Antidepressants may lead to a decrease in niacin and NAD in patients with poor dietary intake

Show simple item record Viljoen, Margaretha Swanepoel, Annie Bipath, Priyesh 2015-06-11T05:59:40Z 2015-06-11T05:59:40Z 2015-03
dc.description.abstract The term niacin is the generic name for the two compounds nicotinic acid and nicotinamide, the major dietary precursors for two important coenzymes, nicotinamide adenine dinucleotide (NAD) and its phosphorylated form, NADP. Niacin is important for the maintenance of cellular integrity and energy production and is involved in more than 500 intracellular reactions. Deficiencies of niacin may contribute to neuropsychiatric and neurodegenerative disorders. Patients who develop nutritional deficiencies as a result of poor dietary intake, could potentially suffer from niacin deficiency and NAD depletion. However, de novo synthesis of niacin and NAD in the kynurenine pathway of tryptophan metabolism may compensate for impaired dietary intake. The rate of synthesis of NAD and niacin from tryptophan oxidation depends on the induction of the enzyme indoleamine 2,3- dioxygenase (IDO) by pro-inflammatory cytokines such as interferon-gamma. Niacin synthesis is not limited by a decrease in tryptophan and excessive IDO activity may therefore lead to a decline in tryptophan levels. Antidepressants have an anti-inflammatory effect, including reduction of interferon-gamma and therefore inhibition of IDO, the ratelimiting enzyme of the kynurenine pathway. In theory, this could account for increased serotonin as more tryptophan becomes available for serotonin synthesis. However, the downside may be that less NAD and niacin are synthesised downstream, which could exacerbate common psychiatric problems. It is our hypothesis that patients with poor dietary intake, who are treated with antidepressants, are at risk of developing niacin/NAD deficiency with possible development of associated neuropsychiatric symptoms. We therefore propose that niacin supplementation be considered in patients with inadequate diets who are treated with antidepressants. We believe that if this does not happen, a subclinical niacin deficiency may result, which would be difficult to detect as it would cause the same symptoms of the original illness (e.g. depression). Niacin deficiency should be considered and ruled out in all patients with treatment-resistant depression, who have a poor response to antidepressants. This is potentially a cost-effective and easy intervention, which could be examined in a randomized controlled trial. en_ZA
dc.description.embargo 2016-03-31 en_ZA
dc.description.librarian hb2015 en_ZA
dc.description.uri en_ZA
dc.identifier.citation Viljoen, M, Swanepoel, A & Bipath, P 2015, 'Antidepressants may lead to a decrease in niacin and NAD in patients with poor dietary intake', Medical Hypotheses, vol. 84, no. 3, pp. 178-182. en_ZA
dc.identifier.issn 0306-9877 (print)
dc.identifier.issn 1532-2777 (online)
dc.identifier.other 10.1016/j.mehy.2014.12.017
dc.language.iso en en_ZA
dc.publisher Elsevier en_ZA
dc.rights © 2014 Elsevier Ltd. All rights reserved. Notice : this is the author’s version of a work that was accepted for publication in Medical Hypotheses. 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 Medical Hypotheses, vol. 84, no. 3, pp. 178-182, 2015. doi : 10.1016/j.mehy.2014.12.017 en_ZA
dc.subject Antidepressants en_ZA
dc.subject Nicotinamide adenine dinucleotide (NAD) en_ZA
dc.subject Niacin en_ZA
dc.subject Nutritional deficiencies en_ZA
dc.subject Niacin deficiency en_ZA
dc.subject NAD depletion en_ZA
dc.subject Niacin supplementation en_ZA
dc.subject Inadequate diets en_ZA
dc.title Antidepressants may lead to a decrease in niacin and NAD in patients with poor dietary intake en_ZA
dc.type Postprint Article en_ZA

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