ROLE OF ASCORBIC ACID IN IMPROVING MOOD IN PATIENTS WITH DEPRESSION: A RANDOMIZED CONTROLLED TRIAL
Article Sidebar
Main Article Content
Abstract
Objective: To find out the effect of ascorbic acid in improving mood in patients undergoing treatment for depression.
Methodology: A randomized control trial was conducted at Department of Psychiatry, Mercy Teaching Hospital, Peshawar, involving 102 subjects equally divided into two groups: interventional (IG) and control (CG). The IG received antidepressants (+ Psychological support) and daily Ascorbic Acid 500 mg, while the CG received antidepressants (+ Psychological support). Plasma ascorbic acid levels were carried out in addition to Hamilton Depression Rating Scale (HAM-D). Data analysis was performed using SPSS 26 and paired sample t test was used as the test of significance. This trial was registered at Australian New Zealand Clinical Trial Registry (ACTRN12624000525583).
Results: The baseline HAM-D score for the overall sample was 21.81±6.16 and ascorbic acid level of 1.27±0.45, approaching the lower limit of the normal range. Following a three-month treatment, the mean HAM-D score was 13.39±7.39 (p=0.000), and ascorbic acid level of 1.97±0.69 (p=0.000). In the IG, baseline values were 20.92±6.49 for HAM-D and 1.32±0.48 for ascorbic acid, and the end-study values were 14.35±8.29 for HAM-D and 1.94±0.65 for ascorbic acid, with a significant p-value of 0.000. Similarly, at baseline, the HAM D-CG value was 23.14±5.68 and ascorbic acid value was 1.25±0.41, which was 12.53±6.46 for HAM-D and 1.99±0.74 for ascorbic acid at end-study, with a significant p-value of 0.000 for both.
Conclusion: Combination of ascorbic acid and antidepressants (+ Psychological support) showed a similar level of effectiveness compared to the use of antidepressants (+ Psychological support).
Article Details
Work published in JPMI is licensed under a
Creative Commons Attribution-NonCommercial 2.0 Generic License.
Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
References
Burrows K, Stewart JL, Antonacci C, Kuplicki R, Thompson K, Taylor A, Teague TK, Paulus MP. Association of poorer dietary quality and higher dietary inflammation with greater symptom severity in depressed individuals with appetite loss. J Affect Disord. 2020 Feb 15;263:99-106. doi: 10.1016/j.jad.2019.11.160. Epub 2019 Dec 2. PMID: 31818803; PMCID: PMC6989386.
Berton O, Nestler EJ. New approaches to antidepressant drug discovery: beyond monoamines. Nat Rev Neurosci. 2006 Feb;7(2):137-51. doi: 10.1038/nrn1846. PMID: 16429123.
Pizzino G, Irrera N, Cucinotta M, Pallio G, Mannino F, Arcoraci V, Squadrito F, Altavilla D, Bitto A. Oxidative stress: harms and benefits for human health. Oxid Med Cell Longev 2017, 8416763, 2017.
Valdecantos MP, Perez-Matute P, Martinez JA. Obesity and oxidative stress: role of antioxidant supplementation. Rev Invest Clin 61, 127–139, 2009.
Abdali D, Samson SE, Grover AK. How effective are antioxidant supplements in obesity and diabetes? Med Princ Pract 24, 201–215. 2015.
Li D, Xu W, Wu Q, Zheng H, Li Y. Ascorbic acid intake is inversely associated with prevalence of depressive symptoms in US midlife women: A cross-sectional study J. Affect. Disord. 2022 Feb 15; 299:498-503.
Gariballa S. Poor vitamin C status is associated with increased depression symptoms following acute illness in older people. Int J Vitam Nutr Res. 2014;84(1-2):12-7. doi: 10.1024/0300-9831/a000188. PMID: 25835231.
Sahraian A., Ghanizadeh A., Kazemeini F. Vitamin C as an adjuvant for treating major depressive disorder and suicidal behavior, a randomized placebo-controlled clinical trial. Trials. 2015;16:94. doi: 10.1186/s13063-015-0609-1.
Tian H, Hu Z, Xu J, Wang C. The molecular pathophysiology of depression and the new therapeutics. MedComm (2020). 2022 Jul 21;3(3):e156. doi: 10.1002/mco2.156. PMID: 35875370; PMCID: PMC9301929.
