This document discusses the role of vitamins in psychiatry. It begins with an overview of how nutrition plays a key role in brain health and the link between nutrition and mental health. It then classifies and describes the 9 water soluble vitamins (B vitamins and vitamin C) and 4 fat soluble vitamins, explaining their roles in brain functioning and common deficiencies. Specific vitamins discussed in more depth include thiamine, niacin, folate, vitamin B12, and vitamin C. The document explains how deficiencies in these vitamins can impact psychiatric manifestations and neurological processes.

1. Role of vitamins in psychiatry
PRESENTER : DR.VIPIN GEORGE

2. “If forgiveness is medicine for
the soul, then gratitude is
vitamins.”
DR.STEEVE MARABOLI

3. Overview
• Classification.
• Role of vitamins in brain functioning.
• Deficiency and psychiatric manifestations.
• Treatment and supplementation.

4. • Nutrition plays a key role in maintaining optimal brain
health throughout the lifespan of an individual .
• The studies examining the link between nutrition and
mental health have gained widespread attention in recent
years.

5. What is a vitamin?
• The term vitamin is from words “vital” and “amine” ,
vitamins are required for life and were originally thought
to be“amines”.

6. • Vitamins are complex organic substances necessary to our
diet in small amounts to promote and regulate the chemical
reactions and processes In the human body.

7. • Vitamins are called micro nutrients needed in only very
small quantities.
• They are dietary components other than carbohydrates,
fats, minerals, and proteins that are necessary for life.

8. Where are they found?
• Most of our vitamins through the food and drink we eat, but
we can also obtain vitamins in supplement form.
• Varied diet to allow for a wide range of nutrients to be
absorbed by the body.

9. CLASSIFICATION OF VITAMINS
• There are 9 water soluble vitamins.
• These are readily excreted from the body
• 1. Vitamin B1 2. Vitamin B2 3. Vitamin B6 4.
Vitamin B12 ,5. Vitamin C (ascorbic acid) 6.
Folic acid 7. Niacin 8. Biotin 9. Pantothenic
acid.

10. There are 4 fat soluble vitamins
• 1. Vitamin A 2. Vitamin D 3. Vitamin E 4. Vitamin K.
• They can dissolve in lipids solutions .
• These are absorbed through intestinal track with
the help of lipids.

11. • Deficiencies may play a causative role in mental
illness .
• Exacerbate symptoms.
• Psychiatric symptoms can result in poor nutrition.
In mental illness

12. • vitamin insufficiency—defined as subclinical deficiency—
may compromise patient recovery.
• Genetic differences may compromise vitamin and
essential nutrient pathways.

13. . B vitamins
• Proper functioning of the methylation cycle.
• Monoamine production.
• DNA synthesis.
• Maintenance of phospholipids such as myelin.

14. Fat-soluble vitamins play important roles in
• Genetic transcription
• Antioxidant recycling
• Inflammatory regulation in the brain.

15. One carbon metabolism
• Crucial biosynthetic pathway for DNA syn&repair and
numerous methylation reactions.
• Amino acid methionine plays central role .
• Dietary source of methionine in insufficient.
• Folate converts methionine to SAM,donor for most of
methylation reactions.
• When folate is low SAM depletion .

16. • The vitamins folic acid, B12 and B6 and B2 are the source
of coenzymes which participate in one carbon metabolism.
• A carbon unit from serine or glycine is transferred to
tetrahydrofolate (THF) to form methylene-THF.
• This is either used as such for the synthesis of thymidine,
which is incorporated into DNA,

17. Oxidized to formyl-THF is used for the synthesis of purines,
which are building blocks of RNA and DNA,
or reduced to methyl-THF which used to methylate
homocysteine to form methionine, a reaction which is
catalyzed by a B12-containing methyltransferase.
• Much of the methionine which is formed is converted to S-
adenosylmethionine (SAM), a universal donor of methyl
groups, including DNA, RNA, hormones, neurotransmitters,
membrane lipids & proteins .

19. Water-soluble vitamins
Vitamin B1 (Thiamine)
• Essential for glucose metabolism.
• Thiamine is a helper molecule (i.e., a coenzyme) of
carbohydrate metabolism. Intermediate products of
these pathways are needed for the generation of other
essential molecules in the cells (e.g., building blocks
of proteins and DNA as well as brain chemicals)

20. Thiamine–rich foods include meat and poultry; whole
grain cereals (e.g., brown rice and bran); nuts; and
dried beans, peas, and soybeans
Humans require a minimum of 0.33 milligrams (mg)
thiamine /1,000 (kcal) of energy they consume.

