluka, A. E., & Renzaho, A. M. (2015). Vitamin D supplementation to reduce depression in adults: meta-analysis of randomized controlled trials. Nutrition31(3), 421-429.
  3. Karonova, T. L., Andreeva, A. T., Belyaeva, O. D., Bazhenova, E. A., Globa, P. Y., Vasil’eva, E. Y., & Grineva, E. N. (2015). Anxiety/depressive disorders and vitamin D status. Zhurnal nevrologii i psikhiatrii imeni SS Korsakova, 115(10 Pt 2), 55-58.
  1. Kraguljac, N. V., Montori, V. M., Pavuluri, M., Chai, H. S., Wilson, B. S., & Unal, S. S. (2009). Efficacy of omega-3 fatty acids in mood disorders-a systematic review and metaanalysis. Psychopharmacology bulletin42(3), 39-54.
  2. Lewis, J. E., Tiozzo, E., Melillo, A. B., Leonard, S., Chen, L., Mendez, A., … & Konefal, J. (2013). The effect of methylated vitamin B complex on depressive and anxiety symptoms and quality of life in adults with depression. ISRN psychiatry2013.
  3. Martins, J. G., Bentsen, H., & Puri, B. K. (2012). Eicosapentaenoic acid appears to be the key omega-3 fatty acid component associated with efficacy in major depressive disorder: a critique of Bloch and Hannestad and updated meta-analysis. Molecular psychiatry17(12), 1144.
  4. Melanson, K. J. (2007). Nutrition review: relationships of nutrition with depression and anxiety. American Journal of Lifestyle Medicine1(3), 171-174.
  5. Shaffer, J. A., Edmondson, D., Wasson, L. T., Falzon, L., Homma, K., Ezeokoli, N., … & Davidson, K. W. (2014). Vitamin D supplementation for depressive symptoms: a systematic review and meta-analysis of randomized controlled trials. Psychosomatic medicine76(3), 190.
  6. Stough, C., Scholey, A., Lloyd, J., Spong, J., Myers, S., & Downey, L. A. (2011). The effect of 90 day administration of a high dose vitamin Bcomplex on work stress. Human Psychopharmacology: Clinical and Experimental26(7), 470-476.
  7. Swardfager, W., Herrmann, N., Mazereeuw, G., Goldberger, K., Harimoto, T., & Lanctôt, K. L. (2013). Zinc in depression: a meta-analysis. Biological psychiatry74(12), 872-878.
  8. Taylor, M. J., Carney, S. M., Goodwin, G. M., & Geddes, J. R. (2004). Folate for depressive disorders: systematic review and meta-analysis of randomized controlled trials. Journal of Psychopharmacology18(2), 251-256.

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Vitamin Deficiencies and Mental Health: Anxiety

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In small doses, anxiety is beneficial. Optimal anxiety levels help us focus on important tasks, get things done and motivate us to solve problems; anxiety also serves to protect us in times of danger. But for many, anxiety can quickly become problematic. Especially in today’s fast-paced and demanding world.

If you’ve ever experienced a panic attack, you’re well aware of how scary they can be. Worry thoughts can interrupt sleep, and loss of sleep impacts daily functioning on many levels. Worry thoughts and muscle tension can lead to avoidance patterns. The biological reactions to anxiety (such as increased cortisol levels) can lead to very serious medical conditions; the body is not designed to be in a perpetual state of fear.

Multiple DSM V disorders are characterized by anxiety; but most of us will experience feelings of high anxiety at some point in our lives.

Anxiety is a very broad term used to describe excessive fear. During times of high anxiety, the fight-or-flight response kicks in leading to muscle tension, feeling keyed up, increased heart rate and rapid breathing. Frequent worrying, preparing for worst-case scenarios, escape behaviors and muscle tension are prominent symptoms.

The more that anxiety triggers are avoided, the worse anxiety becomes. While helpful in the short-term, avoidance strategies promote the core belief that one cannot handle the anxiety and must therefore avoid it at all costs. For some people, anxiety may not appear to have a trigger at all.

Because of the tremendous negative impact anxiety can have, it’s important to find ways to effectively manage and overcome it. Considering its high prevalence in modern day society, there is surprisingly little research available on nutrition’s role in anxiety symptoms.

The majority of information that is available includes both anxiety and depression symptoms, presumably because these two conditions are so frequently co-occurring. While there have been some studies that looked at vitamin deficiencies and anxiety disorders, there appears to be very little research done on how taking a supplement could potentially reduce symptoms.

