Depression and Vitamin D

Vitamin D deficiency is a major contributor to the high rates of depression, as well as other chronic diseases, and is caused by lessened exposure to sunlight.¹ Along with our sedentary lifestyles, we spend much less time outside in the sunlight as was common of our ancestors. It is also hypothesized that lessened exposure to the sun (and therefore vitamin D) in the winter is specifically part of the cause of Seasonal Affective Disorder (SAD); a specific form of depression.

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Wrongly termed a vitamin, vitamin D is actually what is known as a precursor hormone. The metabolic product of vitamin D, the hormone calcitriol, affects the key biological functions of over 2000 genes in the body responsible for hormone balance, cell growth and immune function.² Other nutrients and hormones that help vitamin D in the body with the aforementioned functions include: Magnesium, Zinc, Vitamin K-12, Boron & Vitamin A.^2,3

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The long-standing recommendation of 200 International Units (IU) of vitamin D per day is now thought to be extremely low . Some studies claim it to be safe for people to receive up to 5,000 IUs per day, but the US Food and Nutrition Board and the European Union Scientific Committee on Food say that 2,000 IU per day is the safety cut-off³.

With concerns of excessive UV exposure juxtaposed with the need for more vitamin D in our bodies, setting general guidelines for direct sun exposure is difficult. This coupled with the variability of an individual's ability to absorb vitamin D (due to, among other factors, skin color density) can make testing for a vitamin D deficiency and monitoring of any supplements taken that much more important.

However, general guidelines might include trying to receive 20-30 minutes of sun exposure (with as much skin exposed) a few times a week without burning.

It is important to work with your doctor to monitor your levels to make sure you are within a healthy range (no more than 5,000 IU- the noted toxicity level).

Safety Issues

When taken at recommended dosages, vitamin D appears to be safe. However, when used at considerable excess, vitamin D can build up in the body and cause toxic symptoms. At an intake level of about 40,000 IU daily (about 100 times the recommended daily intake) vitamin D can cause dangerous elevations in blood calcium levels. ¹ Doses five times higher than this were consumed by a few individuals due to a manufacturing error; the resulting toxicity was severe and may have caused death in one individual. ² However, short of these vastly excessive dosages, it is not clear at what level vitamin D becomes toxic.

According to updated recommendations from the Institute of Medicine,⁴⁴ the safe upper limits (UL) for vitamin D daily intake are as follows:

• Children and Infants:
  • 0-6 months: 1,000 IU
  • 6-12 months: 1,500 IU
  • 1-3 years: 2,500 IU
  • 4-8 years: 3,000 IU
  • 9-18 years: 4,000 IU

• Adults:
  • 19-70 years: 4,000 IU
  • 71 years and older: 4,000 IU

• Pregnant/lactating women:
  • 14-50 years: 4,000 IU

There is no disagreement that people with sarcoidosis or hyperparathyroidism should never take vitamin D without first consulting a physician.

Taking vitamin D and calcium supplements might interfere with some of the effects of drugs in the calcium-channel blocker family. ³ It is very important that you consult your physician before trying this combination.

The combination of calcium, vitamin D, and thiazide diuretics could potentially lead to excessive calcium levels in the body. ⁴ If you are taking thiazide diuretics, you should consult with a physician about the right doses of vitamin D and calcium for you.

Interactions You Should Know About

• You may need extra vitamin D if you are taking antiseizure drugs, such as:
  • Phenobarbital
  • Primidone (Mysoline)
  • Valproic acid (Depakene)
  • Phenytoin (Dilantin)
  • Corticosteroids
  • Cimetidine (Tagamet)
  • Heparin
  • Isoniazid (INH)
  • Rifampin

• If you are taking calcium-channel blockers , do not take high-dose vitamin D (with calcium) except under physician supervision.

• If you are taking thiazide diuretics , do not take calcium and vitamin D supplements unless under a doctor's supervision.

1. Klontz KC, Acheson DW. Dietary supplement-induced vitamin D intoxication. N Engl J Med. 357(3):308-9.
2. Klontz KC, Acheson DW. Dietary supplement-induced vitamin D intoxication. N Engl J Med. 357(3):308-9.
3. Bar-Or D, Gasiel Y. Calcium and calciferol antagonise effect of verapamil in atrial fibrillation. Br Med J (Clin Res Ed). 282(6276):1585-6.
4. Riis B, Christiansen C. Actions of thiazide on vitamin D metabolism: a controlled therapeutic trial in normal women early in the postmenopause. Metabolism. 34(5):421-4.

1 Alleger, I. (2009) Therapeutic Lifestyle Change (TLC) to Beat Depression without Drugs. [Review of the book The Depression Cure by Ilardi, S.S.(2009)].

2 http://www.vitamindcouncil.org/

3 http://www.womentowomen.com/healthynutrition/vitamind.aspx