21. • A daily intake of 1.1 mg thiamine is currently
recommended for adult women and 1.2 mg for adult
men.
• Studies have found that most healthy people
typically consume 0.4 to 2.0 mg thiamine daily.

22. • The cells of the nervous system and heart seem
particularly sensitive to the effects of thiamine
deficiency.
• In the brain, thiamine is required both by the nerve
cells (i.e., neurons) and by other supporting cells in
the nervous system (i.e., glia cells).

23. Thiamine deficiency
• Pregnancy, lactation, and fever increase the need
and tea, coffee, and shellfish can impair its
absorption.
• Chronic alcohol consumption can result in thiamine
deficiency by causing inadequate nutritional thiamine
intake, decreased absorption of thiamine from the
gastrointestinal tract,and impaired thiamine utilization.

24. Deficiency leads to an increase in.
• Reactive oxygen species
• Proinflammatory cytokines
• Blood-brain barrier dysfunction

25. .
In short term deficiency
Neurasthenic picture :fatigue, weakness,emotional
Acute & fulminant deficiency
wernicke’s encephalopathy.
WKS typically consists of two components, a short–
lived and severe condition called Wernicke’s
encephalopathy (WE) and a long–lasting and

26. debilitating condition known as Korsakoff’s psychosis.
WE is an acute life–threatening neurologic disorder
stem from the, brain’s inability to oxidize glucose for
energy.
Many WE patients, however, do not exhibit all three of
these signs and symptoms, WE may be present even if
the patient presents with only one or two of them.

27. • Approximately 80 to 90 percent of alcoholics with WE develop
Korsakoff’s psychosis, a chronic neuropsychiatric syndrome
characterized by behavioral abnormalities and memory
impairments .
• Although these patients have problems remembering old
information (i.e., retrograde amnesia), it is the disturbance in
acquisition of new information (i.e., anterograde amnesia) that
is most striking Korsakoff’s psychosis also is called alcohol
amnestic disorder

28. Brain regions affected by thiamine deficiency

29. Various brain regions differ in their sensitivity to alcohol’s
effects
Cerebellum most sensitive
This heightened susceptibility is consistent with the cognitive
deficits typically associated with alcoholism.
Cerebellar damage or of damage to the frontal lobes, which
are connected to the cerebellum through neural pathways.
Reversal of thiamine deficiency revereses cerebellar damage
&improve some brain functions typically associated with the

30. Chronic severe deficiency leads to
Beriberi with
Neuropathy,cardiac failure,or peripheral edema
Treatment
Without neuropsychiatric complications
Oral thiamine min of 300mg /day.
Wernickes encephalopathy
parentral thiamine 500mg 3 times daily for 3-5 days.followed by
500mg once daily for 5days.

31. Vitamin B2 (riboflavin)
• Essential for oxidative pathways.
• Monoamine synthesis.
• Methylation cycle.
B2 is needed to create the essential flavoprotein
coenzymes for synthesis of L-methylfolate—the active
form of folate—and for proper utilization of B6.
Deficiency can occur after 4 months of inadequate
intake.

32. Marginal B2 levels are more prevalent in depressed
patients, possibly because of B2’s role in the function
of glutathione, an endogenous antioxidant.
symptoms
Lethargy,multiple somatic complaints.
Look for sore throat,glossitis,seborrhoeic dermatitis

33. Top dietary sources of B2
Dairy products, meat and fish, eggs, mushrooms,
almonds, leafy greens, and legumes.
Riboflavin is destroyed by light. So food should be
stored away from light to protect its riboflavin content.
.

34. Niacin Vitamin B3.
• Nicotinic acid and nicotinamide are precursors of two
important co-enzymes: nicotinamide adenine dinucleotide
(NAD) and nicotinamide adenine dinucleotide phosphate
(NADP).
• NAD and NADP are crucial to a number of oxidative and
reductive reactions - eg, steroid formation, fatty acid
synthesis, protein metabolism and DNA repair.

35. Sub acute deficiency
• Pellagra :gi symptoms,dermatitis,psychiatric disturbances
Acute and sudden depletion
• Encephalopathy with or without symptoms /signs in other
systems
• Vitamin B3 is found in many foods including yeast, meat,
fish, milk, eggs, green vegetables, beans, and cereal
grains

36. Deficiency
• c/c alcoholism.
• Malnourished homeless.
• Carcinoid syndrome.
• Hartnups d/s defective absorption from diet.

