Vitamin D Supplementation for the Treatment of Depression in Females in a Private Practice Clinic

regarding the effect that vitamin D plasma levels can have in There are also studies that suggest the use of vitamin D supplementation either by mouth or through light therapy as an add-on therapy for depression [2]. Influenced by this evidence, during the winter season of 2019, we used Vitamin D 3 supplementation mainly as an add-on therapy for the treatment of patients suffering from depression in our private practice. In order to better assess the results of this intervention and also to communicate our experience to other practitioners, we concluded a small case series study with all our depressed patients that received vitamin d supplementation, during a certain time frame.

During the last decade there is a strong interest regarding the effect that vitamin D plasma levels can have in depression. There are also studies that suggest the use of vitamin D supplementation either by mouth or through light therapy as an add on therapy for depression. Influenced by this evidence, during the winter season of 2019, we used Vitamin D 3 supplementation mainly as an add-on therapy for the treatment of patients suffering from depression in our private practice. A small sample of eight patients was treated. All of them were women-Caucasian with Vitamin D insufficiency. An oral dose ranging between 2000 and 4000 UI of Vitamin D 3 per day was administered. One of them was treated with Vitamin D 3 as monotherapy while in the rest, Vitamin D 3 was used as an add-on therapy. Vitamin 25(OH) D levels were measured regularly. A significant improvement in depressive symptoms, that was correlated time wise at least with the increased of Vitamin D blood levels, was observed. This is in accordance with patients' satisfaction, which do not consider Vitamin D as another 'Psychiatric drug'. Although results are quite preliminary, there is a strong feeling, that Vitamin D supplementation is effective in treating certain depressive symptoms. Of course, much further study is needed for any firm conclusions.

Method
All subjects were prescribed with Vitamin D 3 oral  (Table 1). Qualitive analysis showed that the main complain that all patients had in common was psychomotor retardation less common but significant was also morning depression. These symptoms and especially psychomotor retardation tend to improve in various degrees two months or more after the beginning of Vitamin D supplementation ( Figure 1).

Discussion
This is a prospective case series; its results are hopeful. It seems that there is a strong possibility that depressed female patients with a certain residual symptom profile might also suffer from vitamin d deficiency. More specifically symptoms such as psychomotor retardation or morning depression seem to be more correlated with vitamin d deficiency [3]. This study was conducted in total in winter time. This happened since we wanted to reduce confounders such as sun exposure, which is much more likely to happen during summer, and can change the levels of vitamin d in blood regardless of our supplementation [4]. of depressed patients to increase their outdoors activities [8].
This study has significant limitations. Firstly, it is a small study.
There are very few patients included. The researchers present this as a case series and not a cohort or other more powerful type of study. Furthermore, the fact that all patient were Caucasian women increases somehow the power of this study. The other limitation is the fact that no standardized assessment of patients initial status or treatment progress, with the use of questionnaires occurred.
This makes more difficult to interpret study's findings. To our view since the aim of our approach was to treat residuals symptoms it was difficult for these symptoms to be detected through formal questionnaires that asses overall depression, furthermore the observation and consensus of two specialized psychiatrists has its value when we asses depression and gives some addition credibility to the results. Also, qualitive analysis that we used is an acceptable measure of outcome [9].

Conclusion
Although results are quite preliminary, there is a strong feeling, that Vitamin D supplementation is effective in treating certain depressive symptoms. Of course, much further study is needed for any firm conclusions.