title: B vitamins to enhance treatment response to antidepressants in middle-aged and older adults: results from the B-VITAGE randomised, double-blind, placebo-controlled trial.
abstract: BACKGROUND
  Depression is common and the efficacy of antidepressants is suboptimal. High plasma homocysteine has been consistently associated with depression, and treatment with certain B vitamins demonstrably reduces its concentration.
  
  
  OBJECTIVE
  To determine whether vitamins B6, B12 and folic acid enhance response to antidepressant treatment over 52 weeks.
  
  
  METHODS
  Randomised, double-blind, placebo-controlled trial of citalopram (20-40 g) together with 0.5 mg of vitamin B12, 2 mg of folic acid and 25 mg of vitamin B6 for 52 weeks (Australian and New Zealand Clinical Trials Registry: 12609000256279). Participants were community-dwelling adults aged 50 years or over with DSM-IV-TR major depression. We measured severity of symptoms with the Montgomery-Åsberg Depression Rating Scale (MADRS). The primary outcome was remission of the depressive episode after 12, 26 and 52 weeks. Secondary outcomes included reduction of MADRS scores over time and relapse of major depression after recovery by week 12. Results In total, 153 people were randomised (76 placebo, 77 vitamins). Remission of symptoms was achieved by 78.1 and 79.4% of participants treated with placebo and vitamins by week 12 (P = 0.840), by 76.5 and 85.3% at week 26 and 75.8 and 85.5% at week 52 (effect of intervention over 52 weeks: odds ratio (OR) = 2.49, 95% CI 1.12-5.51). Group differences in MADRS scores over time were not significant (P = 0.739). The risk of subsequent relapse among those who had achieved remission of symptoms at week 12 was lower in the vitamins than placebo group (OR = 0.33, 95% CI 0.12-0.94).
  
