Zinc in depression: From development to treatment: A comparative/ dose response meta-analysis of observational studies and randomized controlled trials

Somaye Yosaee; Cain C T Clark; Zahra Keshtkaran; Mahkameh Ashourpour; Parisa Keshani; Sepideh Soltani

doi:10.1016/j.genhosppsych.2020.08.001

Zinc in depression: From development to treatment: A comparative/ dose response meta-analysis of observational studies and randomized controlled trials

Somaye Yosaee, Cain C T Clark, Zahra Keshtkaran, Mahkameh Ashourpour, Parisa Keshani, Sepideh Soltani

Research output: Contribution to journal › Review article › peer-review

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Abstract

Background: A previous meta-analysis suggested that zinc status may be linked to depression status. However, it remains unclear whether zinc status can predict the risk of depression development, or whether the monotherapy of zinc is superior to the combination of zinc supplementation and antidepressant medications in the treatment of depression. Therefore, this meta-analysis aimed to clarify the impact of zinc status and supplementation on depression development and status across all available evidence. Methods: PubMed, EMBASE, Scopus, and ISI web of science were searched, up to 14 May 2020, for relevant publications. Pooled relative risks (RRs) with 95% confidence intervals (CI) in observational studies, and mean and standard deviation (SD) for the change in depression score in RCTs were calculated using a random-effects model. Results: The meta-analysis of RCTs indicated that zinc supplementation significantly lowered depressive symptom scores of depressed patients [weighted mean difference (WMD = −4.15 point; 95% CI: −6.56, −1.75 point; P < 0.01)], and the improvement in depression status occurred only when zinc supplementation was prescribed as a monotherapy. The cohort studies showed that the highest level of zinc intake was associated with a 28% reduced risk of depression (RR: 0.66; 95% CI: 0.50, 0.82; I ² = 13.90). Dose-response analyses revealed a significant non-linear effect of baseline mood status on depression score. Conclusion: Current evidence from observational studies and RCT's supports the potential benefits zinc to reduce the risk of, and alleviate, depression. However, further trials are needed to confirm the beneficial effect of zinc as a monotherapy versus adjunctive therapies.

Original language	English
Pages (from-to)	110-117
Number of pages	8
Journal	General Hospital Psychiatry
Volume	74
Early online date	10 Aug 2020
DOIs	https://doi.org/10.1016/j.genhosppsych.2020.08.001
Publication status	Published - 1 Jan 2022

Bibliographical note

NOTICE: this is the author’s version of a work that was accepted for publication in General Hospital Psychiatry. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in General Hospital Psychiatry, (2020) DOI: 10.1016/j.genhosppsych.2020.08.001

© 2020, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/

Funder

Larestan University of Medical Sciences , Research committee (IR.LARUMS.REC.1398.003

Keywords

Depression
Meta-analysis
Monotherapy
Zinc

ASJC Scopus subject areas

Psychiatry and Mental health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.genhosppsych.2020.08.001

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Cite this

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title = "Zinc in depression: From development to treatment: A comparative/ dose response meta-analysis of observational studies and randomized controlled trials",

abstract = "Background: A previous meta-analysis suggested that zinc status may be linked to depression status. However, it remains unclear whether zinc status can predict the risk of depression development, or whether the monotherapy of zinc is superior to the combination of zinc supplementation and antidepressant medications in the treatment of depression. Therefore, this meta-analysis aimed to clarify the impact of zinc status and supplementation on depression development and status across all available evidence. Methods: PubMed, EMBASE, Scopus, and ISI web of science were searched, up to 14 May 2020, for relevant publications. Pooled relative risks (RRs) with 95% confidence intervals (CI) in observational studies, and mean and standard deviation (SD) for the change in depression score in RCTs were calculated using a random-effects model. Results: The meta-analysis of RCTs indicated that zinc supplementation significantly lowered depressive symptom scores of depressed patients [weighted mean difference (WMD = −4.15 point; 95% CI: −6.56, −1.75 point; P < 0.01)], and the improvement in depression status occurred only when zinc supplementation was prescribed as a monotherapy. The cohort studies showed that the highest level of zinc intake was associated with a 28% reduced risk of depression (RR: 0.66; 95% CI: 0.50, 0.82; I 2 = 13.90). Dose-response analyses revealed a significant non-linear effect of baseline mood status on depression score. Conclusion: Current evidence from observational studies and RCT's supports the potential benefits zinc to reduce the risk of, and alleviate, depression. However, further trials are needed to confirm the beneficial effect of zinc as a monotherapy versus adjunctive therapies. ",

keywords = "Depression, Meta-analysis, Monotherapy, Zinc",

author = "Somaye Yosaee and Clark, {Cain C T} and Zahra Keshtkaran and Mahkameh Ashourpour and Parisa Keshani and Sepideh Soltani",

note = "NOTICE: this is the author{\textquoteright}s version of a work that was accepted for publication in General Hospital Psychiatry. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in General Hospital Psychiatry, (2020) DOI: 10.1016/j.genhosppsych.2020.08.001 {\textcopyright} 2020, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ ",

