Creatine and Mental Health Part 2

In which I examine several studies on the impact of creatine on various mental health conditions, and discuss how to supplement creatine as well as how to get more from diet.

Introduction: 

• In part one of this series we looked at the unique and critical role creatine plays in human energy metabolism. We also looked at how creatine deficiency diseases lead to devastating consequences. Then we looked at how SNP’s in the methylation system may impair the abilities of some folks to synthesize enough creatine to keep up with demand under conditions of high physical and/or emotional stress. We observed how very mild deficiencies are seen in the brains of those suffering from various mental disorders. All of this served to highlight the critical role that creatine plays in mental health, and indeed in general wellbeing. If you missed part one you can read it HERE for free. 

In part two we will investigate the research on creatine in mental and cognitive health outcomes. As well as guidelines on how to take it safely. 

What does the science say?  

There is a sizable body of direct evidence using randomized control trials spanning the last 40 years that finds supplementing creatine beyond what we get from diet can increase brain levels of this vital nutrient and more importantly, yields significant positive mental health outcomes. Where the research has seen the most success is with:

•  memory and cognition in the elderly, 

• TBI patients

• treatment of PTSD, especially when depression is also present 

• major depressive disorders

•  Anxiety

• As an adjunct therapy alongside traditional drugs for depression and anxiety

It appears to be less successful in bipolar depression, with a small risk of triggering a manic episode so caution is urged there, and creatine appears to be unsuccessful for schizophrenia. (1)

The Studies: 

One 2015 study found that 5 grams of creatine per day for 8 weeks was able to reduce the HAM-D ( a common tool psychologists use to gauge depression-the lower the score the better) scores on depressed test subjects. They also observed improvements in the Beck Anxiety Inventory and PET scanning showed increased levels of creatine in the frontal cortex of test subjects. (1)

Another study found that adolescent girls who were taking fluoxetine (Prozac) and still had major depressive symptoms had a 50% reduction in their Children’s Depression Rating Scale-Revised score when 4 grams of creatine per day for 8 weeks was added to their Prozac regimen as compared to placebo.(1)

A  larger study by the same researchers took adolescent and adult women who had failed to respond to SSRI treatment and created a randomized trial for either placebo or 2,4, or 10 grams of creatine per day for 8 weeks. This study found similar increases in the brain levels of creatine and improvement in depression symptoms regardless of the dose which is very interesting. (1) 

Another study had excellent results for depression combining creatine with the serotonin precursor 5-htp. (1)

A 2019 full clinical review of 6 different randomized controlled trials performed on those with cognitive impairments found fascinating and mixed findings. It found creatine supplementation in the elderly in particular helped with memory loss, both short and long-term, but was not effective in younger test subjects. Improvements in intelligence and reasoning were also found in the same group of subjects. Also of note was that vegetarians benefitted more from creatine supplementation than non-vegetarians. This makes a lot of sense as the only significant dietary sources of creatine are meats and fish and vegetarians will certainly get less creatine from their diet. This study also noted that Parkinson’s patients did not receive significant relief from creatine supplementation(3)

Traumatic brain injury is another area in which creatine can be useful. A randomized controlled trial of 39 children ages 1-18 showed enormous benefits since creatine is depleted in TBI: “Specifically,  creatine reduced the duration of post-traumatic amnesia, intubation time, and intensive care unit stay, in addition to improving disability, good recovery, self-care, communication, locomotion, sociability, personality and behavior, and neurophysical and cognitive function. Further, creatine improved post-traumatic headaches, dizziness and fatigue, dysarthria, and lingual problems of understanding.” (4)

Conclusions:

1. Creatine has been beneficial as a standalone therapy for depression,  anxiety, TBI, and PTSD

2. It can be an effective adjunct therapy to traditional antidepressants such as Prozac. 

3. It has the potential to help in cases of medication-resistant depression. 

4. That a dose of 3-5 grams per day is effective. 

5. That it should be taken for 8 weeks before expecting results although the first study I mentioned above showed improvement in depression after two weeks. 

Who should consider taking creatine?

• Those with depression, including drug-resistant depression 

• Those with anxiety 

• Those with PTSD, especially if accompanied by depression or anxiety 

• Those with dementia or other cognition or memory impairment disorders, especially the elderly. 

• Shift workers or anyone with disordered sleep.  

• Those with traumatic brain injury 

• Vegetarians or those who don’t eat red meat or fish. 

• Those with an SNP in the MTHFR enzyme system. 

Who should not take creatine cause of the risk of adverse effects, or no benefits observed in research: 

• Those with schizophrenia 

• Those with bipolar disorder 

• Those with Parkinson’s disease (creatine might help them in other ways, however)

• Those with high blood pressure and chronic kidney disease may benefit from creatine, but there is also a risk of their symptoms getting worse, so close doctor’s supervision is required. 

Diet or supplement? 

So how do we go about correcting low levels of creatine? The two options are diet and supplementation of pure creatine. Let’s look at increasing creatine from the diet before diving deeply into supplementation. 