It’s also important to remember that correlation does not indicate causation – meaning, just because a relationship is found does not mean that vitamin deficiency necessarily causes symptoms; it could potentially be the other way around (i.e. anxiety could cause biological changes in the body resulting in vitamin deficiencies) or another cause altogether.


Vitamin D

The majority of studies have pertained to Vitamin D deficiency and anxiety.

Vitamin D is found in many foods, including salmon, sock-eye tuna and egg yolks. We also absorb vitamin D through our skin when exposed to the sun.

Some studies have found lower levels of Vitamin D in people diagnosed with an anxiety disorder, self-reporting anxiety symptoms, or reporting high levels of stress (Bicikova et al 2015; Hashemi et al 2016; Black et al 2013; Karanova et al 2015).

Aydin and colleagues (2015) were unable to identify a link between Vitamin D and depression or anxiety symptoms; however, the study’s population comprised mainly of people who were found to have a Vitamin D deficiency.

One study, geared towards finding treatments for Chronic Fatigue Syndrome, included mental health symptoms as well. They found that Vitamin D treatments appeared to improve overall psychological functioning in periomenopausal women (or women who are entering the beginning stages of menopause) whether they had chronic fatigue syndrome or not (Plescheva et al 2013). Menopause is typically marked by feelings of high anxiety for women so this study may indicate a potential link.

Vitamin D is one of those vitamins that can potentially be toxic. Before taking a vitamin D supplement, blood tests should be performed to determine your current levels and supplements should be discussed with a physician. Vitamin D supplements are generally prescribed by medical providers, although some can be bought over-the-counter as well. But again, it’s recommended to discuss this with a physician prior to starting a Vitamin D regime.

Vitamin B complex

B vitamins have been linked to depression symptoms, which will be discussed further in another post. But one study did evaluate the effectiveness of taking a Vitamin B complex supplement (in this study, it was Max Stress B) for anxiety symptoms. They found significant improvement reported in anxiety and depression symptoms for those taking the supplement when compared to a placebo (Lewis et al 2013).

Iron Deficiency

Iron anemia is linked to many different medical and psychological conditions. Iron levels are often checked during general wellbeing appointments because iron deficiency is fairly common. Iron is also toxic if levels are too high. Again, a physician will easily be able to check iron levels through a simple blood test.

Children and adolescents who had been diagnosed with iron deficiency anemia were found to be more at risk for psychiatric disorders including mood disorders (such as anxiety), autism spectrum disorder, ADHD and developmental disorders. Researchers determined this after reviewing medical records from a period of 10 years (1996-2008) (Chen et al 2013).


The lack of research available indicates a need for further studies to be conducted, particularly on the potential benefits of taking supplements or increasing nutritional intake of Vitamin D, B vitamins and/or iron in order to elevate our understanding of the treatment of anxiety. There is a lot of research out there on other holistic treatments for anxiety such as mindfulness exercises, yoga, meditation and exercise so stay tuned for alternative ways of managing anxiety symptoms.

  • Please note, I am not a medical doctor and will only be posting about information I learn. Before starting any new vitamin regime, be sure to discuss it with your physician as some vitamins can be fatal if overdose occurs and affect medications you may be on.

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Please take a moment to leave your thoughts or give this post a like. Don’t forget to subscribe to receive notification of new posts as I continue the Vitamin Deficiency and Mental Health posting series!


Works Cited:

Aydin, E. P., Varkal, M. D., Toker, O. G., Ozer, O. A., & Karamustafalioglu, O. K. (2015). Vitamin D deficiency in depressive, anxiety and adjustment disorder. Klinik Psikofarmakoloji Bulteni25.

Bicíková, M., Dusková, M., Vítku, J., Kalvachová, B., Rípová, D., Mohr, P., & Stárka, L. (2015). Vitamin D in anxiety and affective disorders. Physiological Research, 64, S101-S103.

Black, L. J., Jacoby, P., Allen, K. L., Mori, T. A., Beilin, L. J., Adams, L. A., & Oddy, W. H. (2013). Low vitamin D levels are associated with symptoms of depression, anxiety and stress in young adult males. The FASEB Journal, 27(1 Supplement), lb264-lb264.

