Vitamin D and clinical symptoms in First Episode Psychosis (FEP): A prospective cohort study

Lally, John; Ajnakina, Olesya; Singh, Nidhita; Gardner-Sood, Poonam; Stubbs, Brendon; Stringer, Dominic; Forti, Marta Di; David, Anthony S.; Smith, Shubulade; Murray, Robin M.; Howes, Oliver; Gaughran, Fiona

doi:10.1016/j.schres.2018.08.011

Cited by 20 publications

(21 citation statements)

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“…Second, there are now extensive data from large‐scale studies showing that psychotic and mood disorders are associated with significantly reduced serum levels of essential nutrients, including zinc, folate and vitamin D. Since these deficits appear to be related to treatment response and clinical outcomes in these populations, there is a possibility that nutrient supplementation could improve outcomes.…”

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confidence: 99%

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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confidence: 99%

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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“…Over 90% of people with established psychosis have suboptimal vitamin D levels, but depression rates in psychotic disorders are not that high, nor are persisting psychotic symptoms universally prevalent (Lally 2017). The observed associations could be due to reverse causation, the illness affecting the vitamin D levels, although our recent prospective study, while requiring replication, opens the possibility of a direct effect of vitamin D levels on outcomes in early psychosis (Lally 2018).…”

Section: Discussionmentioning

confidence: 85%

Vitamin D in schizophrenia and depression: a clinical review

Lally

Gaughran²

2019

BJPsych advances

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SUMMARYEvidence from preclinical and clinical studies supports a role for vitamin D deficiency in many mental disorders. In this review, we discuss the role of vitamin D in the aetiology and treatment of schizophrenia and depression and their physical health comorbidities. Although observational studies support a potential association between vitamin D and schizophrenia and depression, sufficient high-quality evidence from clinical trials does not yet exist to establish a place for vitamin D supplementation in optimising clinical response or promoting physical health. Completed randomised controlled trials are needed to provide insights into the efficacy and safety of vitamin D in the management of mental disorders.LEARNING OBJECTIVESAfter reading this article you will be able to: •outline the epidemiology of vitamin D deficiency in schizophrenia•describe the associations of vitamin D with schizophrenia and depression•know how to assess, and consider treatment for, vitamin D deficiency.DECLARATION OF INTERESTF.G. has received support or honoraria for CME, advisory work and lectures from Bristol-Myers Squibb, Janssen, Lundbeck, Otsuka, Roche and Sunovion, and has a family member with professional links to Lilly and GSK, including shares. She is in part funded by the National Institute for Health Research's (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London and the South London Collaboration for Leadership in Applied Health Research & Care Funding scheme, and by the Maudsley Charity. The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

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“…There is a growing body of evidence that suggests vitamin D is neuroprotective [1, 2, 10] and that vitamin D deficiency is prevalent in those with schizophrenia [12, 16]. Longitudinally, the severity of symptoms in psychosis has also been associated with vitamin D concentration [24]. Lack of vitamin D is also associated with physical health problems, including adverse cardiovascular outcomes [50], and so may potentially compound the poor health status associated with psychotic disorders [51, 52].…”

Section: Discussionmentioning

confidence: 99%

“…Overall, the people with FEP had a nearly threefold greater risk of vitamin D deficiency than comparators. Higher vitamin D levels at presentation were associated with lower total and negative symptoms of psychosis a year later [24]. The deficiency in vitamin D seems to be unrelated to other vitamins and minerals.…”

Section: Introductionmentioning

confidence: 99%

Vitamin D supplementation compared to placebo in people with First Episode psychosis - Neuroprotection Design (DFEND): a protocol for a randomised, double-blind, placebo-controlled, parallel-group trial

Gaughran

Stringer

Berk

et al. 2020

Trials

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BackgroundPeople experiencing their first episode of psychosis are often deficient in vitamin D. Observational studies have reported an association between low vitamin D concentrations and poorer subsequent health outcomes in psychosis. A vitamin D deficiency in neonates and children has been linked to a later increased risk of schizophrenia and psychotic-like experiences. This trial aims to examine the effect of high-dose vitamin D supplementation on outcomes in early psychosis. We hypothesise that vitamin D supplementation will be associated with better mental health outcomes.Methods/designThe DFEND study is a multicentre double-blind placebo-controlled parallel-group trial of vitamin D supplementation in people with early psychosis. Patients with an ICD-10 diagnosis of functional psychosis will be randomised in a 1:1 ratio to receive either 120,000 IU/month of vitamin D (cholecalciferol) or a matched placebo for 6 months. The primary outcome is the total Positive and Negative Syndrome Scale (PANSS) score at the 6-month follow-up for all patients. Secondary outcomes include assessment of mood (Calgary Depression Scale), general function (Global Assessment of Functioning), cardiovascular risk (body mass index, waist circumference, C-reactive protein, cholesterol and HbA1c) and vitamin D levels at the 6-month follow-up. Additionally, 3- and 6-month total PANSS scores will be analysed for those with inadequate vitamin D levels at the baseline.DiscussionThe DFEND study is the first trial to examine whether vitamin D supplementation in early psychosis is associated with better mental health outcomes. The findings of this study may help to resolve the clinical equipoise regarding the benefits and cost-effectiveness of routine vitamin D supplementation in people with psychosis.Trial registrationISRCTN, ISRCTN12424842. Registered on 25 February 2015.

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Vitamin D and clinical symptoms in First Episode Psychosis (FEP): A prospective cohort study

Cited by 20 publications

References 62 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

Vitamin D in schizophrenia and depression: a clinical review

Vitamin D supplementation compared to placebo in people with First Episode psychosis - Neuroprotection Design (DFEND): a protocol for a randomised, double-blind, placebo-controlled, parallel-group trial

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