Creatine for Depression
Creatine appears to be a safe and well-tolerated aid for increasing the antidepressant efficacy of CBT.
This pilot study investigated the potential of creatine monohydrate as an add-on to cognitive-behavioural therapy (CBT) for depression in an under-resourced area. The 8-week, double-blind, randomised, placebo-controlled trial found that creatine combined with CBT led to a significantly greater reduction in depression scores compared to placebo plus CBT.
Key Points
Explored an accessible and affordable nutraceutical (creatine) as a potential adjunct to traditional depression treatment (CBT).
Emphasises the importance of improving treatment outcomes for depression, given the high prevalence and limitations of current therapies.
Aim
The primary aim was to assess the efficacy, acceptability, tolerability, and safety of creatine monohydrate as an add-on to CBT in treating depression. It sought to determine if creatine could enhance the effects of CBT in a community sample of patients diagnosed with depression.
Methods
Study Design: Pilot (Phase 2), randomised, parallel-arm, placebo-controlled, double-blind, feasibility and exploratory trial.
Participants: 100 participants (50 females, mean age = 30.4 ± 7.4 years) with a diagnosis of major depressive disorder and a score ≥5 on the Patient Health Questionnaire (PHQ)-9.
Exclusion criteria included bipolar disorder, psychotic depression, substance misuse, and use of psychotropic drugs.
Intervention:
Creatine + CBT arm: 5 g/day of oral creatine monohydrate + biweekly individual CBT sessions.
Placebo + CBT arm: 5 g/day of oral starch (placebo) + biweekly individual CBT sessions.
CBT Sessions: Low-intensity (biweekly) 45-minute sessions based on Beck’s CBT principles, focusing on psychoeducation, cognitive restructuring, and behavioural activation/modification.
Outcomes Measured:
Primary Outcome: Change in depressive symptom severity, measured using the PHQ-9 at the 8-week endpoint.
Secondary Outcomes: Acceptability (treatment discontinuations due to any cause), tolerability (treatment discontinuations due to adverse events), and safety (proportion of patients experiencing at least one adverse event).
Results
Efficacy: PHQ-9 scores were significantly lower in the creatine + CBT group compared to the placebo + CBT group (mean difference = -5.12).
Acceptability, Tolerability, and Safety: Treatment discontinuations due to any cause or adverse events and the proportion of participants with at least one adverse event were comparable between the two groups.
Conclusion: Creatine could be a useful and safe supplement to CBT for depression.
Practical Use
Mental Health Benefits of Creatine: While creatine is widely used to enhance physical performance, this study suggests it may also benefit mental health, specifically in reducing depressive symptoms when combined with therapy.
Dosage: The study used a 5 g/day dose of creatine monohydrate, a common and generally safe supplement dosage.
Safety Profile: The study found that creatine was well-tolerated and safe, with no significant differences in adverse events compared to the placebo group. This reinforces the existing understanding of creatine as a safe supplement for most people.
Combined Approach: The study combined creatine with CBT, highlighting the potential benefits of a holistic approach to mental health that includes both lifestyle interventions (like creatine supplementation) and psychological therapy.
Related
Key Takeaways
Potential Adjunct Treatment: Creatine monohydrate shows promise as a safe and effective adjunct to CBT for treating depression.
Need for Further Research: The authors emphasise that longer and larger clinical trials are warranted to confirm these findings and explore the mechanisms of action.
Affordable and Accessible Option: Creatine is an affordable and accessible nutraceutical, making it a potentially valuable option for managing depression, especially in resource-limited settings.
Holistic Approach: The study supports a holistic approach to mental health, combining nutritional interventions with traditional therapies.
This study provides preliminary evidence supporting the use of creatine as an add-on treatment for depression. However, it is important to note that this was a pilot study, and more research is needed to confirm these findings and determine the optimal use of creatine in the treatment of depression.
Reference
Sherpa, N. N., De Giorgi, R., Ostinelli, E. G., Choudhury, A., Dolma, T., & Dorjee, S. (2024). Efficacy and safety profile of oral creatine monohydrate in add-on to cognitive-behavioural therapy in depression: An 8-week pilot, double-blind, randomised, placebo-controlled feasibility and exploratory trial in an under-resourced area. European Neuropsychopharmacology, 90, 28-35. https://doi.org/10.1016/j.euroneuro.2024.10.004