CME: Vitamins, Antidepressants, and the Placebo Effect - How to Help Your Patients

Depression affects roughly 280 million people globally. The disease puts patients at increased risk for stroke, cardiovascular disease, hypertension, and diabetes. The psychosocial causes of depression are well-known, but the biochemical causes are multifactorial. Theories range from homocysteine excess, calcium modulation at the neuron, inflammation, cortisol elevation, and disruption of the HPA axis. At the center, however, is serotonin, norepinephrine, and dopamine. Pharmacologic treatment directly aims at modulation of serotonin, norepinephrine, and dopamine. First-line treatment is a combination of SSRIs/SNRIs with cognitive behavioral therapy. If patients do not see improvement with the above therapy other agents such as bupropion, mirtazapine, and tricyclic antidepressants can be added. These adjunct treatments, however, come with a host of side effects and combined with the mainstay treatment of SSRIs and SNRIs may lead to adverse patient outcomes. This study aims to explore the effects of vitamin D, magnesium, and vitamin B12 on the theorized biochemical causes of depression and formulating treatment plans that incorporate them