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Dietary Supplements Speed Efficacy Of SSRIS

Posted by Phillipa on September 12, 2012, at 21:04:01

Don't know what creatine is will google. Phillipa


From Medscape Medical News > Psychiatry

Dietary Supplement Speeds Clinical Efficacy of SSRIs

Fran Lowry

Authors and Disclosures



September 11, 2012 Adding oral creatine monohydrate to a selective serotonin reuptake inhibitor (SSRI) speeds the effect of these antidepressants in women with major depressive disorder, new research shows.

"The standard antidepressants, including selective serotonin reuptake inhibitors (SSRIs), are generally regarded as safe and effective treatments," In Kyoon Lyoo, MD, PhD, Seoul National University College of Medicine, South Korea, and colleagues write. "However, more than a few weeks may be required to achieve reliable antidepressant responses."

The study was published in the September issue of the American Journal of Psychiatry.

The team of investigators previously found that creatine, a dietary supplement that has been available for more than a decade, induced an antidepressant response in female, but not male, rodents.

They hypothesized that augmenting SSRI treatment with creatine would lead to a more rapid onset of the antidepressant effect of the medication, as well as a greater treatment response, in depressed women.

In this study, 52 women aged 19 to 65 years with major depressive disorder were randomly assigned to receive either escitalopram (Lexapro, Forest Laboratories Inc) in addition to either creatine (5 g/day, n = 25) or placebo (n = 27).

The primary outcome measure was change in the Hamilton Depression Rating Scale (HAM-D) score.

At baseline, the mean HAM-D score was 26.9 for women randomly assigned to the creatine group and 26.7 for those randomly assigned to the placebo group.

By week 2, the HAM-D score in the creatine group had fallen to a mean of 14.7, vs 20.3 for the placebo group (95% confidence interval [CI], 0.98 - 1.59).

This differential improvement in the HAM-D score favoring creatine was maintained at weeks 4 (9.4 vs 15.1; 95% CI, 0.86 - 1.54) and 8 (5.4 vs 9.8; 95% CI, 0.75 - 1.52).

Also, the proportion of women who discontinued treatment prematurely was similar, with 8 (32.0%) of women in the creatine group and 5 (18.5%) in the placebo group dropping out of the study.

Adverse events were also similar for both groups, with 36 events reported in the women taking creatine and 45 events among women taking placebo.

Most of the adverse events occurred at an early phase of treatment and improved without specific interventions. The most common in both treatment groups were tension headache, nausea or vomiting, and sleep difficulties.

"The symptom clusters of nausea, tension headache, restlessness, and insomnia, which may be related to the use of SSRIs, were the major reasons for intolerance of the study medications," the authors write.

They note that their findings need replication in a larger study. Also, previous findings that indicate that creatine supplementation increases cerebral creatine levels, which may in turn augment antidepressant efficacy, require further investigation.

Merits Further Investigation

Peter Kramer, MD, clinical professor of psychiatry at Brown University in Providence, Rhode Island, agrees that creatine merits further investigation in this regard.

Dr. Peter Kramer

"Antidepressant treatment is an area where there has been a lot of stasis in getting improved efficacy. The old drugs look effective, the newer drugs look about as effective, and so we're looking for something that will help our patients," Dr. Kramer told Medscape Medical News. "This is a very promising study for a number of reasons."

The results need replication in bigger studies, he agreed.

"There are some animal studies that show that this augmentation may be helpful, and there are older studies looking at enzymes in humans related to creatine that seem to be altered during episodes of depression, so there has been a sense that something may be going on here," he said.

"Creatine is a relatively harmless addition, so it's very testable, and would be very usable, and the fact that the American Journal of Psychiatry accepted the article signals genuine interest. It would be great to have a tool like this," he said.

In an accompanying editorial, Stephen M. Strakowski, MD, from the University of Cincinnati College of Medicine in Ohio, writes that "a paradigm shift in the treatment of depression is overdue, and translational neuroscience, like that presented in this issue, presents a step toward that end."

"Perhaps this study will inspire others to use a similar translational approach, leading to a significant advance in how we manage folks with major depression," added Dr. Strakowski.

Dr. Lyoo reports financial relationships with AstraZeneca, Boryung, Eli Lilly, GlaxoSmithKline, Lundbeck, and Organon. Dr. Kramer has disclosed no relevant financial relationships. Dr. Strakowski reports financial relationships with AstraZeneca, Eli Lilly, Janssen, Martek, Nutrition 21, Pfizer, Repligen, Sumatomo, NARSAD, the National Institute on Drug Abuse, the National Institute of Mental Health, and the National Institute on Alcohol Abuse and Alcoholism. He also reports being a consultant to the University of Utah and the University of Nebraska and receiving speaker fees from the American Academy of Child and Adolescent Psychiatry, CME Outfitters and Adamed, WebMD, Consensus Medical Communications, and the American Psychiatric Association.

Am J Psychiatry. 2012;169:891-893, 937-945

 

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