title: Testing homocysteine-induced neurotransmitter deficiency, and depression of mood hypothesis in clinical practice.
abstract: BACKGROUND
  high total plasma homocysteine (tHcy) levels may cause neurotransmitter deficiency, and consequently depression of mood. We have recently shown that mixed oral nutritional supplements containing B-group vitamins led to a statistically significant benefit on depressive symptoms. The aim of this report was to examine the association between elevated plasma tHcy and symptoms of depression in older patients.
  
  
  METHODS
  two-hundred and thirty-six hospitalised acutely ill older patients, who were part of a randomised double-blind placebo-controlled trial, were assigned to receive daily mixed oral nutritional supplements containing B-group vitamins or a placebo for 6 weeks. Outcome measures included symptoms of depression measured using Geriatric Depression score and plasma tHcy levels.
  
  
  RESULTS
  the mean tHcy concentration fell by 22% among patients given the supplements compared with the placebo group (mean difference 4.1 µmol/l (95% CI: 0.14-8.03), P = 0.043). tHcy concentrations was divided into four quartiles and analysed against depression scores. tHcy concentrations in the first relative to the fourth quartile of the distribution were associated with a lower depression symptoms at the end of the supplement period (Geriatric depression score r = -0.20, P = 0.042).
  
  
  CONCLUSIONS
  lower plasma tHcy concentrations were associated with reduced depression symptoms in older patients recovering from acute illness.
authors.affiliation: Department of Internal Medicine, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE. s.gariballa@uaeu.ac.ae
authors.forename: Salah
authors.initials: S
authors.lastname: Gariballa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D016638:Critical Illness / Q000523:psychology; D003863:Depression / Q000097:blood / Q000188:drug therapy*; D019587:Dietary Supplements; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D015994:Incidence; D007297:Inpatients; D008297:Male; D019964:Mood Disorders / Q000188:drug therapy*; D018377:Neurotransmitter Agents / Q000172:deficiency*; D017063:Outcome Assessment, Health Care; D016896:Treatment Outcome; D014803:Vitamin B Complex / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D015415:Biomarkers; D018377:Neurotransmitter Agents; D006710:Homocysteine; D014803:Vitamin B Complex