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Published Online: 1 September 2012

A Randomized, Double-Blind Placebo-Controlled Trial of Oral Creatine Monohydrate Augmentation for Enhanced Response to a Selective Serotonin Reuptake Inhibitor in Women With Major Depressive Disorder

Abstract

Antidepressants often take several weeks to work, but depressed women who took the antidepressant escitalopram plus 5 g/day of creatine monohydrate, a supplement that increases cellular energy, had earlier and greater symptom decreases than women who took escitalopram plus placebo. The authors found a difference by the second week of treatment, and the remission rate at 8 weeks was twice as high for the creatine group (52%) as for the placebo group (26%). Most side effects were attributed to escitalopram, not creatine, but serum creatinine was elevated in the treatment group.

Abstract

Objective

Antidepressants targeting monoaminergic neurotransmitter systems, despite their immediate effects at the synaptic level, usually require several weeks of administration to achieve clinical efficacy. The authors propose a strategy of adding creatine monohydrate (creatine) to a selective serotonin reuptake inhibitor (SSRI) in the treatment of patients with major depressive disorder. Such augmentation may lead to a more rapid onset of antidepressant effects and a greater treatment response, potentially by restoring brain bioenergetics at the cellular level.

Method

Fifty-two women with major depressive disorder were enrolled in an 8-week double-blind placebo-controlled clinical trial and randomly assigned to receive escitalopram in addition to either creatine (5 g/day, N=25) or placebo (N=27). Efficacy was primarily assessed by changes in the Hamilton Depression Rating Scale (HAM-D) score.

Results

In comparison to the placebo augmentation group, patients receiving creatine augmentation showed significantly greater improvements in HAM-D score, as early as week 2 of treatment. This differential improvement favoring creatine was maintained at weeks 4 and 8. There were no differences between treatment groups in the proportion of patients who discontinued treatment prematurely (creatine: N=8, 32.0%; placebo: N=5, 18.5%) or in the overall frequency of all reported adverse events (creatine: 36 events; placebo: 45 events).

Conclusions

The current study suggests that creatine augmentation of SSRI treatment may be a promising therapeutic approach that exhibits more rapid and efficacious responses in women with major depressive disorder.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 937 - 945
PubMed: 22864465

History

Received: 4 January 2012
Revision received: 28 March 2012
Accepted: 26 April 2012
Published online: 1 September 2012
Published in print: September 2012

