Allison Barfield N00960045

The Effect of Vitamin D Supplementation on Depression in Older Adults

Vitamin D deficiency is one of the most common deficiencies in the United States and other

developed countries;1 It is estimated that around one billion people worldwide have a vitamin D

deficiency.2 The effects of a global vitamin deficiency cannot be understated. Low vitamin D levels

impair our immune function.2 Vitamin D deficiency may also worsen the effects of type 1 diabetes,

multiple sclerosis, sarcopenia, rheumatoid arthritis, and cancer. 2 It is not hard to see why this deficiency is

on the rise; more people are staying inside than ever before, since many jobs can be done indoors or

require the use of a computer, and physical activity is on the decline. Being outdoors in the sun is an

important factor in serum (blood) vitamin D levels, since sun exposure stimulates skin’s production of

vitamin D.1 7-dehydrocholesterol, produced by the cholesterol-forming system in our bodies, is converted

by UV radiation to previtamin D3, which then becomes cholecalciferol (vitamin D 3).1 That second step,

the conversion of 7-dehydrocholesterol into previtamin D3, is reduced as you age and by darker skin

tones, and is blocked by clothing and sunblock.1 Sunlight exposure is a much bigger contributor to

vitamin D status than other sources.1 The other major source of vitamin D for humans is food, with fish,

dairy (fortified), egg yolk, bread (fortified), and liver having the highest amounts of the nutrient. 1 Vitamin

D deficiency is diagnosed if serum 25(OH)D (or blood vitamin D) levels drop below 25nm/L. 1 People

suffering from obesity are more at risk for vitamin D deficiency, since vitamin D is not stored as well in

fat tissues.1 Others at risk for vitamin D deficiency include those living far from the equator, because they

do not get as much sunlight; children younger than five; pregnant women; people over 65; and non-

Western immigrants.1 Calcium, if ingested at the same time as vitamin D, increases the amount of time

that vitamin D is stored in the body, lowering the risk of deficiency. 1

Vitamin D deficiency is especially prevalent among older populations. 2 Lack of exposure to

sunlight, poor dietary intake, and a reduced ability to synthesize vitamin D all contribute to their

deficiency.2 Without vitamin D, it is harder to absorb and metabolize calcium, which can compromise the

bone health of geriatric patients.2 Many studies have also linked depression with low blood 25(OH)D
levels, which is a major problem, because depression is already so prevalent among the elderly. 2 As

Oliveira et al. put it, depression in older adults is often “under-recognized and under-treated”. 2 Depression

symptoms are especially burdensome to the elderly population, who might not be able to do as many

enjoyable activities anymore and who may be seeing their loved ones pass away. 3 Almost 350 million

people worldwide are affected by depression. 3 Since depression is a strong contributor toward disability

and mortality, and depression medications often have unwanted side effects, it is reasonable to explore a

different direction of treatment methods. 3 Since cholecalciferol supplements are so cheaply and readily

available nowadays, clinical trials must be pursued in order to find out if the answer was right under our

noses.3 Supplemental vitamin D could be a much easier way for geriatric patients to treat their depression.

Low vitamin D levels have long been associated with depressive symptoms, but are vitamin D pills a

viable treatment for depression?2 This review will evaluate the current literature on the issue, and will

determine whether depression in vitamin D-deficient older adults can be treated with a vitamin D

supplement.

Methods

CINAHL, PubMed, and ScienceDirect were utilized in the research article search. The keywords

“vitamin”, “vitamin D”, “supplement”, “supplementation”, “depression”, “depressive”, “elderly”, and

“geriatric” were all used at varying points to search for relevant articles. Through the use of search filters,

any articles older than 2012, articles that weren’t peer reviewed, and any that weren’t published in a

scientific journal were excluded.

Studies 1 and 2- Low Vitamin D Levels have been Associated with Depression Symptoms

Study 1 was conducted by Brower-Brolsma et al.3 This study examined 2839 Dutch adults over

the age of 65. Depression symptoms were assessed using the 15-point Geriatric Depression Scale (GDS).

A calcidiol test (also called a 25(OH)D test) was performed on each subject. The researchers were able to

observe an association between low serum 25(OH)D levels and higher depressive symptom scores. This
study provides evidence that suggests low blood Vitamin D levels and depression may be linked in

elderly patients.

Study 2 was conducted by Hoogendijk et al.4 In this study, 3107 randomly selected Dutch men

and women age 55-85 were chosen to participate. Their serum vitamin D levels were tested, and they

were given a Center for Epidemiologic Studies Depression (CES-D) questionnaire. Then, 10 years later,

all of the participants who were still alive and consented were tested again, with serum vitamin D and

depression symptoms again being measured. In those who scored in the depression category on the

questionnaire or who were medically diagnosed with depression, 25(OH)D levels were 14% lower than

those who did not have depression. This study shows that even with a large, population-based sample

size, decreased serum 25(OH)D levels and depression status are associated.

