Posted by Tomatheus on January 7, 2015, at 10:49:00
In reply to Is there a medical reason for a psychiatrist...., posted by Phil on January 7, 2015, at 9:34:38
Phil,
My understanding of the literature on vitamin D and depression is that low vitamin D clearly seems to be related to depression in some way, but that the jury is still out on the causality of the vitamin D-depression relationship and on whether vitamin D supplementation can treat depression. Even though there are some studies that have found vitamin D to be an effective treatment for depression, there are other studies (all of which went on for six months or less) that have found that vitamin D supplementation didn't outperform placebo as a treatment for depression. I personally don't think that six months is long enough to evaluate whether or not vitamin D3 might serve as an effective antidepressant because of study data that I've come across suggesting that it takes between one and three years for vitamin D levels to return to baseline levels after individuals supplement with the vitamin for a year and then stop supplementing with it. There is only one year-long controlled clinical trial that I'm aware of that evaluated the effectiveness of vitamin D(3) in the treatment of depression, and the results of the trial indicated that vitamin D3 significantly outperformed placebo. Still, that's just one study, and more research is needed to determine just how effective vitamin D might be as a treatment for depression. I would personally hypothesize that when more year-long trials looking at vitamin D as a treatment for depression are conducted that they'll show supplementation to outperform placebo in depressed patients who have low vitamin D levels. As of right now, though, it's my understanding that there isn't enough evidence to conclusively say that vitamin D can effectively treat depression, even though there's some evidence that points toward that possibility.
I think that I'd describe the use of vitamin D as a treatment for mood-disordered patients with low levels of the vitamin to be a cutting-edge type of treatment for psychiatry. A lot of patients, in my view, will ultimately be better helped by getting their vitamin D levels checked than they are with psychiatry's current trial-and-error approach, and I think that it's because some psychiatrists can see this that they're ordering vitamin D level tests currently. However, I don't think that testing vitamin D levels in depressed patients is part of the standard protocol that psychiatrists follow, largely because I don't think that there's enough evidence in yet to say just how effective vitamin D supplementation might be for depression. So, because of this, insurance companies might not see a vitamin D level test as being medically necessary for patients with mood disorders, and psychiatrists would probably have a hard time making a case to insurance companies that vitamin D level tests should be covered. If there were conclusive evidence that vitamin D can treat depression, the situation would be different, as psychiatrists would be able to point to conclusions in scientific papers indicating that vitamin D is an effective treatment for depression.
So, what I've written basically sums up what I suspect your psychiatrist's reasoning might be for not making a case for the coverage of your test, but of course, I don't know for sure what might be going through his head. I think that it would be helpful of your psychiatrist to explain to you why he hasn't, as of yet, made a case that your test should be covered, but it doesn't sound like he's done that, and that's too bad. It could be that your psychiatrist doesn't think that there's enough evidence to support the idea that a vitamin D test is medically necessary, but I'm just speculating here, and my speculations only mean so much.
I hope that you can get your psychiatrist to offer you some sort of explanation.
Tomatheus
Has long-standing difficulties with energy and concentration, as well as perceptual and cognitive problems
Taking Abilify & supplements including vitamins B3 & D3
poster:Tomatheus
thread:1074906
URL: http://www.dr-bob.org/babble/20150102/msgs/1074911.html