The best dietary sources of creatine are red meat and fish, with herring topping the list. You would need about two lbs of beef, chicken, pork, or fish to get 3-5 grams of creatine, which might become a little tedious after a few weeks of consuming that much every day.  A tidy pound of herring would also get you there, which perhaps would become tedious even faster. For creatine to be effective 3-5 grams needs to be ingested every day for 8 weeks per the studies I quoted above to start seeing results, which is possible with food, but would take a lot of discipline. Here is a small chart with the creatine content of a few common foods. (2)

Most people do NOT get enough creatine from diet alone.

An important study that tracked the diet of 89,000 people found that the average consumption in the US is about .7 grams per day, with a problematic decline in children’s intake occurring over the last 20 years. This is largely due to the increased consumption of processed foods which increase calories but are deficient in most nutrients(5) I think the best approach for those interested in getting more creatine is to eat a high-protein diet, as well as to consider supplementation. But the caveat is that the protein source needs to be red meat, pork, chicken, or fish. Unfortunately, eggs have very little creatine, only about 10 mg per yolk. I recommend getting a minimum of 60-80 grams of animal protein per day as part of your program to improve creatine levels. This would mean between 8-12 oz per day, which provides between 1-2 grams of creatine. For people following a keto or paleo diet, this is par for the course. But as we see in the study I quoted above, the average American diet is woefully deficient in fresh animal protein and therefore is creatine deficient. I recommend that 100% of vegetarians supplement creatine, as plant-based protein sources, while excellent in so many ways, don’t have adequate creatine. For vegetarians with an MTHFR SNP, this is even more critical.

How to supplement creatine: 

Classic creatine advice from the sports medicine department is to take a 20-gram ‘loading dose’  per day for a week and then drop it down to 3-5 grams per day. My suggestion for those interested in trying creatine for themselves (having discussed it with their doctor first of course) is to skip the loading dose and just take 3-5 grams per day. My reasoning is simply to avoid potential stomach upset and also I prefer a cautious approach for anything that affects mental health. Creatine is very well studied and has about the lowest side effect profile of any supplement and most people will tolerate it well. It truly is orthomolecular since it’s a nutrient essential to life that we make in our bodies. The most commonly observed side effects are; dehydration, upset stomach, and muscle cramps. Starting with a lower dose is the best way to avoid these side effects and as the research shows is still very effective for mental health. It was shown to be safe at 5 grams per day even for children as young as five, and adults can take it for years safely. (3)

On a personal note, I take 5 grams per day myself and it helped me recover from brain fog and fatigue I developed from long-haul COVID as part of my personal COVID recovery protocol. 

The protocol:

As usual, I make no brand recommendation here. Most creatine studies used creatine monohydrate which is the form most commonly sold. I think any pure powder from any reputable brand will do just fine. Capsules are also fine if you don’t mind taking 10-15 per day to get to the right dose. 

1 tsp of the powder is about 2.5-3 grams so it takes two teaspoons per day to get up to 5. You can take this in divided doses or all at once. It dissolves much better in hot liquids and you can add it to tea or coffee as I often do myself, or blend it in a smoothy. It’s better absorbed if completely dissolved. You can take two tsp at once or one in the morning and one in the evening which is what I do. 

Do not expect instant results with creatine. As is true with most nutritional therapies it will take time, persistence, and patience. And as always your mileage may vary- we are all different. Some readers might feel improvements in a couple of weeks, for some it might take several months, and some might see no improvements. But the same can be said for antidepressant medications and these have many more serious side effects and risks associated with them. If it affects you negatively you should stop immediately or reduce your dose dramatically and work up slowly. Creatine offers so much upside potential for so few risks of side effects that I feel it's worth giving it a try. 

Parting words:

If you decide to try creatine I’d love to hear about your experience! As always thank you for reading, and sharing this newsletter with your friends and family, and supporting my mission to provide life-changing information to a million people who would like to enjoy greater mental and physical wellness. 

All the best on your journey to better mental and physical health! 

Disclaimer: I am not a medical doctor or licensed dietitian.  The information in this article does not constitute medical advice and is not intended to diagnose or treat a disease. Readers should speak with their personal medical professional before acting on any of the information discussed.

References:

1.  “Creatine for the Treatment of Depression”:

Kious, B. M., Kondo, D. G., & Renshaw, P. F. (2019). Creatine for the Treatment of Depression. Biomolecules https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6769464/

2. Korovljev, D., Todorovic, N., Stajer, V. et al.Temporal trends in dietary creatine intake from 1999 to 2018: an ecological study with 89,161 participants. J Int Soc Sports Nutr 18, 53 (2021). https://doi.org/10.1186/s12970-021-00453-1

3. Avgerinos, K. I., Spyrou, N., Bougioukas, K. I., & Kapogiannis, D. (2018). Effects of creatine supplementation on cognitive function of healthy individuals: A systematic review of randomized controlled trials. Experimental Gerontology, 108, 166-173. https://doi.org/10.1016/j.exger.2018.04.013

4. Candow, D.G., Forbes, S.C., Ostojic, S.M. et al. “Heads Up” for Creatine Supplementation and its Potential Applications for Brain Health and Function. Sports Med 53 (Suppl 1), 49–65 (2023). https://doi.org/10.1007/s40279-023-01870-9

5.Korovljev, D., Todorovic, N., Stajer, V. et al.Temporal trends in dietary creatine intake from 1999 to 2018: an ecological study with 89,161 participants. J Int Soc Sports Nutr 18, 53 (2021). https://doi.org/10.1186/s12970-021-00453-1