Chen, M.-H., Su, T.-P., Chen, Y.-S., Hsu, J.-W., Huang, K.-L., Chang, W.-H., … Bai, Y.-M. (2013). Association between psychiatric disorders and iron deficiency anemia among children and adolescents: a nationwide population-based study. BMC Psychiatry13, 161. http://doi.org/10.1186/1471-244X-13-161

Hashemi, S., Amani, R., Cheraghian, B., Neamatpour, S., & Afsharmanesh, M. (2016). Association of Serum Vitamin D and Total Antioxidant Capacity Levels With Stress and Anxiety in Young Female Students. Iranian Journal of Psychiatry and Behavioral Sciences, (In Press).

Karonova, T. L., Andreeva, A. T., Belyaeva, O. D., Bazhenova, E. A., Globa, P. Y., Vasil’eva, E. Y., & Grineva, E. N. (2015). Anxiety/depressive disorders and vitamin D status. Zhurnal nevrologii i psikhiatrii imeni SS Korsakova, 115(10 Pt 2), 55-58.

Lewis, J. E., Tiozzo, E., Melillo, A. B., Leonard, S., Chen, L., Mendez, A., … & Konefal, J. (2013). The effect of methylated vitamin B complex on depressive and anxiety symptoms and quality of life in adults with depression. ISRN psychiatry2013.

 

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Vitamins and Mental Health: New Series!

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I’m really excited about starting this posting series; I think that there is going to be a lot to learn and share with you guys about  the relationship between nutrition and mental health.

 

This past year, I went through a period of very high anxiety and fatigue to an extreme that I had never experienced before. I couldn’t make it through a whole day without a nap. Doctors told me it could be hormonal (which, my hormones probably were all out of whack), thyroid, diabetes, or stress. My stress level was lower than ever, so I knew it wasn’t stress-related but there was no denying I didn’t feel like myself. They ran more bloodwork than I care to remember and kept telling me the results were normal.

 

For the umpteenth time in my adult life, I decided to start taking a multivitamin.

 

I have been consistently taking them for 2 months now and I must say, I feel absolutely freaking fabulous. I’m sleeping normal again, energized during the day and gave up my midmorning naps. I also haven’t had a panic attack in over a month and I was getting them almost daily along with vertigo.

 

Obviously, despite all of the bloodwork done I was missing something important. But it took me feeling sick and fearful in order to actually change my habits so that I would remember the damn vitamin.

 

So why wasn’t I taking vitamins?

 

This hasn’t been an easy feat for me – like I said, I had made the decision numerous times to take a daily multivitamin and failed to remain consistent. Please don’t be too critical of me, but it is hard to incorporate a new habit into my daily routine. I tend to go on autopilot.

 

For the past two years, I have really been trying to improve my overall nutrition and eating habits; I’ve made a lot of progress. I gave up boxed food and precooked meals pretty easily and quickly; I eat more vegetables and fruits (almost daily at this point, hooray!) and have been successful at giving up fast foods.

 

Even so, on my best nutritional day I know that I am not getting the recommended fruits/vegetables. I also know that my meats aren’t straight up animal anymore either – and has anyone else noticed that the fish seem to be getting bigger and bigger?! Something tells me that this isn’t mother nature’s doing.

 

Giving up things in my diet hasn’t been a problem for me – aside from coffee. That one is so much harder than I thought it would be despite all the positive things I hear from others about cutting back on caffeine. I don’t really want to give it up. That’s truth.

 

But adding things, like the vitamin, is harder for me to stick with. As soon as one day is missed; it’s a domino effect. Because I struggled so much with remembering to take them daily, I bought a ginormous bottle; enough for at least 4 months and stuck it right next to my coffee pot (because, like I said, I will never forget coffee). This is the longest I have ever taken them consistently and I’m satisfied with the changes I feel. I also made sure that everyone knew not to move my bottle of vitamins.

 

(Side note: I actually have fingernails for the first time ever now! A nice little side effect to the vitamins.)

 

So throughout this series, I will be posting research and studies that I find linking vitamins to mental health symptoms. I really would love for some ideas on topics from readers, so feel free to post ideas here.

  • Please note, I am not a medical doctor and will only be posting about information I learn. Before starting any new vitamin regime, be sure to discuss it with your physician as some vitamins can be fatal if overdose occurs and affect medications you may be on.

So welcome to the Vitamins and Mental Health Series! I hope you enjoy and stay tuned!

So far we have:

Attention-Deficit Hyperactivity Disorder and Vitamin Deficiencies

Vitamin Deficiencies and Mental Health: Anxiety

Vitamin Deficiencies and Mental Health: Depression

Make sure you follow my blog to continue the journey on how our behaviors impact our well-being.

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