title: Creatine monohydrate in resistant depression: a preliminary study.
abstract: OBJECTIVE
  Creatine plays a pivotal role in brain energy homeostasis, and altered cerebral energy metabolism may be involved in the pathophysiology of depression. Oral creatine supplementation may modify brain high-energy phosphate metabolism in depressed subjects.
  
  
  METHODS
  Eight unipolar and two bipolar patients with treatment-resistant depression were treated for four weeks with 3-5 g/day of creatine monohydrate in an open add-on design. Outcome measures were the Hamilton Depression Rating Scale, Hamilton Anxiety Scale, and Clinical Global Impression scores, recorded at baseline and at weeks 1, 2, 3 and 4.
  
  
  RESULTS
  One patient improved considerably after one week and withdrew. Both bipolar patients developed hypomania/mania. For the remaining seven patients, all scale scores significantly improved. Adverse reactions were mild and transitory.
  
  
  CONCLUSIONS
  This small, preliminary, open study of creatine monohydrate suggests a beneficial effect of creatine augmentation in unipolar depression, but possible precipitation of a manic switch in bipolar depression.
authors.affiliation: Ness Ziona Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Suzana
authors.initials: S
authors.lastname: Roitman
authors.forename: Tamar
authors.initials: T
authors.lastname: Green
authors.forename: Yamima
authors.initials: Y
authors.lastname: Osher
authors.forename: Nathan
authors.initials: N
authors.lastname: Karni
authors.forename: Joseph
authors.initials: J
authors.lastname: Levine
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000139:chemically induced / Q000188:drug therapy* / Q000378:metabolism* / Q000523:psychology; D001921:Brain / Q000187:drug effects / Q000378:metabolism; D003401:Creatine / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D004734:Energy Metabolism / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000378:metabolism; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D010710:Phosphates; D003401:Creatine