Evidence-Based Reviews

Vitamin D deficiency and psychiatric illness

Current Psychiatry. 2013 April;12(4):18-27

References

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Seasonal affective disorder (SAD). Seasonal variation in vitamin D levels suggests that supplementation may help patients who have seasonal mood disturbances. In a randomized, double-blind study, 44 healthy individuals received vitamin D₃, 400 IU/d, 800 IU/d, or no vitamin D₃ for 5 days during late winter. Based on self-reports, vitamin D₃ significantly enhanced positive affect and there was some evidence it reduced negative affect.³⁷ In a pilot study of 9 women with serum vitamin D levels <40 ng/ml, vitamin D supplementation during winter was associated with an average 10-point decline in Beck Depression Inventory-II scores.³⁸ In a prospective RCT of 15 individuals with SAD, all patients who received vitamin D improved in all outcome measures.³⁹ Vieth⁴⁰ randomized 82 adults with vitamin D deficiency to 600 IU/d or 4,000 IU/d of vitamin D₃ for 3 months over 2 consecutive winters. Patients taking the higher dose showed some evidence of improved well-being compared with those taking the lower dose, although results were not significant for all comparisons. Two other trials did not observe any improvement in SAD symptoms with vitamin D treatment.^41,42

Clinical Point

A typical vitamin D replacement regimen consists of oral ergocalciferol, 50,000 IU per week for 8 weeks

Treating vitamin D deficiency

The Endocrine Society recently developed consensus guidelines for diagnosing and managing vitamin D deficiency.⁴³ In addition, the Institute of Medicine of the National Academies recommends daily vitamin D supplementation to prevent deficiency:

age <70: 400 IU/d
age >70: 800 IU/d
pregnant or lactating women: 600 IU/d
upper limit: 4,000 IU/d.⁷

Clinical Point

Granulomatous diseases, sarcoidosis, and metastatic bone disease are contraindications to vitamin D supplementation

Higher doses may be used for patients deprived of sun exposure.⁸ A typical replacement regimen consists of oral ergocalciferol, 50,000 IU per week for 8 weeks.⁴⁴ The optimal time for rechecking serum levels after repletion has not been clearly defined, but serum 25(OH)D levels should be measured again after therapy is completed. If values have not reached or exceeded 20 ng/mL, consider a second 8-week course of ergocalciferol (see the Box 1 for a discussion of measuring vitamin D levels). If serum 25(OH)D levels have not increased, the most likely cause is nonadherence or malabsorption.

Contraindications and toxicity. Contraindications to vitamin D supplementation include granulomatous diseases, sarcoidosis, metastatic bone disease, and Williams syndrome.⁴⁵Table 3⁴⁵ lists signs of vitamin D toxicity. There is little risk of toxicity at dosages of up to 2,000 IU/d.⁴⁶

Table 3

Signs of vitamin D toxicity

Headache
Metallic taste
Nephrocalcinosis or vascular calcinosis
Pancreatitis
Nausea
Vomiting
Source: Reference 45

Related Resources

LaFerney MC. Vitamin D deficiency in older adults. Current Psychiatry. 2012;11(11):63.
National Institutes of Health Office of Dietary Supplements. Dietary supplement fact sheet: vitamin D. http://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional.

Drug Brand Names

Cholestyramine • Questran
Ergocalciferol • Calciferol, Drisdol

Disclosures

Dr. Harris is an employee of Rho, Chapel Hill, NC.

Dr. Jaiswal reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.

Dr. Holmes receives research support from Bristol-Myers Squibb, Elan, Merck, Otsuka, Shire, Takeda, and Theravance, and is on the speaker’s bureau for Forest Pharmaceuticals and PamLab.

Dr. Patkar is a consultant for Dey Pharmaceuticals, Forest, Gilead, and TTK Pharma and is on the speaker’s bureau and received honoraria from Alkermes, Bristol-Myers Squibb, Dey Pharmaceuticals, Pfizer, and Sunovion; and has received grant support from the Duke Endowment, Dey Pharmaceuticals, Envivo, Forest, Janssen, Lundbeck, The National Institutes of Health, the National Institute on Drug Abuse, National Institute on Alcohol Abuse and Alcoholism, Pfizer Inc., Shire, Sunovion, and Titan.

Dr. Weisler has been a consultant to, on the speaker’s bureaus of, and/or received research support from Abbott, Agency for Toxic Substances and Disease Registry, AstraZeneca, Biovail, Bristol-Myers Squibb, Burroughs Wellcome, Cenerx, Centers for Disease Control and Prevention, Cephalon, Ciba Geigy, CoMentis, Corcept, Cortex, Dainippon Sumitomo Pharma America, Eisai, Elan, Eli Lilly and Company, Forest Pharmaceuticals, GlaxoSmithKline, Janssen, Johnson & Johnson, Lundbeck, McNeil Pharmaceuticals, Medicinova, Medscape Advisory Board, Merck, National Institute of Mental Health, Neurochem, New River Pharmaceuticals, Novartis, Organon, Otsuka America Pharma, Pfizer Inc., Pharmacia, Repligen, Saegis, Sandoz, Sanofi, Sanofi-Synthelabo, Schwabe/Ingenix, Sepracor, Shire, Solvay, Sunovion, Synaptic, Takeda, TAP, Theravance, Transcept Pharma, TransTech, UCB Pharma, Validus, Vela, and Wyeth.