Magnesium for treatment-resistant depression: A review and hypothesis
Magnesium for treatment-resistant depression: A review and hypothesis
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DOI：
10.1016/j.mehy.2009.10.051
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发表时间：
2010-04-01
影响因子：
4.7
通讯作者：
Eby, Karen L.
中科院分区：
文献类型：
--
作者：
Eby, George A., III;Eby, Karen L.
60%的临床抑郁症被认为是难治性抑郁症(TRD)。缺镁导致N-甲基-u-天冬氨酸(NMDA)偶联钙通道偏向开放，导致神经元损伤和神经功能障碍，在人类看来可能是严重的抑郁症。给动物口服镁可以产生类似于强效抗抑郁药物的抗抑郁效果。脑脊液(CSF)镁在难治性自杀抑郁症和曾试图自杀的患者中被发现较低。使用磷核磁共振波谱发现脑镁含量较低，这是一种准确测量脑镁的手段。血液和脑脊液镁似乎与重度抑郁症没有很好的相关性。尽管1921年发表了第一份镁治疗躁郁症的报告，显示250例中有220例成功，现代病例报告显示TRD迅速终止，但只有少数现代临床试验被发现。2008年的一项随机临床试验表明，镁在治疗糖尿病患者抑郁方面与三环类抗抑郁药丙咪嗪一样有效，而且没有丙咪嗪的任何副作用。据报道，特定方案的静脉和口服镁可以快速、安全、无副作用地终止TRD。镁已经在很大程度上被从加工食品中去除，这可能会损害大脑。钙、谷氨酸和天冬氨酸是常见的食品添加剂，可能会加剧情感障碍。我们假设--综合起来--有足够的证据表明饮食中不足的镁是TRD的主要原因，医生应该为TRD开镁处方。由于大脑镁不足似乎降低了5-羟色胺水平，而且抗抑郁药已被证明具有提高大脑镁的作用，我们进一步假设镁治疗将被发现对几乎所有抑郁症患者有益，而不仅仅是TRD。(C)2009爱思唯尔有限公司。保留所有权利。
Sixty percent of cases of clinical depression are considered to be treatment-resistant depression (TRD). Magnesium-deficiency causes N-methyl-u-aspartate (NMDA) coupled calcium channels to be biased towards opening, causing neuronal injury and neurological dysfunction, which may appear to humans as major depression. Oral administration of magnesium to animals led to anti-depressant-like effects that were comparable to those of strong anti-depressant drugs. Cerebral spinal fluid (CSF) magnesium has been found low in treatment-resistant suicidal depression and in patients that have attempted suicide. Brain magnesium has been found low in TRD using phosphorous nuclear magnetic resonance spectroscopy, an accurate means for measuring brain magnesium. Blood and CSF magnesium do not appear well correlated with major depression. Although the first report of magnesium treatment for agitated depression was published in 1921 showing success in 220 out of 250 cases, and there are modern case reports showing rapid terminating of TRD, only a few modern clinical trials were found. A 2008 randomized clinical trial showed that magnesium was as effective as the tricyclic anti-depressant imipramine in treating depression in diabetics and without any of the side effects of imipramine. Intravenous and oral magnesium in specific protocols have been reported to rapidly terminate TRD safely and without side effects. Magnesium has been largely removed from processed foods, potentially harming the brain. Calcium, glutamate and aspartate are common food additives that may worsen affective disorders. We hypothesize that - when taken together - there is more than sufficient evidence to implicate inadequate dietary magnesium as the main cause of TRD, and that physicians should prescribe magnesium for TRD. Since inadequate brain magnesium appears to reduce serotonin levels, and since anti-depressants have been shown to have the action of raising brain magnesium, we further hypothesize that magnesium treatment will be found beneficial for nearly all depressives, not only TRD. (C) 2009 Elsevier Ltd. All rights reserved.