Vitamin D deficiency as a result of long-term severe depression?

Mental health
1

I have Bipolar 1, and my depressions are very severe, sometimes with psychosis, and can last up to two years at a time, during which i am pretty much bedridden and housebound. I only go out when I absolutely have to, and hide inside long, baggy clothes, hoods, scarves and dark glasses summer and winter (ie I hide).

Over the past 5 years I have been diagnosed with bone pain and osteoarthritis. Bone pain is a primry presenting symptom of Vitamin D deficiency.

Ive made an appointment to see my GP and in the meantime have started taking Vit D supplements, but I'd love to hear if anybody out there has had a similar problem?

I would also be interested to know if anybody is aware if GPs are alive to this potential problem, because it seems to me that it could be a very common problem in people with long-term severe depression.

Any thoughts?

2

Given what you describe it is very likely that you have vitamin D deficiency. Even people who do go out in the sun in this country are at risk of this because the angle of the sunlight means the UV light is weak, particularly in the winter. I think GPs are beginning to be aware of this, and luckily it is fairly easy to treat the problem with vitamin D supplements. I hope your GP is sympathetic. I am a doctor who has had to retire because of depression. It sounds like you have a really difficult time because of your depression. All the best.

3

Hello there and thanks for your extremely helpful advice! I just had a lightbulb moment about this the other day, as i have really painful degenerative joint disease in my spine with osteophytes... Probably not directly or purely due to vit D deficiency, but am i rght in suspecting it hasnt helped, plus of course the years of cumulative immobility whilst stuck in bed.. I am so sorry to hear you had to retire due to depression. I have Bipolar 1 and had to drop out of Uni due to a very colourful manic episode, but I cant imagine how painful it must be to lose an entire career you have worked so hard for. Especially when friends family and the public at large tend not to understand particularly well...?! Take care of yourself and thanks again

4

Thanks for your kind words - yes it is difficult to come to terms with no longer being able to do the job I loved. Being a depressed doctor puts one on both sides of the fence, but with a feeling of not belonging on either. I'm working on it!

5

Id say you can still make a very valuable contribution on the medical side of that fence, maybe in a freelance or voluntary way when youre feeling well enough? Meanwhile, you are certainly very welcome on the mental side of the fence! sorry talk about inelegantly put! It has its moments - it can be liberating, it gives you insights that most people never experience, and its a form of "living in interesting times"! 

6

Hi 

I've been doing a lot of reading about vitamin d deficiency as I have been diagnosed with this a couple of days ago. I stumbled upon this discussion and noticed in your post that you're a retired doctor. I understand that you may not want to receive random queries like this and please don't feel obliged to reply to this, I respect that. 

i just feel that I have received inadequate support from my doctor since being diagnosed and I feel that my GP lacks expertise in this condition . I have been feeling depressed about this and that's why I have been eager to find out more and it would be great to get some input from a medical professional such as yourself. 

ive been ill for about 8 months now, firstly developed a neck pain and gradually my health deteriorated. I have leg pain, muscle weakness, fatigue and constant dizziness which varies throughout the day. It took a while before I found out that I have a deficiency, this due to my previous doctors refusing to refer me for blood tests as they didn't think i had anything serious.... 

after I got diagnosed, my GP has prescribed me 1000iu of vitamin d to be taken daily. I don't know if this dosage is enough ? I feel this is too low to start with it. My vit d level is 30. And also, as I have been having pain in my legs, should an xray be taken? To check for any cracks/fractures? And does this mean that I have osteomalacia or is this for more severe cases?

I'm so sorry to have to ask as this is out of desperation as I feel that vit d is not commonly known and any response would be greatly appreciated. I hope more doctors will include this in their tests as I think its really important as its widely undiagnosed. Thank you very much. 

7

Hi there, I dont know what Jo's response will be - ie the medical response, but for myself, I have actually bypassed my GP on this one and gone straight on Amazon and ordered a years supply of 5000iu Vitamin D3, cost me about £12. Ive done some reading and discovered that NICE's advice on this is very guarded and that many researchers believe you have to take a max dose to correct long-term deficiency. I have an appt with GP in 3 weeks time and i will tell him about the supplement, but meantime im not taking any chances - I cant find anything anywhere to suggest vitD is especially dangerous in high doses, the whole problem is we cant manufacture or store it. The advice Ive received is also to take the tablet with a piece of generously buttered bread because it needs some good old-fashioned fat to be absorbed properly. Maybe im overreacting but the pain is so bad i want to try everything i can to help!

8

Ive just found this page online: http://www.medpagetoday.com/PrimaryCare/DietNutrition/43267

- a very interesting overview of metadata including lots of major studies of vit D supplementation concludes that correction of deficiency probably requires approx 2000 - 3000 iu per day. And that the vast majority of doctors dont prescribe anything like enough given the potential benefits (vit D sufficiency leads to better health and longer life expectancy). 

