Effects of Vitamin D Supplementation on Depression and Inflammatory Markers

Effects of Vitamin D Supplementation on Depression and Inflammatory Markers in Adolescent and Youth With Major Depression and Vitamin D-deficiency: a Partially Randomized Preference Trial in Taiwan

The current study is designed as a prospective partially randomized patient preference (PRPP) trial and recruit psychiatric outpatients or inpatients. Participants who agree to receive randomization will be randomly assigned into a supplementation or placebo group, after stratification for pre-intervention vitamin D status (12-20 ng/mL or <12 ng/mL) and depression status (HDRS-17 ≥ 17 or < 17). Participants who decline randomization but agree to receive follow-up in the observational cohort choose their preferred method (either 4800 IU vitamin D3 per day, or usual care without supplementation). Severity of depression, any change of medication, and side effect will be assessed at baseline and at 2-week intervals for 8 weeks. Serum levels of 25(OH)D, C-Reactive protein (CRP) and 12 cytokines, anthropometrical measurements, dietary intake, physical activity and sun exposure will be assessed at baseline and post-intervention. Additionally, serum levels of 25(OH)D will be assessed at 4 weeks to ensure its safety level.

Study Overview

• Status: Recruiting
• Conditions: Vitamin D Deficiency; Major Depression
• Intervention / Treatment: Dietary supplement: Vitamin D3

Detailed Description

Investigators will conduct a partially randomized patient preference (PRPP) trial and recruit psychiatric outpatients or inpatients. Inclusion criteria are young people aged 10 to 24, fulfilling the DSM-V criteria of major depressive disorder (MDD) with scores of HDRS-17≥10, psychotropic medication have been kept unchanged for a month and will remain unchanged during intervention period, and serum 25-hydroxycholecalciferol (25-OH-D) levels lower than 20 ng/ml. Exclusion criteria are comorbid with organic mental disorders, alcohol or substance use disorders, schizophrenia, delusion disorder, bipolar disorder, autistic spectrum disorder, anorexia nervosa, and IQ less than 70; endocrine disorders including diabetes, thyroid and parathyroid disorder; serious neurological disorders including epilepsy, severe traumatic brain injury, and neurodegenerative conditions; liver disease, kidney disease, heart disease or other serious health conditions; use drug interfering with vitamin D metabolism.

Participants who agree to receive randomization will be randomly assigned into a supplementation or placebo group, after stratification for pre-intervention vitamin D status (12-20 ng/mL or <12 ng/mL) and depression status (HDRS-17 ≥ 17 or < 17). Supplementation arm will receive oral dose 4800 IU vitamin D3 per day (three soft capsules of 800 IU vitamin D, twice a day) and placebo arm will receive placebo every day (three soft capsules with identical appearance, twice a day) for 8 weeks. Both groups continue to receive standard psychiatric care by child psychiatrists. Randomization and allocation will be concealed from researchers, participants and treating physicians. Participants who decline randomization but agree to receive follow-up in the observational cohort choose their preferred method (either 4800 IU vitamin D3 per day, or usual care without supplementation). Severity of depression, any change of medication, and side effect will be assessed at baseline and at 2-week intervals for 8 weeks. Serum levels of 25(OH)D, CRP and 12 cytokines, anthropometrical measurements, dietary intake, physical activity and sun exposure will be assessed at baseline and post-intervention. Additionally, serum levels of 25(OH)D will be assessed at 4 weeks to ensure its safety level.

• Study Type: Interventional
• Enrollment (Estimated): 460
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Hui-Chun Huang, PhD; Phone Number: 3055 +886-2-28094661; Email: aihch@mmh.org.tw

Study Locations

• Taiwan
  • Taipei, Taiwan
    • Recruiting
    • Mackay Memorial Hospital
    • Contact: Hui-Chun Huang, PhD; Phone Number: 3055 +886-2-28094661; Email: aihch@mmh.org.tw

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 10 years to 24 years (Child, Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• 1.patients who attend psychiatric outpatient clinics or who are admitted to the psychiatric inpatient ward at the above sites.
• 2.clinical diagnosis of depression-related disorders and scores of HDRS-17 ≥ 10.
• 3.psychotropics have been kept unchanged for at least a month.
• 4.aged 10 to 24.
• 5.serum 25-hydroxycholecalciferol (25-OH-D) levels lower than 20 ng/ml.

Exclusion Criteria:

• 1.endocrine disorders

  1. including diabetes
  2. thyroid
  3. parathyroid disorder.

• 2.serious neurological disorders

  1. epilepsy
  2. severe traumatic brain injury
  3. neurodegenerative conditions
• 3.liver disease
• 4.kidney disease
• 5.heart disease
• 6.other serious health conditions.

• 7.severe mental disorders

  1. Organic mental disorders
  2. Alcohol or substance use disorders active within 3 months
  3. Schizophrenia
  4. Delusional disorder
  5. Psychotic disorders not elsewhere classified.
  6. Bipolar disorder.
  7. Autistic spectrum disorder.
  8. Anorexia nervosa.
  9. Mental retardation with IQ less than 70.
  10. High violence or suicide risk.

