Efficacy and safety of a mineral and vitamin treatment on symptoms of antenatal depression: 12-week fully blinded randomised placebo-controlled trial (NUTRIMUM)

Abstract

Background: Broad-spectrum micronutrients (minerals and vitamins) have shown benefit for treatment of depressive symptoms.

Aims: To determine whether additional micronutrients reduce symptoms of antenatal depression.

Method: Eighty-eight medication-free pregnant women at 12-24 weeks gestation, who scored ≥13 on the Edinburgh Postnatal Depression Scale (EPDS), were randomised 1:1 to micronutrients or active placebo (containing iodine and riboflavin), for 12 weeks. Micronutrient doses were generally between recommended dietary allowance and tolerable upper level. Primary outcomes (EPDS and Clinical Global Impression - Improvement Scale (CGI-I)) were analysed with constrained longitudinal data analysis.

Results: Seventeen (19%) women dropped out, with no group differences, and four (4.5%) gave birth before trial completion. Both groups improved on the EPDS, with no group differences (P = 0.1018); 77.3% taking micronutrients and 72.7% taking placebos were considered recovered. However, the micronutrient group demonstrated significantly greater improvement, based on CGI-I clinician ratings, over time (P = 0.0196). The micronutrient group had significantly greater improvement on sleep and global assessment of functioning, and were more likely to identify themselves as 'much' to 'very much' improved (68.8%) compared with placebo (38.5%) (odds ratio 3.52, P = 0.011; number needed to treat: 3). There were no significant group differences on treatment-emergent adverse events, including suicidal ideation. Homocysteine decreased significantly more in the micronutrient group. Presence of personality difficulties, history of psychiatric medication use and higher social support tended to increase micronutrient response compared with placebo.

Conclusions: This study highlights the benefits of active monitoring on antenatal depression, with added efficacy for overall functioning when taking micronutrients, with no evidence of harm. Trial replication with larger samples and clinically diagnosed depression are needed.

Keywords: Perinatal psychiatry; antenatal depression; micronutrients; mineral; vitamin.

Fig. 1

Consolidated Standards of Reporting Trials diagram displaying the flow of participants through the trial. EPDS, Edinburgh Postnatal Depression Scale.

Fig. 2

Individual and average trajectories on the Clinical Global Impression – Improvement Scale (CGI-I) for participants in the micronutrient and active placebo group over the course of the trial.

Fig. 3

Predicted improvements based on the clinician-rated Clinical Global Impression – Improvement Scale (CGI-I) over the course of the trial, for participants in the micronutrient and active placebo group with and without personality difficulties (Standardised Assessment of Personality – Abbreviated Scale (SAPAS)) and with and without a history of psychiatric medication. The predictions have been adjusted for age of 30 years, gestational age of 30 weeks, New Zealand Socio-Economic Index of 50, Multidimensional Scale of Perceived Social Support score of 65.

Fig. 4

Predicted percentage of responders (much to very much improved) on the self-report modified Clinical Global Impression – Improvement Scale (M-CGI-I) for 71 participants who completed the M-CGI-I with and without personality difficulties (Standardised Assessment of Personality – Abbreviated Scale (SAPAS)) and with and without a history of taking psychiatric medication. The predictions have been adjusted for age of 30 years, gestational age of 30 weeks, New Zealand Socio-Economic Index of 50, Multidimensional Scale of Perceived Social Support score of 65.