Authors

Details

In Kyoon Lyoo, M.D., Ph.D.
From the Department of Psychiatry and the Interdisciplinary Program in Neuroscience, Seoul National University College of Medicine and College of Natural Sciences, Seoul, South Korea; the Department of Psychiatry, Catholic University of Korea College of Medicine, Seoul, South Korea; the Brain Institute and the Department of Psychiatry, University of Utah, Salt Lake City; the Department of Psychiatry, Soonchunhyang University College of Medicine, Seoul, South Korea; and the Department of Brain and Cognitive Sciences, Ewha Women’s University Graduate School, Seoul, South Korea.
Sujung Yoon, M.D., Ph.D.
From the Department of Psychiatry and the Interdisciplinary Program in Neuroscience, Seoul National University College of Medicine and College of Natural Sciences, Seoul, South Korea; the Department of Psychiatry, Catholic University of Korea College of Medicine, Seoul, South Korea; the Brain Institute and the Department of Psychiatry, University of Utah, Salt Lake City; the Department of Psychiatry, Soonchunhyang University College of Medicine, Seoul, South Korea; and the Department of Brain and Cognitive Sciences, Ewha Women’s University Graduate School, Seoul, South Korea.
Tae-Suk Kim, M.D., Ph.D.
From the Department of Psychiatry and the Interdisciplinary Program in Neuroscience, Seoul National University College of Medicine and College of Natural Sciences, Seoul, South Korea; the Department of Psychiatry, Catholic University of Korea College of Medicine, Seoul, South Korea; the Brain Institute and the Department of Psychiatry, University of Utah, Salt Lake City; the Department of Psychiatry, Soonchunhyang University College of Medicine, Seoul, South Korea; and the Department of Brain and Cognitive Sciences, Ewha Women’s University Graduate School, Seoul, South Korea.
Jaeuk Hwang, M.D., Ph.D.
From the Department of Psychiatry and the Interdisciplinary Program in Neuroscience, Seoul National University College of Medicine and College of Natural Sciences, Seoul, South Korea; the Department of Psychiatry, Catholic University of Korea College of Medicine, Seoul, South Korea; the Brain Institute and the Department of Psychiatry, University of Utah, Salt Lake City; the Department of Psychiatry, Soonchunhyang University College of Medicine, Seoul, South Korea; and the Department of Brain and Cognitive Sciences, Ewha Women’s University Graduate School, Seoul, South Korea.
Jieun E. Kim, M.D., Ph.D.
From the Department of Psychiatry and the Interdisciplinary Program in Neuroscience, Seoul National University College of Medicine and College of Natural Sciences, Seoul, South Korea; the Department of Psychiatry, Catholic University of Korea College of Medicine, Seoul, South Korea; the Brain Institute and the Department of Psychiatry, University of Utah, Salt Lake City; the Department of Psychiatry, Soonchunhyang University College of Medicine, Seoul, South Korea; and the Department of Brain and Cognitive Sciences, Ewha Women’s University Graduate School, Seoul, South Korea.
Wangyoun Won, M.D.
From the Department of Psychiatry and the Interdisciplinary Program in Neuroscience, Seoul National University College of Medicine and College of Natural Sciences, Seoul, South Korea; the Department of Psychiatry, Catholic University of Korea College of Medicine, Seoul, South Korea; the Brain Institute and the Department of Psychiatry, University of Utah, Salt Lake City; the Department of Psychiatry, Soonchunhyang University College of Medicine, Seoul, South Korea; and the Department of Brain and Cognitive Sciences, Ewha Women’s University Graduate School, Seoul, South Korea.
Sujin Bae, Ph.D.
From the Department of Psychiatry and the Interdisciplinary Program in Neuroscience, Seoul National University College of Medicine and College of Natural Sciences, Seoul, South Korea; the Department of Psychiatry, Catholic University of Korea College of Medicine, Seoul, South Korea; the Brain Institute and the Department of Psychiatry, University of Utah, Salt Lake City; the Department of Psychiatry, Soonchunhyang University College of Medicine, Seoul, South Korea; and the Department of Brain and Cognitive Sciences, Ewha Women’s University Graduate School, Seoul, South Korea.
Perry F. Renshaw, M.D., Ph.D.
From the Department of Psychiatry and the Interdisciplinary Program in Neuroscience, Seoul National University College of Medicine and College of Natural Sciences, Seoul, South Korea; the Department of Psychiatry, Catholic University of Korea College of Medicine, Seoul, South Korea; the Brain Institute and the Department of Psychiatry, University of Utah, Salt Lake City; the Department of Psychiatry, Soonchunhyang University College of Medicine, Seoul, South Korea; and the Department of Brain and Cognitive Sciences, Ewha Women’s University Graduate School, Seoul, South Korea.

Notes

Address correspondence to Dr. Lyoo ([email protected]).

Funding Information

Dr. Lyoo has received research support from AstraZeneca, Boryung, Eli Lilly, GlaxoSmithKline, Lundbeck, and Organon. Dr. Renshaw has been a consultant for Kyowa Hakko, Novartis, Repligen, and Roche and has received research support from GlaxoSmithKline and Roche, and he is also an inventor on related patent applications assigned to McLean Hospital and the University of Utah; Dr. Renshaw did not participate in the assessment of study subjects in this project. The other authors report no financial relationships with commercial interests.
Supplementary Material
This study was supported by an independent investigator award from NARSAD (Dr. Lyoo), grant 2011K000273 from the Brain Research Center of the 21st Century Frontier Research Program (Dr. Lyoo), grant KRF-2008-220-E00021 from the Global Research Network Program, the Korea Research Foundation (Dr. Lyoo), the Mental Illness Research, Education and Clinical Center of Veterans Integrated Service Network 19 (Dr. Renshaw), National Institute on Drug Abuse grants DA-015116 and DA-031247 (Dr. Renshaw) and DA-024070 (Drs. Renshaw and Lyoo), and NIMH grant MH-058681 (Dr. Renshaw).

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