That's a bit of a sensational title. But hey, I guess sensationalism works in the blogosphere these days (or forever in the past and forevermore), and I'm not proud.
Creatine! We love creatine. There's lots of it in skeletal muscle, which we omnivores tend to eat and love because steak is oh so yummy. Vegetarians are low in it and more apt to have mental illness, at least in some observational studies. Muscleheads have been supplementing with creatine forever for muscle building and power at the gym, but some studies have shown some benefits for vegetarians and folks with Parkinson's disease. But wow, a pilot study was published the other day in the Green Journal (the best of the best of psychiatry medical journals) that could blow the door open for more applications for this supplement. It turns out the medical doctors in Utah are staging a larger follow-up study as we speak, which warrants a mention on Evolutionary Psychiatry for sure. Thanks to @AnnChildersMD for the link.
Here is the gist of the new study. A depressed brain has crappy energetics. It's inflamed and not using energy as efficiently as it could. That means ATP (body gasoline) is not being created and used as efficiently as possible. Creatine supplementation, it is well known, can juice up a superfast pathway to create new ATP by increasing the reservoirs of phosphocreatine, which provides phosphate to make more ATP (adenosine-tri-phosphate). It turns out that depressed brains that respond to treatment with SSRIs or thyroid hormones tend to have higher levels of ATP at the ready. That finding caused some researchers' brains to click to the "on" position. After all, only 60% of folks respond to antidepressant treatment (barely better than placebo). What if we augmented antidepressant treatment with creatine? (For more excrutiating details, follow some of those links in the previous paragraph.)
52 women (in mice, the effect was found to be more profound among female rodents, so female humans were used in the pilot trial to ensure the best results. I would have recommended female vegetarians, but no one listens to me much) met the criteria for inclusion in the pilot trial. They had to meet criteria for a depressive disorder, not be on antidepressants, not be pregnant, otherwise sick, etc. 1/2 the group was put on ecitalopram (lexapro) plus placebo and the other 1/2 was put on ecitalopram plus creatine (3g daily for a weeks, then 5g daily for the next 7 weeks).
Turns out the creatine supplementers responded earlier and better than the antidepressant alone group using a couple different scales (HAM-D and MADRS). The creatine group had higher response and remittance rate and no higher incidence of side effects. Sounds like a win win. Of note, SAM-e may provide a similar benefit, and it is a methyl donor which helps in the natural production of creatine.
So this was a small study, and a single study so more something to scratch your head about and take notice than for any sort of recommendations. But very interesting. I'm all for investigating the roots of brain energetics in the pathology of major depressive disorders, and finding inexpensive and practical solutions to make lives with depression better faster.