• 8.Patients use drugs or herbals interfering with vitamin D metabolisms

  1. phenobarbital
  2. phenytoin
  3. anti-tuberculosis drugs
  4. thiazide diuretics.
• 9.Pregnant or expect to be pregnant during study participation.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Vit D Group (randomized); Subjects will be randomly assigned to receive a daily vitamin D supplementation (4800IU daily) for 8 weeks	Dietary supplement: Vitamin D3; Vitamin D3 4800IU daily
No Intervention: Control Group (randomized); Subjects will be randomly assigned to receive a placebo for 8 weeks.
Experimental: Preference Vit D Group (non-randomized); Subjects with a strong preference to receive a daily vitamin D supplementation (4800IU daily) for 8 weeks.	Dietary supplement: Vitamin D3; Vitamin D3 4800IU daily
No Intervention: Preference no Vit D Group (non-randomized); Subjects with a strong preference to receive usual care (not receiving vitamin D supplements) for 8 weeks.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change of total score of 17-item Hamilton Depression Rating Scale (HDRS-17)	17-item Hamilton Depression Rating Scale is an interview-based instrument for rating the overall levels of severity of the symptoms of depression and the response to treatment. Each item is rated from 0 to 4 or 0 to 2; the scores correspond to increases in severity. Total scores range from 0 to 52.	baseline and at 8 weeks (the end of intervention)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
17-item Hamilton Depression Rating Scale (HDRS-17)	HDRS-17 is measured totally 5 times, at week 0, 2 weeks, 4 weeks, 6 weeks, 8 weeks. The change in total HDRS-17 score between baseline and the intermediate 2-week, 4-week, 6-week follow-ups were considered secondary outcomes measures.	change from baseline score at 8 weeks
Response rate of 17-item Hamilton Depression Rating Scale (HDRS-17)	Response rate is defined as a reduction in HDRS-17 total score of at least 50 percent relative to the beginning of the randomized phase (baseline).	at 2 weeks, 4 weeks, 6 weeks, 8 weeks
Remission rate of 17-item Hamilton Depression Rating Scale (HDRS-17)	Remission rate is defined as an absolute HDRS-17 total score of ≤ 7 at each follow-up assessment.	at week 2, 4, 6, 8 weeks
End of intervention remission rate in17-item Hamilton Depression Rating Scale (HDRS-17)	Remission rate is defined as an absolute HDRS-17 total score of ≤ 7 at the end of treatment (8 week after intervention).	at 8 weeks
Change of total score of Beck Depression Inventory-Second Edition	Beck Depression Inventory is a 21-item self-report measure, scored from 0 to 3 (range 0-63), and greater scores indicate severe depression symptoms.Beck Depression Inventory (BDI) is measured totally 5 times, at week 0, 2 weeks, 4 weeks, 6 weeks, 8 weeks. The change in total BDI score between baseline and each of follow-ups (2-week, 4-week, 6-week, 8-week follow-ups) were considered secondary outcomes measures.	change from baseline score at 8 weeks
Significant change (mean±SD) in vitamin D status	serum levels of 25(OH)D, units of measure is ng/mL	baseline and at 8 weeks

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change of total score of Generalized Anxiety Disorder Questionnaire	Generalized Anxiety Disorder Questionnaire is a 7-item self-report measure, scored from 0 to 3 (range 0-21), and greater scores indicate severe anxiety symptoms.	baseline and at 8 weeks (the end of intervention)
Significant change (mean±SD) in serum concentration of hs-CRP	The serum concentration of hs-CRP (mg/L) will be measured at baseline and 8 weeks after intervention. Normal range is <0.3 mg/L.	baseline and 8 weeks after intervention
Significant change (mean±SD) in serum concentration of cytokine targets	The serum concentration of cytokine targets (IL-1β, IL-2, IL-6, IL-12, IL-15, TNF-α, IFN-γ, IL-4, IL-5, IL-13, IL-10, IL-1Ra) (unit: pg/mL) will be measured at baseline and 8 weeks after intervention.	baseline and 8 weeks after intervention

Collaborators and Investigators

• Sponsor: Mackay Memorial Hospital
• Investigators: Principal Investigator: Shen-Ing Liu, PhD, Mackay Memorial Hospital

Study record dates

Study Major Dates

• Study Start (Actual): April 12, 2021
• Primary Completion (Estimated): April 28, 2024
• Study Completion (Estimated): June 28, 2024

Study Registration Dates

• First Submitted: May 4, 2021
• First Submitted That Met QC Criteria: May 18, 2021
• First Posted (Actual): May 24, 2021

Study Record Updates

• Last Update Posted (Actual): July 14, 2023
• Last Update Submitted That Met QC Criteria: July 12, 2023
• Last Verified: July 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Behavioral Symptoms; Mental Disorders; Mood Disorders; Nutrition Disorders; Avitaminosis; Deficiency Diseases; Malnutrition; Depression; Depressive Disorder; Vitamin D Deficiency; Depressive Disorder, Major; Physiological Effects of Drugs; Micronutrients; Vitamins; Bone Density Conservation Agents; Calcium-Regulating Hormones and Agents; Vitamin D; Cholecalciferol
• Other Study ID Numbers: 109-2314-B-195 -017 -MY3

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No