A Randomized Clinical Trial
Olivia I. Okereke, MD, SM1,2,3; Charles F. Reynolds III, MD4; David Mischoulon, MD, PhD1; et al Grace Chang, MD, MPH5; Chirag M. Vyas, MBBS, MPH1; Nancy R. Cook, ScD3,6; Alison Weinberg, MA6; Vadim Bubes, PhD6; Trisha Copeland, MS, RD6; Georgina Friedenberg, MPH6; I-Min Lee, MBBS, ScD3,6; Julie E. Buring, ScD3,6; JoAnn E. Manson, MD, DrPH2,3,6
Author Affiliations
JAMA. 2020;324(5):471-480. doi:10.1001/jama.2020.10224
Key Points
Question Can long-term supplementation with vitamin D3 prevent depression in the general adult population?
Findings In this randomized clinical trial that included 18 353 adults aged 50 years or older without depression or clinically relevant depressive symptoms at baseline, vitamin D3 supplementation compared with placebo did not result in statistically significant differences in the incidence and recurrence of depression or clinically relevant depressive symptoms (hazard ratio, 0.97) or for change in mood scores over a 5-year treatment period.
Meaning These findings do not support the use of vitamin D3 in adults to prevent depression.
Abstract
Importance Low levels of 25-hydroxyvitamin D have been associated with higher risk for depression later in life, but there have been few long-term, high-dose large-scale trials.
Objective To test the effects of vitamin D3 supplementation on late-life depression risk and mood scores.
Design, Setting, and Participants There were 18 353 men and women aged 50 years or older in the VITAL-DEP (Vitamin D and Omega-3 Trial-Depression Endpoint Prevention) ancillary study to VITAL, a randomized clinical trial of cardiovascular disease and cancer prevention among 25 871 adults in the US. There were 16 657 at risk for incident depression (ie, no depression history) and 1696 at risk for recurrent depression (ie, depression history but no treatment for depression within the past 2 years). Randomization occurred from November 2011 through March 2014; randomized treatment ended on December 31, 2017, and this was the final date of follow-up.
Intervention Randomized assignment in a 2 × 2 factorial design to vitamin D3 (2000 IU/d of cholecalciferol) and fish oil or placebo; 9181 were randomized to vitamin D3 and 9172 were randomized to matching placebo.
Main Outcomes and Measures The primary outcomes were the risk of depression or clinically relevant depressive symptoms (total of incident and recurrent cases) and the mean difference in mood scores (8-item Patient Health Questionnaire depression scale [PHQ-8]; score range, 0 points [least symptoms] to 24 points [most symptoms]; the minimal clinically important difference for change in scores was 0.5 points).
Results Among the 18 353 randomized participants (mean age, 67.5 [SD, 7.1] years; 49.2% women), the median treatment duration was 5.3 years and 90.5% completed the trial (93.5% among those alive at the end of the trial). Risk of depression or clinically relevant depressive symptoms was not significantly different between the vitamin D3 group (609 depression or clinically relevant depressive symptom events; 12.9/1000 person-years) and the placebo group (625 depression or clinically relevant depressive symptom events; 13.3/1000 personyears) (hazard ratio, 0.97 [95% CI, 0.87 to 1.09]; P = .62); there were no significant differences between groups in depression incidence or recurrence. No significant differences were observed between treatment groups for change in mood scores over time; mean change in PHQ-8 score was not significantly different from zero (mean difference for change in mood scores, 0.01 points [95% CI, −0.04 to 0.05 points]).
Conclusions and Relevance Among adults aged 50 years or older without clinically relevant depressive symptoms at baseline, treatment with vitamin D3 compared with placebo did not result in a statistically significant difference in the incidence and recurrence of depression or clinically relevant depressive symptoms or for change in mood scores over a median followup of 5.3 years. These findings do not support the use of vitamin D3 in adults to prevent depression.
Zusammenfassung (aus Infomed.ch):
In der placebokontrollierten VITAL-Studie, die vor gut 1½ Jahren publiziert worden ist, hatte man untersucht, ob Vitamin D kardiovaskuläre Ereignisse und Krebserkrankungen verhütet (wobei das Ergebnis negativ war). Ungefähr 70% der VITAL-Population wurde für eine ergänzende Analyse herangezogen, bei der man die Hypothese prüfte, dass Vitamin D vor Depressionen schütze (VITAL-DEP). Depressive Symptome traten allerdings in der Vitamin-D-Gruppe (Einnahme von Cholecalciferol 2000 IU/Tag während über 5 Jahren) nicht seltener auf als in der Placebogruppe.
Fazit:
Vitamin D hat wie schon bei vielen anderen Erkrankungen bei Krebserkrankungen, kardiovaskulären Ereignissen und Depression keine Wirkung.
„Vitamin D zu geben hat keinen Sinn, die Patienten sollen in die Sonne gehen.“
Fazit Regen:
Nichts Genaues weiß man nicht! Supplementieren bis zu 4.000 IE unbedenklich.