Published date: Jun 30 2021

Journal Title: Sudan Journal of Medical Sciences

Issue title: Sudan JMS: Volume 16 (2021), Issue No. 2

Pages: 233–244

DOI: 10.18502/sjms.v16i2.9291

Janan A. Alrefaeejanan1969@yahoo.comDepartment of Medical Physiology, College of Medicine, University of Mosul, Mosul, Iraq

Ban K. RushdiDepartment of Physiology, Senior Chief General Practitioners, Mosul, Iraq

Ghada K. AdeebIbn Sina Teaching Hospital Mosul, Iraq

Background: A widespread severe deficiency of vitamin D (vit D) exists in Iraq, especially among women of reproductive age. Depression or anxiety is related to deficiency of vit D. These patients may present with psychosomatic symptoms which are symptoms with no sufficient organic cause in the body but from psychological causality. The study aimed to investigate the serum level of vit D in females with psychosomatic symptoms residing in Mosul City, Iraq and explore the effect of vitamin D3 (vit D3) supplements for treating psychosomatic symptoms.

Methods: A total of 73 female patients aged 15–45 years presented with several symptoms. All patients underwent physical examination and psychiatric interviews. Patients with minimal to mild depression were selected. All included patients underwent investigation of first serum vit D level. The supplementation with vitamin D3 was started. The second serum vit D level was investigated at first post-improvement visit.

Results: In the improved group, the post-supplementation serum vit D level was higher than that before the supplementation (p = 0.00). In addition, the vit D serum difference before and after its supplementation was greater in the improved group than the nonimproved one (p = 0.00). Patients not only experienced improvement in their mood swings, but also recovered from other recorded symptoms such as headache, fatigue, tiredness, and joint pain.

Conclusion: This study revealed a noticeable association concerning serum levels of 25-OH D and mild depression in addition to psychosomatic symptoms in females living in Mosul City. Supplementation with suitable loading vit D3 dosages improved these symptoms showing a probable causal relationship.

Keywords: psychosomatic symptom, vit D, depression, vit D3 supplementation

[1] Zerwekh, J. E. (2008). Blood biomarkers of vitamin D status. American Journal of Clinical Nutrition, vol. 87, no. 4, pp. 1087S–1091S.


[2] Holick, M. F. (2007). Vitamin D deficiency. New England Journal of Medicine, vol. 357, pp. 266–281.


[3] Guardia, G., Parikh, N., Eskridge, T., et al. (2008). Prevalence of vitamin D depletion among subjects seeking advice on osteoporosis: a five year cross-sectional study with public health implications. Osteoporosis International, vol. 19, no. 1, pp. 13–19.


[4] Gaugris, S., Heaney, R. P., Boonen, S., et al. (2005). Vitamin D inadequacy among post- menopausal women: a systematic review. QJM, vol. 98, no. 9, pp. 667–676.


[5] Hantoosh, H. A., Mahdi, M. H., Imran, B. W., et al. (2019). Prevalence of vitamin D deficiency in Iraqi female at reproductive age. Medical Journal of Babylon, vol. 16, no. 2, pp. 119–122.


[6] Jawale, B., Rodrigues, L., Jitendra, N., et al. (2019). The effect of a vitamin D3 supplement supracal HD tablet in the acceleration of orthodontic tooth movement - a clinical comparative and observational study. International Journal of Science and Research, vol. 8, no. 6, pp. 539–542.


[7] Wortsman, J., Matsuoka, L. Y., Chen, T. C., et al. (2000). Decreased bioavailability of vitamin D in obesity. American Journal of Clinical Nutrition, vol. 72, no. 3, pp. 690–693.


[8] Hollis, B. W. and Wagner, C. L. (2005). Normal serum vitamin D levels. New England Journal of Medicine, vol. 352, no. 5, pp. 515–516.


[9] Heaney, R. P. (2010). Defining deficiency of vitamin D. Clinical Laboratory International, vol. 34, pp. 16–19.


[10] Heaney, R. P. (2013). Health is better at serum 25OHD above 30 ng/mL. Journal of Steroid Biochemistry and Molecular Biology, vol. 136, pp. 224–228.


[11] Reid, I. R. and Bolland, M. J. (2014). Skeletal and nonskeletal effects of vitamin D: is vitamin D a tonic for bone and other tissues? Osteoporosis International, vol. 25, no. 10, pp. 2347–2357.


[12] Deluca, G. C., Kimball, S. M., Kolasinski, J., et al. (2013). Review: the role of vitamin D in nervous system health and disease. Neuropathology and Applied Neurobiology, vol. 39, no. 5, pp. 458–484.


[13] Józefowicz, O., Rabe-jabłońska, J., Woźniacka, A., et al. (2014). Analysis of vitamin D status in major depression. Journal of Psychiatric Practice, vol. 20, no. 5, pp. 329–337.


[14] Kerr, D. C., Zava, D. T., Piper, W. T., et al. (2015). Associations between vitamin D levels and depressive symptoms in healthy young adult women. Psychiatry Research, vol. 227, no. 1, pp. 46–51.


[15] Bičíková, M., Dušková, M., Vítků, J., et al. (2015). Vitamin D in anxiety and affective disorders. Physiological Research, vol. 64, no. 2, pp. S101–S103.