37. • 2-pyridone and 2-methyl nicotinamide in urine .
• Can be measured to assess niacin deficiency (low levels
will be present).
• RBC levels of NAD/NADP can also be useful in the
diagnosis.
Treatment
• Oral supplementation with nicotinamide is usually used (eg,
100-200 mg three times a day until symptoms remit.

38. Vitamin B6 refers to 3 distinct compounds: pyridoxine,
pyridoxal, and pyridoxamine.
B6 is essential to glycolysis, the methylation cycle, and
recharging glutathione, an innate antioxidant in the brain.
Higher levels of vitamin B6 are associated with a lower
prevalence of depression in adolescents.

39. and low dietary and plasma B6 increases the risk and
severity of depression in geriatric patients.
• Deficiency is common (24% to 56%) among patients
receiving hemodialysis.
• Women who take oral contraceptives are at increased risk
of vitamin B6 deficiency.

40. • It is needed for normal brain development and function
• Role in syn. of hormones serotonin and norepinephrine,
which influence mood
• Melatonin, which helps regulate the circadian rhythm.
• Helps control levels of homocysteine in the blood.
• Need B6 in order to absorb vitamin B12 and to make red
blood cells and cells of the immune system.
• It is rare to have a significant deficiency of B6.

41. Deficiency
• Convulsions Mental deterioration in infants.
• Premenstrual syndrome and depression in women taking
ocp.
• May have role in depression.
• Doses of vit b6 up to 100mg daily are likely to be of benefit
in treating .
• Top dietary sources are fish, beef, poultry, potatoes,

42. Vitamin B5 [Pantothenic acid ]
• From the Greek root “pantos”, meaning "everywhere,"
because it is available in a wide variety of foods.
Deficiency
• Sensory neuropathy ‘burning feet syndrome’
• Role in psychiatric disorder has not been clearly established.

43. Biotin vit B7/vit H
• Vitamin B7, formerly known as Vitamin H or coenzyme R.
Foods with a relatively high biotin content .
peanuts and other leafy green vegetables, raw
egg yolk(however, the consumption of avidin-containing egg
whites with egg yolks minimizes the effectiveness of egg
yolk's biotin in one's body), liver

44. Biotin is also called vitamin H (the H represents Haar und
Haut, German words for "hair and skin") or vitamin B7
Valproate can cause biotin deficiency and may lead to low
serum and liver tissue biotinidase enzyme a major clinical
manifestation of biotin deficiency is alopecia.

45. Vitamin B9 [Folic acid]
• Participates in one carbon metabolism.
• A carbon unit from serine or glycine is transferred to
tetrahydrofolate (THF) to form methylene-THF.
• This is either used as such for the synthesis of thymidine,
which is incorporated into DNA.
• oxidized to formyl-THF which is used for the synthesis of
purines, which are building blocks of RNA and DNA.

46. or it is reduced to methyl-THF which used to methylate
homocysteine to form methionine, a reaction which is
catalyzed by a B12-containing methyltransferase.

47. Co factor in the re methylation of homocysteine to methionine
hence deficiency leads to increased homocysteine
Neuronal excitotoxicity through NMDA [r]
Increased oxidative stress
Neuronal damage and apoptosis

48. • Synthesis of serotonin, norepinephrine, dopamine, and
DNA and in phospholipid production.
• Low maternal folate status risk of neural tube defects in
newborns.
• Folate deficiency and insufficiency are common among
patients with mood disorders and correlate with illness
severity.
• Leafy greens and legumes such as lentils are top dietary

49. • Dietary folate must be converted to L-methylfolate for use in
the brain. Patients with a methylenetetrahydrofolate
reductase (MTHFR) C677T polymorphism produce a less
active form of the enzyme. The TT genotype is associated
with major depression and bipolar disorder.Clinical trials
have shown that several forms of folate can enhance
antidepressant treatment.Augmentation with L-methylfolate,
which bypasses the MTHFR enzyme, can be an effective
strategy for treating depression in these patients.

51. Deficiency
• A diet low in fresh fruits, vegetables, and fortified cereals is
the main cause of folate deficiency.
• Diseases that affect absorption in the gastrointestinal
Crohn’s disease,celiac disease
• Genetic mutation that hinders converting dietary or
supplemental folate to its usable form, methylfolate.
• Medications: phenytoin ,methotrexate
• Excessive alcohol intake interferes with folate absorption

52. Folic acid deficiency :serum level <5nmol/L
Treatment
Replacement with folic acid 5mg thrice daily
Always screen for vit b12 def.to prevent neurological
disturbances.
Augmentation with L-methylfolate, which bypasses the
MTHFR enzyme, can be an effective strategy for treating
depression .