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doi = "10.1016/j.genhosppsych.2020.08.001",

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T2 - From development to treatment: A comparative/ dose response meta-analysis of observational studies and randomized controlled trials

AU - Yosaee, Somaye

AU - Clark, Cain C T

AU - Keshtkaran, Zahra

AU - Ashourpour, Mahkameh

AU - Keshani, Parisa

AU - Soltani, Sepideh

N1 - NOTICE: this is the author’s version of a work that was accepted for publication in General Hospital Psychiatry. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in General Hospital Psychiatry, (2020) DOI: 10.1016/j.genhosppsych.2020.08.001 © 2020, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/

PY - 2022/1/1

Y1 - 2022/1/1

N2 - Background: A previous meta-analysis suggested that zinc status may be linked to depression status. However, it remains unclear whether zinc status can predict the risk of depression development, or whether the monotherapy of zinc is superior to the combination of zinc supplementation and antidepressant medications in the treatment of depression. Therefore, this meta-analysis aimed to clarify the impact of zinc status and supplementation on depression development and status across all available evidence. Methods: PubMed, EMBASE, Scopus, and ISI web of science were searched, up to 14 May 2020, for relevant publications. Pooled relative risks (RRs) with 95% confidence intervals (CI) in observational studies, and mean and standard deviation (SD) for the change in depression score in RCTs were calculated using a random-effects model. Results: The meta-analysis of RCTs indicated that zinc supplementation significantly lowered depressive symptom scores of depressed patients [weighted mean difference (WMD = −4.15 point; 95% CI: −6.56, −1.75 point; P < 0.01)], and the improvement in depression status occurred only when zinc supplementation was prescribed as a monotherapy. The cohort studies showed that the highest level of zinc intake was associated with a 28% reduced risk of depression (RR: 0.66; 95% CI: 0.50, 0.82; I 2 = 13.90). Dose-response analyses revealed a significant non-linear effect of baseline mood status on depression score. Conclusion: Current evidence from observational studies and RCT's supports the potential benefits zinc to reduce the risk of, and alleviate, depression. However, further trials are needed to confirm the beneficial effect of zinc as a monotherapy versus adjunctive therapies.

AB - Background: A previous meta-analysis suggested that zinc status may be linked to depression status. However, it remains unclear whether zinc status can predict the risk of depression development, or whether the monotherapy of zinc is superior to the combination of zinc supplementation and antidepressant medications in the treatment of depression. Therefore, this meta-analysis aimed to clarify the impact of zinc status and supplementation on depression development and status across all available evidence. Methods: PubMed, EMBASE, Scopus, and ISI web of science were searched, up to 14 May 2020, for relevant publications. Pooled relative risks (RRs) with 95% confidence intervals (CI) in observational studies, and mean and standard deviation (SD) for the change in depression score in RCTs were calculated using a random-effects model. Results: The meta-analysis of RCTs indicated that zinc supplementation significantly lowered depressive symptom scores of depressed patients [weighted mean difference (WMD = −4.15 point; 95% CI: −6.56, −1.75 point; P < 0.01)], and the improvement in depression status occurred only when zinc supplementation was prescribed as a monotherapy. The cohort studies showed that the highest level of zinc intake was associated with a 28% reduced risk of depression (RR: 0.66; 95% CI: 0.50, 0.82; I 2 = 13.90). Dose-response analyses revealed a significant non-linear effect of baseline mood status on depression score. Conclusion: Current evidence from observational studies and RCT's supports the potential benefits zinc to reduce the risk of, and alleviate, depression. However, further trials are needed to confirm the beneficial effect of zinc as a monotherapy versus adjunctive therapies.

KW - Depression

KW - Meta-analysis

KW - Monotherapy

KW - Zinc

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DO - 10.1016/j.genhosppsych.2020.08.001

M3 - Review article

C2 - 32829928

SN - 0163-8343

VL - 74

SP - 110

EP - 117

JO - General Hospital Psychiatry

JF - General Hospital Psychiatry

ER -

Zinc in depression: From development to treatment: A comparative/ dose response meta-analysis of observational studies and randomized controlled trials

Abstract

Bibliographical note

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Keywords

ASJC Scopus subject areas

UN SDGs

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