Department of Psychiatry, Residence of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
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The Role of Vitamin C in the Treatment of Depression
Reza Bidaki; MD 1, 2, Mahsa Mahdavi Firoozabadi; MD 3, Mahsa Motamed; MD *4,
Sina Taherzadeh Borujeni; MD 5 & Azadeh Nadjarzadeh; PhD 6,7
1 Research Center of Addiction and Behavioral Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; 2 Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; 3 Research center of Addiction and Behavioral Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; 4 Department of Psychiatry, Residence of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran; 5 Department of Psychiatry, Psychiatrist, Tehran University of Medical Sciences, Tehran, Iran; 6 Nutrition and Food Security Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; 7 Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
ARTICLE INFO |
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LETTER to EDITOR |
*Corresponding author
Motamed.mhs@gmail.com
Department of Psychiatry, Residence of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran.
Postal code: 13337159140
Tel: +98-02155419151-5 |
Article history:
Received: 12 Jul 2021
Revised: 1 Dec 2021
Accepted: 1 Dec 2021
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Dear editor
Some studies have suggested that vitamin C deficiency may play a role in the etiology of depression although the efficient dose and time of prescription is not clear now. Also, it is not known which antidepressant drugs could be more efficient in augmentation with vitamins. Nowadays, due to the importance and more prevalence of psychiatric disorders, dietary supplements which would augment the effects of drugs have been taken into consideration. Moreover, dose titration of anti-depressant drugs is a lifelong challenge due to unwanted side effects.
Long time ago, it was introduced a disease called Scurvy, which is caused by vitamin C deficiency in malnourished individuals. It has
some presentations like melancholia, cognitive impairment, and organic problems. Vitamin C is an antioxidant soluble vitamin that has an important effect on regulation, modulating, synthesis
and releasing of neurotransmitters and myelin formation. It is also a cofactor for dopamine beta hydroxylase in converting dopamine to noradrenaline. Vitamin C also has a role in regulating glutaminergic and dopaminergic system. It takes part in releasing catecholamines and acetylcholine from synaptic vesicles in synaptic cleft. One of the key features of this antioxidant is to prevent excessive secretion of glutamate, which could have a toxic effect.
The direct or indirect effects of vitamin C on mood disorders or other emotional dysregulation and disturbance are not known. Moreover, it is not known whether or not it has psychiatric unfavorable drug interactions and if its effects depend on gender or age of the patients. In a study about vitamin C and depression, there was no significant effect of vitamin C on depression symptoms in menopause women who took this vitamin as an adjuvant with antidepressant drugs (Jokar and Farahi, 2014). In other study, it has been demonstrated that having kiwi fruit twice a day improves symptoms in patients with depression. It is important to regularly use these types of fruits every day to decline risk of depression (Carr et al., 2013). Plasma vitamin C concentration was inversely correlated with total mood impairment, anger, and confusion in young male students with depression and high vitamin C condition declined depression score (Pullar et al., 2018). Amr et al. demonstrated a positive effect of the vitamin in a combination therapy with fluoxetine on depressive symptoms (Amr et al., 2013). On the other hand, in another study, adding vitamin C to citalopram was not effective on depression and suicide (Sahraian et al., 2015). It seems that different questionnaires and other characteristics such as age, gender, smoking, socioeconomic status, sample size, time of follow up, severity of depression or existence of other medical illnesses, such as gastrointestinal disorders may have a role in discrepancies of results. It has been recommended in a systematic review to measure serum level of vitamin C in resistant psychiatric patients. It seems that this vitamin has significant roles in some brain areas such as cortex, hippocampus and amygdala and it has important effects on mood, cognition, and memory (Plevin and Galletly, 2020).
Vitamin C deficiency associated with low degree of mentality. Attentional focus and work drive will be increased with vitamin C augmentation. Sustained attention and concentration as cognitive tasks will be better, too. Of course it may not be significant relationship between serum concentration of vitamin c and self-regulation and depression (Sim et al., 2022).
There is a challenging issue that whether or not vitamin C could play a role as an antidepressant drug and elevate mood in normal population; and which antidepressant drug has a better effect in combination with vitamin C. Finally, how long and how much of this antioxidant must be used to have its useful outcomes, and whether using supplement instead of natural sources such as fruits and vegetables could take part in changing mood or not. Based on multiple studies, established effects of vitamin C in treating depression have been explained. Prescribing supplement as an adjuvant to antidepressant drug may have potential effects instead of using natural resources. Due to recent pandemic and current advice of using vitamin C, and also its low possibility of toxicity, this vitamin has been a good choice in combination with antidepressant drugs. Today's current socioeconomic status issues have caused an increase in psychiatric problems such as anxiety and depression.
According to potential positive effects of vitamin C in treatment of depression and its low cost and rates of side effects, it could be prescribed as tablets, capsules, effervescent tablets or powders to treat patients. It would be also an alternative choice to use natural resources of the vitamin C like fruits (orange, pineapple, and mango) or vegetables (cabbage, turnip, scallion, parsley, basil, coriander and spinach). There might be a need to have a guideline for prescribing this antioxidant and the best way to follow up the patients.
References
Amr M, El-Mogy A, Shams T, Vieira K & Lakhan SE 2013. Efficacy of vitamin C as an adjunct to fluoxetine therapy in pediatric major depressive disorder: a randomized, double-blind, placebo-controlled pilot study. Nutrition journal. 12 (1): 1-8.
Carr AC, Bozonet SM, Pullar JM & Vissers MC 2013. Mood improvement in young adult males following supplementation with gold kiwifruit, a high-vitamin C food. Journal of nutritional science. 2: e24.
Jokar A & Farahi F 2014. Effect of vitamin C on depression in menopausal women with balanced diet: a randomized clinical trial. Iranian journal of obstetrics, gynecology and infertility. 17 (121): 18-23.
Plevin D & Galletly C 2020. The neuropsychiatric effects of vitamin C deficiency: a systematic review. BMC psychiatry. 20 (1): 315.
Pullar JM, Carr AC, Bozonet SM & Vissers MCM 2018. High Vitamin C Status Is Associated with Elevated Mood in Male Tertiary Students. Antioxidants. 7 (7): 91.
Sahraian A, Ghanizadeh A & Kazemeini F 2015. Vitamin C as an adjuvant for treating major depressive disorder and suicidal behavior, a randomized placebo-controlled clinical trial. Trials. 16: 94.
Sim M, et al. 2022. Vitamin C supplementation promotes mental vitality in healthy young adults: results from a cross-sectional analysis and a randomized, double-blind, placebo-controlled trial. European journal of nutrition. 61 (1): 447-459.
Type of article:
editorial article |
Subject:
public specific Received: 2021/07/12 | Published: 2023/05/20 | ePublished: 2023/05/20