53. Vitamin B12 (cobalamin)
• An essential cofactor in one-carbon metabolism, B12 is
needed to produce monoamine neurotransmitters and
maintain myelin.
• Maintenance of equilibrium between neurotrophic and
neurotoxic factors in the central nervous system .
Neurotrophins are growth factors that influence the
proliferation, differentiation,survival and death of neuronal
and non-neuronalcells.

54. Deficiency is found in up to one-third of depressed patients and
compromises antidepressant response
• Pernicious anemia ,Gastrointestinal illness, older adults with
achlorhydria, and vegetarians,
• Proton pump inhibitors interfere with B12 absorption
Elevated methylmalonic acid and total homocysteine
concentrations are considered as sensitive metabolic
markers for vitamin B12 deficiency .
S.Vit b12 assy less sensitive for assessing tissue deficiency .

55. vitamin B12 deficiency
• Myelopathy and neuropathy are known to be the main
clinical manifestations
• Megaloblastic anaemia,tingling and numbness of the
extremities, gait abnormalities,visual disturbances,
• Memory loss and dementia.
• Psychotic depression .

56. • Low B12 levels and elevated homocysteine increase the
risk of cognitive decline and Alzheimer’s disease and are
linked to a 5-fold increase in the rate of brain atrophy.
• Psychiatric symptoms of B12 deficiency may present before
hematologic findings. Folic acid supplementation may mask
a B12 deficiency by delaying anemia but will not delay
psychiatric symptoms. Ten percent of patients with an
insufficiency (low normal levels of 200 to 400 pg/mL) have

57. elevated homocysteine, which increases the risk of psychiatric
disorders as well as comorbid illnesses such as cardiovascular
disease.
Treatment
Intramuscular hydroxycobalamin at a dosage of 1 mg weekly
for eight weeks, followed by 1 mg monthly for life.
Top dietary sources include fish,meat, and dairy products
..

58. Vitamin C
• Vital for the synthesis of monoamines such as serotonin
and norepinephrine.
• Vitamin C’s primary role in the brain is as an antioxidant. As
a necessary cofactor, it keeps the copper and iron in
metalloenzymes reduced, and also recycles vitamin E.
• Proper function of the methylation cycle depends on vitamin
C, as does collagen synthesis and metabolism of
xenobiotics by the liver.

59. • Humans cannot manufacture vitamin C.
• vitamin C (90 mg/d) .
• Older adults and patients with a poor diet due to drug or
alcohol abuse, eating disorders, or affective symptoms are
at risk.
• Scurvy is caused by vitamin C deficiency and leads to
bleeding gums and petechiae.

60. Patients with insufficiency report irritability, loss of appetite,
weight loss, and hypochondriasis.
Vitamin C intake is significantly lower in older adults (age ≥60)
Citrus, potatoes, and tomatoes are top dietary sources of
vitamin C.

61. Fat-soluble vitamins
Vitamin A.
• Although vitamin A activity in the brain is poorly understood,
retinol—the active form of vitamin A—is crucial for formation
of opsins, which are the basis for vision.
• Childhood vitamin A deficiency may lead to blindness.
• . Vitamin A also plays an important role in maintaining bone
growth, reproduction, cell division, and immune system
integrity.

62. • Animal sources such as beef liver, dairy products, and eggs
provide retinol, and plant sources such as carrots, sweet
potatoes, and leafy greens provide carotenoids that humans
convert into retinol.
vitamin A deficiency
• Deficiency most often seen with excessive alcohol use,
rigorous dietary restrictions, and gastrointestinal diseases
accompanied by poor fat absorption.

63. Excess vitamin A ingestion may result in bone abnormalities,
liver damage, birth defects, and depression.
Isotretinoin—a form of vitamin A used to treat severe acne—
carries an FDA “black-box” warning for psychiatric adverse
effects, including aggression, depression, psychosis, and
suicide.

64. Vitamin D
• Normally, vitamin D is obtained from dietary intake and ultra
violet exposure through normal skin synthesis. Skin
absorption is influenced by duration of sunlight exposure,
skin pigmentation, age, gender, and innate factors(e.g.,
genetic polymorphism) .
• Vitamin D2 and vitamin D3 are available to human beings
as ergocalciferol and cholecalciferol,respectively

65. • The most robust metabolite of vitamin D is 1α, 25-
dihydroxyvitamin D(3) (1,25(OH)(2)D(3)), which has potent
regulatory properties.
• It is the primary bioavailable form of vitaminD has a half-life
of about two to three weeks and is the sole vitamin D
metabolite used to establish vitamin D status.
• The optimal threshold of vitamin D is ≥30 ng/ml

66. Clearly vitamin D status plays a role in overall health
promotion.
• Vitamin D is primarily associated with calcium homeostasis
and is essential in optimal intestinal calcium absorption;
• Serum calcium balance;
• Musculoskeletal health
• Calcium phosphorous metabolism.