[16] David, S. and Roger, S. (2013). Oxford Handbook of Psychiatry (3rd ed.). Oxford University Press.


[17] Katon, W., Kleinman, A., and Rosen, G. (1982). Depression and somatization: a review, Part I-II. American Journal of Medicine, vol. 72, no. 2, pp. 242–247.


[18] BischoflF-Ferrari, H. A. (2008). Optimal serum 25-hydroxyvitamin D levels for multiple health outcomes. In: J. Reichrath (Ed.), Sunlight, Vitamin D and Skin Cancery. Landes Bioscience Book.


[19] Hansson, M., Chotai, J., Nordstöm, A., et al. (Comparison of two self-rating scales to detect depression: HADS and PHQ-9). British Journal of General Practice, vol. 59, no. 566, pp. e283–e288.


[20] Altra company “biomeriuex”, minividas. Retrieved from: http://www.annulab.com/annonces_classees/ v_occasions.shtml


[21] Einarsdóttir, K., Preen, D. B., Clay, T. D., et al. (2010). Effect of a single ‘megadose’ intramuscular vitamin D 600,000 IU injection on vitamin D concentrations and bone mineral density following biliopancreatic diversion surgery. Obesity Surgery, vol. 20, no. 6, pp. 732–737.


[22] Amrein, K., Sourij, H., Wagner, G., et al. (2011). Short-term effects of high-dose oral vitamin D3 in critically ill vitamin D deficient patients: a randomized, double-blind, placebo-controlled pilot study. Critical Care, vol. 15, no. 2, p. R104.


[23] Cipriani, C., Romagnoli, E., Scillitani, A., et al. (2010). Effect of a single oral dose of 600,000 IU of cholecalciferol on serum calciotropic hormones in young subjects with vitamin D deficiency: a prospective intervention study. Journal of Clinical Endocrinology and Metabolism, vol. 95, no. 10, pp. 4771–4777.


[24] Kjærgaard, M., Waterloo, K., Wang, C. E., et al. (2012). Effect of vitamin D supplement on depression scores in people with low levels of serum 25-hydroxyvitamin D: nested case-control study and randomised clinical trial. British Journal of Psychiatry, vol. 201, no. 5, pp. 360–368,


[25] Mozaffari-Khosravi, H., Nabizade, L., Yassini-Ardakani, S. M., et al. (2013). The effect of 2 different single injections of high dose of vitamin D on improving the depression in depressed patients with vitamin D deficiency: a randomized clinical trial. Journal of Clinical Psychopharmacology, vol. 33, no. 3, pp. 378–385.


[26] Daud, K. Mohd., Julies, P., Poblete, X., et al. (2012). Safety of vitamin D supplementation in children: a massive vitamin D overdose with no apparent hypercalcaemia. Archives of Disease in Childhood, vol. 97, no. 1, p. A12.


[27] Marcinowska-Suchowierska, E., Walicka, M., Tałałaj, M., et al. (2010). Vitamin D supplementation in adults-guidelines. Endokrynologia Polska, vol. 616, no. 1, pp. 723–729.


[28] Wilkins, C. H., Sheline, Y. I., Roe, C. M., et al. (2006). Vitamin D deficiency is associated with low mood and worse cognitive performance in older adults. American Journal of Geriatric Psychiatry, vol. 14, no. 12, pp. 1032–1040.


[29] Kerr, D. C., Zava, D. T., Piper, W. T., et al. (2015). Associations between vitamin D levels and depressive symptoms in healthy young adult women. Psychiatry Research, vol. 227, no. 1, pp. 46–51.


[30] Milaneschi, Y., Hoogendijk, W., Lips, P., et al. (2013). The association between low vitamin D and depressive disorders. Molecular Psychiatry, vol. 19, no. 4, pp. 444–451.


[31] Parker, G. and Brotchie, H. (2011). ‘D’ for depression: any role for vitamin D? ’Food for Thought’ II. Acta Psychiatrica Scandinavica, vol. 124, no. 4, pp. 243–249.


[32] Gloth 3rd, F. M., Alam, W., and Hollis, B. (1999). Vitamin D vs broad spectrum phototherapy in the treatment of seasonal affective disorder. Journal of Nutrition, Health and Aging, vol. 3, no. 1, pp. 5–7.


[33] Gowda, U., Mutowo, M. P., Smith, B. J., et al. (2015). Vitamin D supplementation to reduce depression in adults: meta-analysis of randomized controlled trials. Nutrition, vol. 31, no. 3, pp. 421–429.


[34] Knutsen, K. V., Brekke, M., Gjelstad, S., et al. (2010). Vitamin D status in patients with musculoskeletal pain, fatigue and headache: a cross-sectional descriptive study in a multi-ethnic general practice in Norway. Scandinavian Journal of Primary Health Care, vol. 28, no. 3, pp. 166–171.


[35] Prakash, S. and Shah, N. D. (2009). Chronic tension-type headache with vitamin d deficiency: casual or causal association? Headache, vol. 49, no. 8, pp. 1214–1222.


[36] Badsha, H., Daher, M., and Ooi, K. K. (2009). Myalgias or non-specific muscle pain in Arab or IndoPakistani patients may indicate vitamin D deficiency. Clinical Rheumatology, vol. 28, no. 8, pp. 971–973.