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High Vitamin B12 Levels May be Linked to Better Treatment Outcome for Major Depressive Disorder

High levels of vitamin B12 may be associated with a better treatment outcome for patients with major depressive disorder, according to a recent Finnish report.

Previous studies have identified low levels of vitamin B12 and folate in the serum and red blood cells of patients with depressive disorders. Low levels of folate have also been associated with a poor response to antidepressive therapy. However, results from several recent large studies investigating the link between vitamin B12, folate and depressive disorders have been conflicting.

To better understand this relationship, investigators led by Jukka Hintikka, MD, PhD, of Kuopio University Hospital, Finland, performed a naturalistic follow-up study analysing potential associations between vitamin B12 and folate levels and the 6-month treatment outcome in patients with major depressive disorders.

The study included 115 outpatients (mean age, 42.9±10.9 years; 70 females) with DSM-III-R major depressive disorder consecutively consulted at the University Hospital. Serum vitamin B12 and erythrocyte folate levels were measured at baseline, and serum vitamin B12 levels again at 6 months.

The patients were treated by their regular outpatient psychiatrists and therapists during the study period. Level of depression was assessed at baseline and 6 months with the 17 item Hamilton Depression Rating Scale (HDRS). According to the researchers, 56% of the patients were on adequate antidepressive medication and 72% had had an adjunct therapeutic relationship during the study.

Patients with greater HDRS responses had higher vitamin B12 levels both at baseline (r = 0.39, P < .001) and at 6 months (r = 0.26, P = .021). The positive relationship between higher vitamin B12 levels and improved HDRS score was also confirmed by linear regression analysis.

The researchers found a weaker positive correlation between erythrocyte folate levels at baseline and improvement in HDRS score (r = 0.20, P = .037). Haematological indices, which may be affected by vitamin B12 and folate deficiencies, were also measured at baseline. However, no correlation was found between these parameters and HDRS score.

None of the patients had a low vitamin B12 level at baseline, and the researchers note that previous research has focused on associations between low vitamin B12 levels and poor treatment response. "As far as we know, there have been no previous studies that have suggested a positive relationship between the vitamin B12 level and the treatment outcome in patients with major depressive disorder who generally have normal or high serum vitamin B12 levels."

The researchers caution that sociodemographic, clinical and treatment variables were not controlled in this study, and recommend "further studies with controlled illness and treatment variables to confirm or refute our findings."

BMC Psychiatry 2003 Nov 27;[Epub ahead of print]. "High vitamin B12 level and good treatment outcome may be associated in major depressive disorder"

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