  
  CONCLUSIONS
  B vitamins did not increase the 12-week efficacy of antidepressant treatment, but enhanced and sustained antidepressant response over 1 year. Replication of these findings would mandate that treatment guidelines adopt the adjunctive use of B vitamins as a safe and inexpensive strategy to manage major depression in middle-aged and older adults.
authors.affiliation: Osvaldo P. Almeida, MD, PhD, FRANZCP, Andrew H. Ford, MBBS, PhD, FRANZCP, WA Centre for Health & Ageing, Centre for Medical Research, Perth, School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth and Department of Psychiatry, Royal Perth Hospital, Perth; Varsha Hirani, BSc, WA Centre for Health & Ageing, Centre for Medical Research, Perth, School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth; Vash Singh, MBBS, FRANZCP, Department of Psychiatry, Royal Perth Hospital, Perth; Frank M. vanBockxmeer, PhD, Department of Clinical Biochemistry, PathWest Laboratory Medicine WA, Royal Perth Hospital, Perth; Kieran McCaul, PhD, WA Centre for Health & Ageing, Centre for Medical Research, Perth; Leon Flicker, MBBS, PhD, FRACP, School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, School of Medicine and Pharmacology, University of Western Australia, Perth and Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia.
authors.forename: Osvaldo P
authors.initials: OP
authors.lastname: Almeida
authors.affiliation: Osvaldo P. Almeida, MD, PhD, FRANZCP, Andrew H. Ford, MBBS, PhD, FRANZCP, WA Centre for Health & Ageing, Centre for Medical Research, Perth, School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth and Department of Psychiatry, Royal Perth Hospital, Perth; Varsha Hirani, BSc, WA Centre for Health & Ageing, Centre for Medical Research, Perth, School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth; Vash Singh, MBBS, FRANZCP, Department of Psychiatry, Royal Perth Hospital, Perth; Frank M. vanBockxmeer, PhD, Department of Clinical Biochemistry, PathWest Laboratory Medicine WA, Royal Perth Hospital, Perth; Kieran McCaul, PhD, WA Centre for Health & Ageing, Centre for Medical Research, Perth; Leon Flicker, MBBS, PhD, FRACP, School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, School of Medicine and Pharmacology, University of Western Australia, Perth and Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Ford
authors.affiliation: Osvaldo P. Almeida, MD, PhD, FRANZCP, Andrew H. Ford, MBBS, PhD, FRANZCP, WA Centre for Health & Ageing, Centre for Medical Research, Perth, School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth and Department of Psychiatry, Royal Perth Hospital, Perth; Varsha Hirani, BSc, WA Centre for Health & Ageing, Centre for Medical Research, Perth, School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth; Vash Singh, MBBS, FRANZCP, Department of Psychiatry, Royal Perth Hospital, Perth; Frank M. vanBockxmeer, PhD, Department of Clinical Biochemistry, PathWest Laboratory Medicine WA, Royal Perth Hospital, Perth; Kieran McCaul, PhD, WA Centre for Health & Ageing, Centre for Medical Research, Perth; Leon Flicker, MBBS, PhD, FRACP, School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, School of Medicine and Pharmacology, University of Western Australia, Perth and Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia.
authors.forename: Varsha
authors.initials: V
authors.lastname: Hirani
authors.affiliation: Osvaldo P. Almeida, MD, PhD, FRANZCP, Andrew H. Ford, MBBS, PhD, FRANZCP, WA Centre for Health & Ageing, Centre for Medical Research, Perth, School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth and Department of Psychiatry, Royal Perth Hospital, Perth; Varsha Hirani, BSc, WA Centre for Health & Ageing, Centre for Medical Research, Perth, School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth; Vash Singh, MBBS, FRANZCP, Department of Psychiatry, Royal Perth Hospital, Perth; Frank M. vanBockxmeer, PhD, Department of Clinical Biochemistry, PathWest Laboratory Medicine WA, Royal Perth Hospital, Perth; Kieran McCaul, PhD, WA Centre for Health & Ageing, Centre for Medical Research, Perth; Leon Flicker, MBBS, PhD, FRACP, School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, School of Medicine and Pharmacology, University of Western Australia, Perth and Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia.
authors.forename: Vash
authors.initials: V
authors.lastname: Singh
authors.affiliation: Osvaldo P. Almeida, MD, PhD, FRANZCP, Andrew H. Ford, MBBS, PhD, FRANZCP, WA Centre for Health & Ageing, Centre for Medical Research, Perth, School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth and Department of Psychiatry, Royal Perth Hospital, Perth; Varsha Hirani, BSc, WA Centre for Health & Ageing, Centre for Medical Research, Perth, School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth; Vash Singh, MBBS, FRANZCP, Department of Psychiatry, Royal Perth Hospital, Perth; Frank M. vanBockxmeer, PhD, Department of Clinical Biochemistry, PathWest Laboratory Medicine WA, Royal Perth Hospital, Perth; Kieran McCaul, PhD, WA Centre for Health & Ageing, Centre for Medical Research, Perth; Leon Flicker, MBBS, PhD, FRACP, School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, School of Medicine and Pharmacology, University of Western Australia, Perth and Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia.
authors.forename: Frank M
authors.initials: FM
authors.lastname: vanBockxmeer
authors.affiliation: Osvaldo P. Almeida, MD, PhD, FRANZCP, Andrew H. Ford, MBBS, PhD, FRANZCP, WA Centre for Health & Ageing, Centre for Medical Research, Perth, School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth and Department of Psychiatry, Royal Perth Hospital, Perth; Varsha Hirani, BSc, WA Centre for Health & Ageing, Centre for Medical Research, Perth, School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth; Vash Singh, MBBS, FRANZCP, Department of Psychiatry, Royal Perth Hospital, Perth; Frank M. vanBockxmeer, PhD, Department of Clinical Biochemistry, PathWest Laboratory Medicine WA, Royal Perth Hospital, Perth; Kieran McCaul, PhD, WA Centre for Health & Ageing, Centre for Medical Research, Perth; Leon Flicker, MBBS, PhD, FRACP, School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, School of Medicine and Pharmacology, University of Western Australia, Perth and Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia.
authors.forename: Kieran
authors.initials: K
authors.lastname: McCaul
authors.affiliation: Osvaldo P. Almeida, MD, PhD, FRANZCP, Andrew H. Ford, MBBS, PhD, FRANZCP, WA Centre for Health & Ageing, Centre for Medical Research, Perth, School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth and Department of Psychiatry, Royal Perth Hospital, Perth; Varsha Hirani, BSc, WA Centre for Health & Ageing, Centre for Medical Research, Perth, School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth; Vash Singh, MBBS, FRANZCP, Department of Psychiatry, Royal Perth Hospital, Perth; Frank M. vanBockxmeer, PhD, Department of Clinical Biochemistry, PathWest Laboratory Medicine WA, Royal Perth Hospital, Perth; Kieran McCaul, PhD, WA Centre for Health & Ageing, Centre for Medical Research, Perth; Leon Flicker, MBBS, PhD, FRACP, School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, School of Medicine and Pharmacology, University of Western Australia, Perth and Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia.
authors.forename: Leon
authors.initials: L
authors.lastname: Flicker
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000008:administration & dosage; D015283:Citalopram / Q000008:administration & dosage*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D016903:Drug Monitoring; D004357:Drug Synergism; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012074:Remission Induction / Q000379:methods; D055502:Secondary Prevention / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D014805:Vitamin B 12 / Q000008:administration & dosage*; D025101:Vitamin B 6 / Q000008:administration & dosage*; D014815:Vitamins / Q000008:administration & dosage
chemical_list: D000928:Antidepressive Agents; D014815:Vitamins; D015283:Citalopram; D025101:Vitamin B 6; D005492:Folic Acid; D014805:Vitamin B 12