Major depressive disorder: association with vitamin C levels and role of vitamin C supplementation in pharmacotherapy
Keywords:CGI, Depression, HDRS, Vitamin C deficiency
Background: Oxidative stress has a well-documented role in pathophysiology of depression. Decrease in levels of vitamin C, an antioxidant, has also been reported in major depressive patients. This study was conducted to assess the association of vitamin C deficiency with major depressive disorder and any change in clinical response to antidepressant therapy with vitamin C co-administration vis-a-vis baseline vitamin C level status.
Methods: This study was a prospective, interventional, parallel, randomized and open label study. Sixty patients diagnosed as a case of major depressive disorder in accordance to ICD-10 criteria were enrolled after taking a written informed consent. Two clinical scales namely Hamilton depression rating scale (HDRS) and clinical global impression- illness severity (CGI-S) scale were used for assessment and monitoring.
Results: Vitamin C deficient subjects had relatively severe disease as assessed by HDRS and CGI-S scales. A highly significant (p<0.001) reduction was observed in HDRS and CGI-S scores in vitamin C deficient and insufficient groups with supplementation. A statistically insignificant (p>0.05) reduction was seen in HDRS and CGI-I scores in vitamin C sufficient group while also showing a comparatively milder disease.
Conclusions: Vitamin C deficiency was found to have a direct relation with severity of illness, as those patients who had insufficient and sufficient vitamin C levels at recruitment were found to exhibit milder symptoms compared to those who were vitamin C deficient. With treatment, greater improvement was observed in those patients who were deficient at the outset.
Hidaka BH. Depression as a disease of modernity: explanations for increasing prevalence. J Affect Disord. 2012;140(3):205-14.
Sarris J, O’Neil A, Coulson CE, Schweitzer I, Berk M. Lifestyle medicine for depression. BMC Psychiatr. 2014;14:107.
Horwitz AV. How an Age of anxiety became an age of depression. Milbank Q. 2010;88(1):112-38.
Paykel ES. Basic concepts of depression. Dialogues Clin Neurosci. 2008;10(3):279-89.
Cowen PJ, Browning M. What has serotonin to do with depression? World Psychiatr. 2015;14(2):158-60.
Moret C, Briley M. The importance of norepinephrine in depression. Neuropsychiatr Dis Treat. 2011;7(Suppl 1):9-13.
Undurraga J, Baldessarini RJ. Direct comparison of tricyclic and serotonin-reuptake inhibitor antidepressants in randomized head-to-head trials in acute major depression: systematic review and meta-analysis. J Psychopharmacol Oxf Engl. 2017;31(9):1184-9.
Liu T, Zhong S, Liao X, Chen J, He T, Lai S, et al. A meta-analysis of oxidative stress markers in depression. PLoS One. 2015;10(10):e0138904.
Black CN, Bot M, Scheffer PG, Cuijpers P, Penninx BWJH. Is depression associated with increased oxidative stress? A systematic review and meta-analysis. Psychoneuroendocrinology. 2015;51:164-75.
Bajpai A, Verma AK, Srivastava M, Srivastava R. Oxidative stress and major depression. J Clin Diagn Res JCDR. 2014;8(12):CC04-7.
Obeid S, Abi Elias Hallit C, Haddad C, Hany Z, Hallit S. Validation of the Hamilton depression rating scale (HDRS) and sociodemographic factors associated with Lebanese depressed patients. L’Encephale. 2018;44(5):397-402.
Rohan KJ, Rough JN, Evans M, Ho SY, Meyerhoff J, Roberts LM, et al. A protocol for the hamilton rating scale for depression: item scoring rules, rater training, and outcome accuracy with data on its application in a clinical trial. J Affect Disord. 2016;200:111-8.
Worboys M. The Hamilton rating scale for depression: the making of a “gold standard” and the unmaking of a chronic illness, 1960-1980. Chronic Illn. 2013;9(3):202-19.
Busner J, Targum SD. The clinical global impressions scale. Psychiatr Edgmont. 2007;4(7):28-37.
Dunlop BW, Gray J, Rapaport MH. Transdiagnostic clinical global impression scoring for routine clinical settings. Behav Sci. 2017;7(3).
Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-23.
Ravindran RD, Vashist P, Gupta KS, Young SI, Maraini G, Camparini M, et al. Prevalence and risk factors for vitamin C deficiency in North and South India: a two centre population based study in people aged 60 years and over. PLoS One. 2011;6(12).
Chiplonkar SA, Agte VV, Mengale SS, Tarwadi KV. Are lifestyle factors good predictors of retinol and vitamin C deficiency in apparently healthy adults? Eur J Clin Nutr. 2002;56(2):96-104.
Hampl JS, Taylor CA, Johnston CS. Vitamin C deficiency and depletion in the United States: The Third National Health and Nutrition Examination Survey, 1988 to 1994. Am J Public Health. 2004;94(5):870.
Gupta P, Haria J. Relationship between depression and vitamin c status: a study on rural patients from Western Uttar Pradesh in India. Int J Sci Stud. 2014;1(4):37-9.