Plevin D, Galletly C. The neuropsychiatric effects of vitamin C deficiency: a systematic review. BMC Psychiatry. 2020 Jun 18;20(1):315. doi: 10.1186/s12888-020-02730-w. PMID: 32552785; PMCID: PMC7302360.
Bajpai A, Verma AK, Srivastava M, Srivastava R. Oxidative stress and major depression. J Clin Diagn Res. 2014 Dec;8(12):CC04-7. doi: 10.7860/JCDR/2014/10258.5292. Epub 2014 Dec 5. PMID: 25653939; PMCID: PMC4316245.
Ait Tayeb AEK, Poinsignon V, Chappell K, Bouligand J, Becquemont L, Verstuyft C. Major Depressive Disorder and Oxidative Stress: A Review of Peripheral and Genetic Biomarkers According to Clinical Characteristics and Disease Stages. Antioxidants (Basel). 2023 Apr 17;12(4):942. doi: 10.3390/antiox12040942. PMID: 37107318; PMCID: PMC10135827.
Sim, M., Hong, S., Jung, S. et al. Vitamin C supplementation promotes mental vitality in healthy young adults: results from a cross-sectional analysis and a randomized, double-blind, placebo-controlled trial. Eur J Nutr 61, 447–459 (2022). https://doi.org/10.1007/s00394-021-02656-3
Ding J, Zhang Y. Associations of Dietary Vitamin C and E Intake With Depression. A Meta-Analysis of Observational Studies. Front Nutr. 2022 Apr 7;9:857823. doi: 10.3389/fnut.2022.857823. PMID: 35464032; PMCID: PMC9021894.
Dulabi AN, Shakerin Z, Mehranfard N, Ghasemi M. Vitamin C protects against chronic social isolation stress-induced weight gain and depressive-like behavior in adult male rats. Endocr Regul. (2020) 54:266–74. 10.2478/enr-2020-0030
Fraga DB, Camargo A, Olescowicz G, Padilha DA, Mina F, Budni J. A single administration of ascorbic acid rapidly reverses depressive-like behavior and hippocampal synaptic dysfunction induced by corticosterone in mice. Chem Biol Interact. (2021) 342:109476.
Koizumi M, Kondo Y, Isaka A, Ishigami A, Suzuki E. Vitamin C impacts anxiety-like behavior and stress-induced anorexia relative to social environment in SMP30/GNL knockout mice. Nutr Res. (2016) 36:1379–91. 10.1016/j.nutres.2016.11.006
Wang A, Luo J, Zhang T, Zhang D. Dietary Vitamin C and Vitamin C Derived from Vegetables Are Inversely Associated with the Risk of Depressive Symptoms among the General Population. Antioxidants (Basel). 2021 Dec 13;10(12):1984. doi: 10.3390/antiox10121984. PMID: 34943087; PMCID: PMC8750333.
Amr M., El-Mogy A., Shams T., Vieira K., Lakhan S.E. Efficacy of vitamin C as an adjunct to fluoxetine therapy in pediatric major depressive disorder: A randomized, double-blind, placebo-controlled pilot study. Nutr. J. 2013;12:31. doi: 10.1186/1475-2891-12-31.
Brody S, Preut R, Schommer K, Schurmeyer TH. A randomized controlled trial of high dose ascorbic acid for reduction of blood pressure, cortisol, and subjective responses to psychological stress. Psychopharmacology (Berl) 2002;159(3):319–24. doi: 10.1007/s00213-001-0929-6.
Khajehnasiri F, Mortazavi SB, Allameh A, Akhondzadeh S. Effect of omega-3 and ascorbic acid on inflammation markers in depressed shift workers in Shahid Tondgoyan Oil Refinery, Iran: a randomized double-blind placebo-controlled study. J Clin Biochem Nutr. 2013;53(1):36–40. doi: 10.3164/jcbn.12-98.
Yoshimatsu H, Imaeda T, Higa S, Nomoto K. Clinical implication of children's depression rating scale-revised score: Linking the children's depression rating scale-revised score and clinical global impression using patients data from clinical trials. Health Sci Rep. 2023 Aug 31;6(9):e1512. doi: 10.1002/hsr2.1512. PMID: 37662533; PMCID: PMC10469025.
Mazloom Z, Ekramzadeh M, Hejazi N. Efficacy of supplementary vitamins C and E on anxiety, depression and stress in type 2 diabetic patients: a randomized, single-blind, placebo-controlled trial. Pak J Biol Sci. 2013;16(22):1597–600. doi: 10.3923/pjbs.2013.1597.1600.