Studies 3, 4, 5- The Effect of Different Vitamin D Doses on Geriatric Depression Scores

Many studies have seen the correlation between low vitamin D status and depression and have

tried to remedy it with supplementation. Study 3 was conducted by Yalamanchili et al. 5 In this double-

blind, randomized trial, researchers examined African American and Caucasian women who were at least

7 years post-menopause over a 12-month period. Participants were given vitamin D supplements ranging

in dose from 400 to 4800 IU per day, and calcium supplements of 1200mg per day. Depression in the

participants was assessed using the GDS, and it changed from 3.8 to 3.6 (Caucasian) and 3.0 to 3.02

(African American). This study suggests that vitamin D supplementation is not a good solution for

depression symptoms in elderly women.

Study 4 was conducted by Mousa et al.6 This study looked at 48 overweight or obese vitamin D-

deficient Australian adults without a clinical depression diagnosis over a period of 16 weeks. Participants

were randomly sorted into two groups. Group one consumed a one-time oral dose of 100,000 IU of

vitamin D and a daily dose of 4000 IU of cholecalciferol. Group two received equivalent placebos.

Depression was measured in all participants with the Beck Depression Inventory, and 25(OH)D levels
were also measured. The researchers found no significant differences in the depression scores of both

groups at the end of the study.

Study 5 was conducted by Song et al.7 In this prospective observational study, 177 patients from

heart failure outpatient clinics in Seoul, Korea who had depression symptoms and a diagnosis of heart

failure for two or more years were examined. All patients were between the ages of 54 and 76. A three-

day food diary was used to assess dietary vitamin D intake, and 80 patients reported taking vitamin D

supplements. The study found that heart failure patients who had vitamin D deficiency and did not use

vitamin D supplements had the highest risk for depression symptoms. However, the researchers noted that

vitamin D supplementation alone was not associated with a lower risk of depressive symptoms.

Discussion

Studies 1 (Brouwer-Brolsma et al.) and 2 (Hoogendijk et al.), which connected depression and

low serum vitamin D, both utilized elderly Dutch participants. 3,4 Although they used different depression

scales to assess depression symptoms in their participants, they both tested serum vitamin D levels. Both

studies found a correlation between low blood vitamin D and higher incidence of depression. 3,4 These

were the studies that other researchers built on, in order to see if supplementation of vitamin D could be a

viable option in preventing or treating depression in geriatric patients. It was at that time promising to

assume that fixing a patient’s serum vitamin D levels through a vitamin D supplement could alleviate or

at least reduce the patient’s depression symptoms, with the added benefit of remedying their deficiency.

Studies 3 (Yalamanchili et al.), 4 (Mousa et al.), and 5 (Song et al.) explored the possibility of

treating depression in the elderly with vitamin D.5,6,7 Study three was conducted with American

participants, study four with Australians, and study five with Koreans. 5,6,7 Study three tested many doses

of vitamin D, in order to assess whether the problem was that previous studies just hadn’t used a big

enough dose to make an impact.5 For all their doses, they unfortunately found no association. 5 Study 3

was the only study referenced that supplemented the participants’ calcium in addition to their vitamin D. 5
They were also the only referenced study to compare the participation groups by race. 5 In study four,

participants all received one large dose of vitamin D designed to last them 16 weeks, so this study

approached the dose problem of previous research in a different way. 6 They too, however, found no

significant reduction in depression symptoms after taking the supplement. 6 Study 4 did not specify the

race of their participants.6 Study 5 was the only one to assess dietary intake of vitamin D, although they

used a food diary, which is easily manipulated or misunderstood. 7 Out of the patients who reported taking

vitamin D supplements, the researchers did not make designations to separately compare the patients by

dosage (ex. putting those who took 500 IU of vitamin D in a separate group than those who took 1000 IU

for comparison purposes).7 They found that, like previous studies had shown, those who were deficient in

vitamin D were more likely to have depression symptoms. 7 They did find, however, that vitamin D

supplementation alone was not associated with a lower risk of depressive symptoms. 7 We are left to

assume that all of the patients who participated in study 5 were Korean, since the study took place in

Korea.7 Of the referenced studies, we have tested Asian, Caucasian, and African American men and

women.5,6,7 Further studies should be conducted to determine if people of Hispanic descent derive any

depression benefit from vitamin D supplementation, or perhaps other Asians, like Indians.

Conclusion

Depression and vitamin D deficiency are both widespread problems that affect many people

worldwide.1 Although many studies have been able to link a low vitamin D status and a higher incidence

of depression, including studies 1 and 2, studies 3, 4, and 5 did not find that supplementing vitamin D

resulted in a reduction of depression symptoms in the elderly populations they tested. 3,4,5,6,7 A study that

showed fewer depression symptoms in elderly patients who supplemented vitamin D could not be found.

Although vitamin D supplementation can be useful in maintaining blood 25(OH)D levels, which can aid

the immune system and other body functions, so far there is unfortunately no evidence that vitamin D

supplementation makes a significant difference in geriatric depression scores. 3,4,5,6,7 There may still be a
link, such as a possible depression preventative, but further clinical trials and prospective studies are

needed to determine any possible correlations.

 References

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