 

9

Just found a brilliant website called the Vitamin D Coucil (its American). It states that a dose of up to around 600iu pd is only suitable if someones not already deficient. If youre already deficient, they recommend a 'physiologic' dose designed to replicate vit D levels in someone getting year-round sunshine - of about 3000-5000iu pd. And if you're severely deficient, doctors are supposed to give a 'pharmacologic' or mega-dose by injection. The dangers of overdose are only if you take over 10000iu pd, or a one off dose of over 50000iu especially if you are very underweight. I had read that toxicity was unlikely, but i didnt realise the margin was so high! So it seems that NICE or whoever really need to read the latest evidence because vit D really contributes to morbidity and mortality rates! 

10

Apologies for the delay in replying - I've been away for a few days. You are right that there is a lack of clarity about how to diagnose and treat vitamin D deficiency. I'm assuming your level is in  nmol/ml, (where the normal level is more than 100) which does put you into the definitely deficient category, and on the basis of my understanding of the situation I think you do need to be on a higher dose, at least initially, to get your levels up to the normal range as soon a possible. Bone pain and muscle weakness are symptoms of osteomalacia, and it could be argued that an x-ray could clarify whether you have this or not, which would support a plan to give you higher doses of vitamin D. If I was your GP I would be considering giving you a high-dose injection of vitamin D now as well as continuing with vitamin D supplements. Having read up on all this I think I will start taking vitamin D supplements myself!

Hope that's helpful.

11

Hi Jo - very helpful to my mind. The more i read, the more I wonder why there isnt more awareness of Vit D! I thought it was just to do with bones, but it seems to have all sorts of involvement with the immune system, circulatory system, brain function..... maybe they should put it in the water supply, given that the UK gets so little sunshine, and that we all spend half our time on computers/playstations/watching tv, even non-depressed people, even kids.

12

Hi jo, thank you for your reply. Basically my GP told me that my level is 30 and I asked if this is signifcantly low, and she said yes this is. So I assume that the level is in ml?. I did ask if taking a higher dose can speed up my recovery, however she said that it is advisable based on my vit d level I should be only be on 800 (however i have already been taking 1000iu prior to diagnosis) so she said to just continue with this. I'm still not satisfied however so I have even doubled my dosage.. and I'm hoping to do so for a few weeks then I will go back to 1000iu. So far, my symptoms haven't improved and i still have this throbbing pain in my legs which is worse at the end of the day after work. I now had to reduce my hours at work as Im struggling to do 5 days in a row, the fatigue crushes me after 2 days. 

13

Hi Christine, you're right, the dosage in america is higher than in the UK, I think here there is a restricted dosage doctors have to follow here. Your comment encouraged me to buy a higher dosage, I bought 2000iu and i take this twice a day, its hard to find vitamin d in 4000iu, unless you buy it online. My biggest concern is if my calcium levels shoot up but as I'm deficient, i hope that won't happen! Have you have any improvement with your symptoms? Mine was getting better as I was resting for days then when i came back to work i started to ache even more again. 

14

Hi Helenab, I think our doctors are restricted in what they can prescribe by NICE guidelines which are controversially conservative, but more and more research is coming out to suggest Britons in general should be supplemented - as Jo commented in her first reply, even for those who get outdoors, the angle of the sun in the UK especially in winter means its practically impossible to get enough vitD in normal everyday life. especially as you cant get it from sun thru glass - so most people sitting in a car, or at work in a  shop, factory or office all day will be missing out.

I posted the original question because it occurred to me its sort of a failure of imagination, or empathy for the realities of living with longtime severe depression - it doesnt occur to doctors the knock-on effects of basically, being bed- or house-bound for months and months on end!

I have been taking the 5000iu pd dose for about 3 weeks now, and before that a standard multivitamin. I have already noticed a reduction in pain from my knees and spine, though of course that may well be psychsomatic or the placebo effect this early on! (but Im not complaining even if it is - even a 1% pain reduction is welcome!) I have an appointment with my GP in a fortnight and will be asking him for regular vit D levels testing - I have to have monthly blood tests for lithium, thyroid, kidney function, cholesterol, etc etc.... they may as well fill up another syringe whilst they're at it! (tho' because my bipolar led to drug addiction in my twenties, its not easy for them to find a vein so that makes me kind of unpopular with the nurses and makes me feel terribly guilty since its self-inflicted). 

I have done yet more reading and sounds to me that 2000iu is a perfectly safe, yet sufficiently high amount for long-term supplementation. I highly recommend the Vitamin D Council website - its really informative, data-led, and sensible. I think Vit D is a silent epidemic and could be a really big factor in why we have so many people with arthritis, osteoporosis, as well as being implicated in all sorts of other health problems like cardiovascular function, mental health, one study even suggested things like dementia and parkinsons disease could have Vit D as a contributory factor (ie, why they are so high in the West).

