Open Study of Creatine Monohydrate in Treatment-Resistant Posttraumatic Stress Disorder

Abstract

Sir: Creatine-containing compounds play an important role in brain energy homeostasis and may have a beneficial effect on brain functioning.1-3 Accumulated evidence suggests the possible involvement of altered cerebral energy metabolism in the pathophysiology of posttraumatic stress disorder (PTSD). 4 Oral creatine supplementation may increase brain creatine level and modify brain high-energy phosphate metabolism in hypoactive brain areas in subjects with treatment-resistant PTSD.Method. The study was an open, 4-week clinical trial examining the effect of creatine monohydrate added to ongoing psychotropic treatment in PTSD patients. Male and female patients aged 18 to 65 years with chronic PTSD (according to DSM-IV-TR criteria) who had received psychotropic treatment for at least 6 weeks (selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors) without a clinically relevant therapeutic response were included in the study. Patients with alcohol or drug abuse or any clinically significant unstabilized medical condition were excluded. The study was approved by the local institutional review board.

Sex-specific antidepressant effects of dietary creatine with and without sub-acute fluoxetine in rats

“…A growing number of clinical studies are finding that creatine supplementation is an effective adjunct to conventional medicines in patients with treatment resistant depression (Amital et al, 2006ab; Kondo et al, 2011b; Roitman et al, 2007). Converging evidence from animal studies assessing forced swim test behavior showed that creatine supplementation produced antidepressant-like effects in female rats, but not male rats (Allen et al, 2010).…”

Mitochondrial Energy Depletion in Depression with Somatization

“…Q10 and riboflavin, components of the respiratory chain, have demonstrated efficacy in migraine, a somatic condition common in mitochondrial disorders as well as in depression [16][17][18] . Creatine is gaining interest as a treatment option in depressive and neurodegenerative conditions [19,20] . Substantial clinical experience, although anecdotal, with 'mitochondrial-directed' therapies in our own patients leads us to believe that they often demonstrate beneficial effects with the somatic symptoms common in depression and possibly in depression itself.…”

A Potential Role for Creatine in Drug Abuse?

“…Preliminary findings suggest that creatine supplementation can improve mood in humans [4,5]. Individuals with treatment-resistant depression [5] or PTSD with and without comorbid depression [4] who were supplemented with 3-5 g/day of creatine monohydrate for 4 weeks reported elevated mood on the Hamilton Depression Rating Scale.…”

“…Individuals with treatment-resistant depression [5] or PTSD with and without comorbid depression [4] who were supplemented with 3-5 g/day of creatine monohydrate for 4 weeks reported elevated mood on the Hamilton Depression Rating Scale. This evidence is encouraging, but these studies are also methodologically limited and confounded by comorbidity, concurrent drug treatment, age, sex, and severity of depression.…”

“…There is growing evidence that creatine may be of value in the treatment of neurological conditions, which are linked to dysfunctional energy metabolism such as age-related cognitive decline and neurodegenerative diseases [1,2]. Moreover, creatine supplementation is beginning to attract attention as a complementary strategy in the treatment of psychiatric disorders such as depression and post-traumatic stress disorder [3][4][5]. Although there is virtually no research directly investigating the relationship between creatine supplementation and drug use, there is considerable evidence to support the role of creatine in both depression and stress, which are highly linked with drug use.…”