Drew Ramsey, MD
Assistant Clinical Professor of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY
Philip R. Muskin, MD
Professor of Clinical Psychiatry, Columbia University College of Physicians and Surgeons, Chief, Consultation-Liaison Psychiatry, NY-Presbyterian Hospital, Columbia Campus, New York, NY
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Patients today often are overfed but undernourished. A growing body of literature links dietary choices to brain health and the risk of psychiatric illness. Vitamin deficiencies can affect psychiatric patients in several ways:
- deficiencies may play a causative role in mental illness and exacerbate symptoms
- psychiatric symptoms can result in poor nutrition
- vitamin insufficiency—defined as subclinical deficiency—may compromise patient recovery.
Additionally, genetic differences may compromise vitamin and essential nutrient pathways.
Vitamins are dietary components other than carbohydrates, fats, minerals, and proteins that are necessary for life. B vitamins are required for proper functioning of the methylation cycle, monoamine production, DNA synthesis, and maintenance of phospholipids such as myelin (Figure). Fat-soluble vitamins A, D, and E play important roles in genetic transcription, antioxidant recycling, and inflammatory regulation in the brain.
Figure: The methylation cycle
Vitamins B2, B6, B9, and B12 directly impact the functioning of the methylation cycle. Deficiencies pertain to brain function, as neurotransmitters, myelin, and active glutathione are dependent on one-carbon metabolism
Illustration: Mala Nimalasuriya with permission from DrewRamseyMD.com
To help clinicians recognize and treat vitamin deficiencies among psychiatric patients, this article reviews the role of the 6 essential water-soluble vitamins (B1, B2, B6, B9, B12, and C; Table 1,1) and 3 fat-soluble vitamins (A, D, and E; Table 2,1) in brain metabolism and psychiatric pathology. Because numerous sources address using supplements to treat vitamin deficiencies, this article emphasizes food sources, which for many patients are adequate to sustain nutrient status.