Efficacy of adding nutritional supplements in unipolar depression: A systematic review and meta-analysis

Schefft, Cora; Kilarski, Laura L.; Bschor, Tom; Köhler, Stephan

doi:10.1016/j.euroneuro.2017.07.004

Cited by 102 publications

(71 citation statements)

References 81 publications

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“…No meta‐analyses directly compared nutrient supplementation to psychotropic medications. All studies were placebo‐controlled.…”

Section: Resultsmentioning

confidence: 99%

“…Specific psychiatric conditions (and reported outcomes) considered in this meta‐review included: schizophrenia (examining total symptoms along with positive, negative, general and depressive symptoms, and tardive dyskinesia); states at risk for psychosis (examining attenuated psychosis symptoms, negative symptoms, transition to psychosis, and functioning); depressive disorders (including any clinical depression, diagnosed major depressive disorder (MDD), depression in pregnancy, in old age, or as a comorbidity to chronic health conditions); anxiety and stress‐related conditions (including generalized anxiety disorder, obsessive‐compulsive disorder (OCD) and trichotillomania); bipolar disorder type I and II (examining overall symptoms, bipolar mania, bipolar depression, functional impairments, and quality of life); and ADHD (including composite symptoms, hyperactivity‐impulsivity, inattention, behavioural comorbidities such as aggression, and cognitive functioning).…”

Section: Resultsmentioning

confidence: 99%

“…Eleven RCTs examined the efficacy of mineral supplementation for depression, using either zinc or magnesium. Zinc was administered at 25 mg/day (elemental) as an adjunctive treatment for MDD, and had moderate significant effects on depressive symptoms (N=104, n=4, SMD=0.66, 95% CI: 0.26‐1.06, p=<0.01). Although there was no evidence of heterogeneity (I 2 =0%), all included RCTs were identified as having high risk of attrition bias, due to lack of intent‐to‐treat analyses.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta‐review of meta‐analyses of randomized controlled trials

et al. 2019

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The role of nutrition in mental health is becoming increasingly acknowledged. Along with dietary intake, nutrition can also be obtained from “nutrient supplements”, such as polyunsaturated fatty acids (PUFAs), vitamins, minerals, antioxidants, amino acids and pre/probiotic supplements. Recently, a large number of meta‐analyses have emerged examining nutrient supplements in the treatment of mental disorders. To produce a meta‐review of this top‐tier evidence, we identified, synthesized and appraised all meta‐analyses of randomized controlled trials (RCTs) reporting on the efficacy and safety of nutrient supplements in common and severe mental disorders. Our systematic search identified 33 meta‐analyses of placebo‐controlled RCTs, with primary analyses including outcome data from 10,951 individuals. The strongest evidence was found for PUFAs (particularly as eicosapentaenoic acid) as an adjunctive treatment for depression. More nascent evidence suggested that PUFAs may also be beneficial for attention‐deficit/hyperactivity disorder, whereas there was no evidence for schizophrenia. Folate‐based supplements were widely researched as adjunctive treatments for depression and schizophrenia, with positive effects from RCTs of high‐dose methylfolate in major depressive disorder. There was emergent evidence for N‐acetylcysteine as a useful adjunctive treatment in mood disorders and schizophrenia. All nutrient supplements had good safety profiles, with no evidence of serious adverse effects or contraindications with psychiatric medications. In conclusion, clinicians should be informed of the nutrient supplements with established efficacy for certain conditions (such as eicosapentaenoic acid in depression), but also made aware of those currently lacking evidentiary support. Future research should aim to determine which individuals may benefit most from evidence‐based supplements, to further elucidate the underlying mechanisms.

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“…No meta‐analyses directly compared nutrient supplementation to psychotropic medications. All studies were placebo‐controlled.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta‐review of meta‐analyses of randomized controlled trials

et al. 2019

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“…Similarly, folic acid supplementation has been studied in multiple trials of adult depression with meta-analyses suggesting minimal-to-no benefit compared with placebo (Almeida, Ford, & Flicker, 2015;Roberts, Carter, & Young, 2018;Sarris et al, 2016;Schefft, Kilarski, Bschor, & Kohler, 2017). However, initial case report-level data in adolescents with treatment-refractory depression suggest that folate deficiency may play a role in refractory symptoms, with improvement by folate supplementation (Dartois, Stutzman, & Morrow, 2019).…”

Section: Pharmacologic Augmentation Strategiesmentioning

confidence: 99%

Annual Research Review: Defining and treating pediatric treatment‐resistant depression

Dwyer

Stringaris

Brent

et al. 2020

Child Psychology Psychiatry

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Background Adolescent major depressive disorder (MDD) is a significant health problem, associated with substantial morbidity, cost, and mortality. Depression is a significant risk factor for suicide, which is now the second leading cause of death in young people. Up to twenty per cent of adolescents will experience MDD before adulthood, and while a substantial proportion will improve with standard‐of‐care treatments (psychotherapy and medication), roughly one third will not. Methods Here, we have reviewed the literature in order to discuss the concept of treatment‐resistant depression (TRD) in adolescence, examine risk factors, diagnostic difficulties, and challenges in evaluating symptom improvement, and providing guidance on how to define adequate medication and psychotherapy treatment trials. Results We propose a staging model for adolescent TRD and review the treatment literature. The evidence base for first‐ and second‐line treatments primarily derives from four large pediatric clinical trials (TADS, TORDIA, ADAPT, and IMPACT). After two medications and a trial of evidence‐based psychotherapy have failed to alleviate depressive symptoms, the evidence becomes quite thin for subsequent treatments. Here, we review the evidence for the effectiveness of medication switches, medication augmentation, psychotherapy augmentation, and interventional treatments (i.e., transcranial magnetic stimulation, electroconvulsive therapy, and ketamine) for adolescent TRD. Comparisons are drawn to the adult TRD literature, and areas for future pediatric depression research are highlighted. Conclusions As evidence is limited for treatments in this population, a careful consideration of the known risks and side effects of escalated treatments (e.g., mood stabilizers and atypical antipsychotics) is warranted and weighed against potential, but often untested, benefits.

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“…Hypovitaminosis D has been extensively associated with MDD in general population (for meta-analysis see (Ju et al, 2013) and for review see (Lerner et al, 2018)) and supplementing subjects with MDD has been found to improve depressive symptoms in another recent metaanalysis (Schefft et al, 2017). Patients with SZ are at higher risk of hypovitaminosis D (Belvederi Murri et al, 2013) and this association has been replicated in first episode psychosis in another recent meta-analysis (Firth et al, 2017) (for review see (Adamson et al, 2017)).…”

Section: Introductionmentioning

confidence: 97%

Hypovitaminosis D is associated with depression and anxiety in schizophrenia: Results from the national FACE-SZ cohort.

Fond

Godin

Schürhoff

et al. 2018

Psychiatry Research

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Efficacy of adding nutritional supplements in unipolar depression: A systematic review and meta-analysis

Cited by 102 publications

References 81 publications

The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta‐review of meta‐analyses of randomized controlled trials

The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta‐review of meta‐analyses of randomized controlled trials

Annual Research Review: Defining and treating pediatric treatment‐resistant depression

Hypovitaminosis D is associated with depression and anxiety in schizophrenia: Results from the national FACE-SZ cohort.

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