title: Cognitive effects of creatine monohydrate adjunctive therapy in patients with bipolar depression: Results from a randomized, double-blind, placebo-controlled trial.
abstract: Depressive episodes and cognitive impairment are major causes of morbidity and dysfunction in individuals suffering from bipolar disorder (BD). Novel treatment approaches that target clinical and cognitive aspects of bipolar depression are needed, and research on pathophysiology suggests that mitochondrial modulators such as the nutraceutical creatine monohydrate might have a therapeutic role for this condition.
  
  
  
  Eighteen (N=18) patients with bipolar depression according to DSM-IV criteria who were enrollled in a 6-week, randomized, double-blind, placebo-controlled trial of creatine monohydrate 6g daily as adjunctive therapy were submitted to neuropsychological assessments (Wisconsin Card Sorting Test, Digit Span subtest of the Wechsler Adult Intelligence Scale-Third Edition, Stroop Color-Word Test, Rey-Osterrieth complex figure test, FAS Verbal Fluency Test) at baseline and week 6.
  
  
  
  There was a statistically significant difference between the treatment groups of the change on the total scores after 6 weeks in the verbal fluency test, with improvement in the group receiving adjunctive treatment with creatine. We did not find significant differences between the groups of the changes on other neuropsychological tests.
  
  
  
  Small sample and lack of a control group of healthy subjects.
  
  
  
  Our trial, which was the first to investigate the cognitive effects of creatine monohydrate on bipolar depression, indicates that supplementation with this nutraceutical for 6 weeks is associated with improvement in verbal fluency tests in patients with this condition.
authors.affiliation: Bipolar Disorder Research Program (PROMAN), Institute of Psychiatry, University of São Paulo Medical School, Brazil.
authors.forename: Ricardo Alexandre
authors.initials: RA
authors.lastname: Toniolo
authors.affiliation: Bipolar Disorder Research Program (PROMAN), Institute of Psychiatry, University of São Paulo Medical School, Brazil.
authors.forename: Francy de Brito Ferreira
authors.initials: FBF
authors.lastname: Fernandes
authors.affiliation: Bipolar Disorder Research Program (PROMAN), Institute of Psychiatry, University of São Paulo Medical School, Brazil.
authors.forename: Michelle
authors.initials: M
authors.lastname: Silva
authors.affiliation: Bipolar Disorder Research Program (PROMAN), Institute of Psychiatry, University of São Paulo Medical School, Brazil.
authors.forename: Rodrigo da Silva
authors.initials: RDS
authors.lastname: Dias
authors.affiliation: Bipolar Disorder Research Program (PROMAN), Institute of Psychiatry, University of São Paulo Medical School, Brazil. Electronic address: blafer@usp.br.
authors.forename: Beny
authors.initials: B
authors.lastname: Lafer
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000523:psychology; D003071:Cognition; D060825:Cognitive Dysfunction / Q000188:drug therapy; D003131:Combined Modality Therapy; D003401:Creatine / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests
chemical_list: D000928:Antidepressive Agents; D003401:Creatine
keywords: Adjunctive therapy; Bipolar disorder; Cognition; Creatine monohydrate; Depression; Randomized controlled trial