Muscle-Building Dietary Supplement Creatine Can Fight Depression
The new proof-of-concept study conducted by a collaboration of researchers from three South Korean universities and the University of Utah reveals that women with major depressive disorder (MDD) who augmented their daily antidepressant with 5 grams of creatine responded twice as fast and experienced remission of the illness at twice the rate of women who took the antidepressant alone.
The findings mean that creatine taken under doctors' supervision could be a relatively inexpensive method to improve treatment outcomes in women who have not responded well to SSRI (selective serotonin reuptake inhibitor) antidepressants.
Senior researcher Perry F. Renshaw, M.D., Ph.D., M.B.A, USTAR professor of psychiatry at the U of U medical school states: "If we can get people to feel better more quickly, they're more likely to stay with treatment and, ultimately, have better outcomes."
Further, larger trials that support these findings could have a great positive impact on people in Utah, as the state is estimated to have a 25% higher depression rate compared with the rest of the nation, which also means a reduction in the burden of the huge economic cost to both the state and individuals. Utah University recently estimated that in 2008 the state paid $214 million in depression-related Medicaid and disability insurance, which when adding the costs of in- and outpatient treatment, medication, and lost productivity in the workplace, the total cost Utah paid for depression amounted to $1.3 billion. A new treatment to improve outcomes could therefore not only lift the burden of numerous women in Utah, but also save a great deal of money.
Renshaw, who is also medical director of the Mental Illness Research, Education and Clinical Center at the Salt Lake City Veterans Affairs Health Care System explains: "There has been a misunderstanding of how crippling and common this disease is in Utah. It begs that we understand it better than we do."
Creatine is an amino acid that is produced in the human liver, kidneys, and pancreas, but is also present in meat and fish. Creatine converts into phosphocreatine, which is stored in muscle fibers and converted into ATP, a vital energy source for cells during high-intensity exercise. Creatine has become a popular supplement for bodybuilders and athletes who want to improve athletic ability or add muscle mass.
The function of creatine in relation to depression remains uncertain. However, Renshaw and his team hypothesize that creatine's pro-energetic effect including the production of more phosphocreatine could contribute to patients responding earlier and better to antidepressants.
The team conducted an eight-week long blind study involving 52 South Korean women with major depressive disorder, aged between 19 to 65 years who all took an antidepressant called Lexapro (escitalopram) during the study. The team divided the women into groups, with 25 women receiving creatine in addition to the Lexapro and 27 women whose Lexapro therapy was added with placebo. The total number of participants dropped to 39 after 8 women in the creatine group and 5 in the placebo group failed to finish the trial.
At the start of the trial both groups were interviewed to establish baselines for their depression, with a follow-up to check their treatment responses at 2,4 and 8 weeks. The severity of depression was determined by primary outcomes being measured using the widely accepted Hamilton Depression Rating Scale (HDRS).
The findings revealed that those in the creating group demonstrated considerably higher rates of improvement on the HDRS at 2 weeks (32%) and 4 weeks (68%) compared with those in the placebo group, whose improvement rate was 3.7% and 29% respectively. At the end of the trial, 50% of those in the creatine group were free of depression compared with one-quarter of those in the placebo group. The team observed no important adverse side effects linked to creatine.
Antidepressants commonly do not work until 4 to 6 weeks into the treatment, although studies have proven that the sooner an antidepressant begins working, the better the treatment outcome. Renshaw comments: "Getting people to feel better faster is the Holy Grail of treating depression."
Study co-author Tae-Suk Kim, M.D., Ph.D., associate professor of psychiatry at the Catholic University of Korea College of Medicine and visiting associate professor of psychiatry at the U of U, already recommends creatine to some of his female depressed patients.
Renshaw states that previous studies have shown creatine only to be effective in female rats. However, he continues, this should not rule out also testing the supplement in men.
U of U researchers are hoping to soon start another trial to test creatine in adolescent and college-age females who failed to respond to SSRI medications. Leading researcher Douglas G. Kondo, M.D., assistant professor of psychiatry, explains that they are looking to recruit 40 female volunteers aged between 13 to 21 years. Recruitment will commence pending the study's approval by the U of U Institutional Review Board, which is expected in July.
Recommended related news
"A Randomized, Double-Blind Placebo-Controlled Trial of Oral Creatine Monohydrate Augmentation for Enhanced Response to a Selective Serotonin Reuptake Inhibitor in Women With Major Depressive Disorder"
In Kyoon Lyoo, M.D., Ph.D.; Sujung Yoon, M.D., Ph.D.; Tae-Suk Kim, M.D., Ph.D.; Jaeuk Hwang, M.D., Ph.D.; Jieun E. Kim, M.D., Ph.D.; Wangyoun Won, M.D.; Sujin Bae, Ph.D.; Perry F. Renshaw, M.D., Ph.D.
American Journal of Psychiatry, August 2012, doi: 10.1176/appi.ajp.2012.12010009
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