67. vitamin D receptors (VDR)
Prefrontal cortex, the amygdala and the hippocampus.
• Vitamin D metabolites protect the integrity of neurons .
• Upregulation of neurotrophic factors present in the
hippocampus and neocortex.
• vitamin D affects inflammatory pathways (downregulating
autoimmune pathways producing proinflammatory
cytokines and promoting anti-inflammatory pathways
through VDR-mediated gene transcription that in turn have
been linked to depression.

68. • In depression higher levels of
pro-inflammatory cytokine interleukin(IL-1)beta and lower
levels of anti-inflammatory cytokine IL-10
• Medications used to treat depression& schizophrenia
• serum levels of interleukin-1beta and interferon-gamma
and stabilize the overproduction of inflammatory cytokines.
Aberrations in these mechanisms are associated with an
imbalance betweenserum 1, 25-Dihydroxyvitamin D3 and
prostaglandin cellular signaling processes.

69. Prescribing Vitamin D
Vit D supplementation as a potential anti-inflammatory option
for mild to moderate depression
The clinical challenge is to diagnose vitamin D deficiency and
determine the appropriate dose of vitamin D supplementation.
vitamin D deficiency
< 20 ng/mL (< 50 nmol/L)
Sub optimal status: 20–30 ng/mL (50–75 nmol/L)
Target concentrationfor optimal Vitamin D effects: 30–50
ng/mL (75-125nmol/L)

70. Treatment
How much vitamin D is needed to correct deficiency?
Although not validated by clinical trials, a commonly applied
strategy is to prescribe a “loading dose” (eg, 50,000 IU of vitamin
D orally once weekly for 2-3 months, or 3 times weekly for 1
month.
• Once an optimal concentration of 25(OH)D of 30–50 ng/mL
(75–125 nmol/L) is attained

71. • Order serum levels several months later and then twice a
year
• Daily doses of 800–2,000 IU/day to sustain 20–50 ng/per
day.
• Vitamin D exists in food as either D2 or D3, from plant and
animal sources, respectively. Concentrated sources include
oily fish, sun-dried or “UVB-irradiated” mushrooms, and
milk

72. Vitamin E
• There are 8 isoforms of vitamin E
• 4 tocopherols and 4 tocotrienols
• Function as fat-soluble antioxidants and also promote
innate antioxidant enzymes.
• Protects neuronal membranes from oxidation, low levels
may affect the brain via increased inflammation.
• Alpha-tocopherol is the most common form
•

73. • Mediate disease by modifying transcription factors in the
brain, such as glutathione reductase, superoxide dismutase,
and nuclear factor-kappa B.
• Low plasma vitamin E levels are found in depressed
patients,.
• Foods rich in vitamin E include almonds, sunflower seeds,
leafy greens, and wheat germ.

74. Points to remember
• Many pts may neglect to care for themselves or adopt
particular eating patterns.
• Deficiencies are more common among geriatric patients
and those who are medically ill.
• Because dietary patterns are linked to the risk of psychiatric
disorders, nutritional inquiry often identifies multiple
modifiable risk factors, such as folate, vitamin B12, and
vitamin D intake.

75. • Psychiatrists should assess patients’ dietary patterns and
vitamin status, particularly older adults and those with
• Lower socioeconomic status or food insecurity
• A history of treatment resistance
• Restrictive dietary patterns such as veganism
• Alcohol abuse.
On initial assessment, test your patient’s blood levels of folate
and vitamins D and B12.

76. Simple assessment of dietary patterns
• A typical breakfast, lunch, and dinner, their favorite snacks
and foods, and specific dietary habits or restrictions (eg, not
consuming seafood, dairy, meat, etc.)
• Rudimentary nutritional recommendations can be effective
in changing a patient’s eating habits, particularly when
provided by a physician.
• Encourage patients to eat nutrient-dense foods and a
variety of vegetables and fruits / consult with a clinical
nutritionist.

77. Conclusion
• Vit B Proper functioning of the methylation cycle,
Monoamine production, DNA synthesis.
• Fat-soluble vitamins play important roles in Genetic
transcription Antioxidant recycling Inflammatory regulation
in the brain.
• Special mention to folic acid,vit B12,vitD.

78. References
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