Good luck with the new supplement and lets keep plugging away at the medical profession to get them Vit D Aware! Im thinking of starting a new vit d thread in 'deficiencies' which ive just noticed has a discussion forum of its own on here. patient.info really is a very helpful website, I think! there's nothing else as well-designed or informative and British, as far as I can see?

15

Hi Christine that's really informative. May I just ask, when you got diagnosed how often did you see your GP after that? I saw my GP twice within the past month since my diagnosis and now i'm not sure when I should go back... She did mention a review in a few weeks time but didn't specify when... Did you have another blood test done after a few months to check if your vitamin d level has been corrected ?

16

Hello Helen - If you mean diagnosed for vitD deficiency levels, I am still waiting for the results (go back next week for them along with the results for a CT scan on my spine and assorted other blood tests i have to do every quarter) - but my GP said its pretty much a foregone conclusion from the discussion we had (the tiny amount of sunlight I get, my bone pain etc). So he was happy for me to take a high dose VitD supplement in the meantime having well versed me in the dangers of taiking more than 5000iug a day. When I get the results he said if necessary he will do the injection (ultra high one-off dose) or prescribe high dose supp's on my repeat script. He also acknowledged there is a really enormous awareness gap in the UK about how widespread this deficiency is and the best ways to treat it. 

My experiences with fighting for a psychiatric assesment (20 years) and my current battles about my thyroid levels tell me that you have to be assertive to get proper treatment, GPs are so busy, so bombarding with info and updates, that you have to take responsibility for your own health. And always remember that GPs arent psychic!! - they wont know if a med is working or not unless you tell them 

- (which I wish I had realised all the years  I was on antidepressants and never told my Doc properly about the manic episodes - because I didnt realise they were manic episodes, I just thought I was stupid and feckless and dumb! - so thats not the doctors fault, just an observation about educating oneself.)

17

I could be wrong,you would have to ask your gp first,but B6 helps,pls do not try without advice.

Vitamin D is good to lifts moods,especially if you live in a cold country.

Sunshine gives us vitamin D

18

Hi, I am recently diagnosed with vit d deficency ( 17) after 4 years of chronic foot pain, a mis diagnosis of plantar fasciitis, indigestion probs and dr's unable to work out what was wrong with me. I was given PPIs for the indigestion which drains vit d levels and at the same time the foot condition worsened, as my body became more and more fatigued and depressed. I had to reduce work hours, sell my house, change cars and lost my old active life.  Well, I have been taking 2000 units of vit d although my gp said my deficiency wasn't too low and only needed 800units over three months to get better?!! I can see that USA sights recommend much more ( Vit D Council). I have not felt better yet, and I am tempted to go higher with the supplements. I am wondering how you arte feeling now and if there is light at the end of this dark tunnel?

19

Hi there im so glad you posted this as ive been lookimg into the same thing recently! Ive suffered from low mood and suicidal thoughts for years and despite this only recently got blood tests to screen for other causes (b12 etc)

And they found I was vit D deficient. I also experience bone pain and finally have an answer why!

Since then ive looked into this and found loads of studies showing a correlation between depression and vit D. However, they're yet to conclude whether it causes depression or is effected by depression. Also they tested to see whether supplementing vit D could treat depression and it was found to be innefective as far as I can remember.

Living in England though I'm not sure whether most people would have low vit D When screened, depression or no depression and as you say mood can effect how much we go outside and how we feel about ourselves can cause us to cover up or hide when outside.

abs

20

My depression is so hard to cope with, I feel so low I want to die, but I dont at the same time, I have 2 children who are my life, my depression came from anxiety to start with, I'm always so very anxious, my biggest fear is I'm going mad, what if I start to hear voices or see things that are not there, that's my biggest worry, I have been prescribed sertraline by my Dr, I only took half a tablet for 5 or 6 days 25mg as I was so scared to take antidepressants, now for 2 weeks I've been on 50mg a day, I dont feel any better, sometimes evening I better , she also gave me some diazipam to help my anxiety and panic in the mornings when its qt its worst, I've been to a&e feeling suicidal, I just don't see how ill get better to being me again? I've asked to have my thyroid checked, and today had my vitamin levels checked , but the dr didn't include bit D? But included bit E? I'm so scared ill get worse and never better or go insaine, please could you reassure me or reassure that it is depression, I'm sorry you are suffering too, I hope not qs bad as me, can I be screened for bipolar at all? Think my mother is bipolar borderline. I've lost weight,ibtry and excersise and swim, but you hear so many people do commit suicide, and I wonder why, if these antidepressants are suppose to work!? Thank you in advance for any feed back you may be able to give me, truly sorry 😢

I'm just at point of despair.