Vitamin B and Anger Treatment – Is it Effective?

B vitamin supplements, similar to other complementary or alternative anger treatment approaches e.g. omega-3 fish oil, essential oils or herbs, represent yet another potential avenue to be explored concerning helping those with anger management problems. As we will see from the various studies covered within this article, results do vary and depend on a variety of factors. However, B vitamin supplementation may be the thing that can make a positive difference in your case.

The following article about vitamin B and anger treatment will address:

• Types of Vitamin B
• Vitamin B Function in the Body
• Sources of Vitamin B
• Vitamin B Recommended Daily Allowance (RDA)
• Vitamin B Research Involving Conditions Where Anger Can Be a Symptom
• Summary

Types of Vitamin B

There exists 8 chemically distinct water-soluble B vitamins and these include:

• B1 Thiamine
• B2 Riboflavin
• B3 Niacin or Nicotinic acid
• B5 Pantothenic acid
• B6 Pyridoxine, Pyridoxal, Pyridoxamine
• B7 Biotin
• B9 Folate or folic acid
• B12 Cobalamin (typically Cyanocobalamin or Methylcobalamin)

Vitamin B Function in the Body

B vitamins play an essential role in the brain and nervous system and are involved in the production and control of various chemicals that impact brain functions, mood and energy levels.

Some examples of the role played by B vitamins in brain function include:

• B1 thiamine – Coenzyme role in the synthesis of acetylcholine, GABA and glutamate.
• B6 pyridoxine – Synthesis of numerous neurotransmitters including dopamine, epinephrine, GABA, histamine, norepinephrine, serotonin.
• B9 folate – Enzyme cofactor involved in converting tryptophan into serotonin, as well as tyrosine into norepinephrine/noradrenalin.
• B12 cobalamin – Involved in the synthesis of monoamine neurotransmitters.

Sources of Vitamin B

Vitamin B occurs naturally in food such as dark leafy greens, dairy, eggs, fish and meat, especially organs like liver.

Vitamin B Recommended Daily Allowance (RDA)

Different B vitamins have different RDA (recommended daily allowance) and these vary depending on factors such such as age and gender. Moreover, figures cited can differ between medical authorities.

To illustrate the above, if we consider B vitamins RDA for adults, the UK National Health System (NHS) recommend the following:

Moreover, if we look specifically at B1 Thiamine, the Institute of Medicine (US) recommends the following RDA based on age, gender and pregnancy/lactation:

Be aware that too high an intake of certain B vitamins can be problematic. For example, excessive B3 can lead to elevated liver enzymes and too much B6 can cause nerve toxicity.

However, vitamin B supplement dosages that exceed RDA’s are sometimes given by medical practitioners depending on a number of factors e.g. patients age, metabolic and other medical conditions, medication being taken etc.

Therefore, before consuming B vitamins, good practice would be to always carefully follow the instructions on the product or seek the advice of a qualified medical practitioner.

Supplementation

Surveys typically place B vitamins in the top 10 of the most popular dietary supplements taken e.g. ConsumerLab.

Vitamin B supplements are available in various forms such as:

• All-in-one as a vitamin B complex pill containing all or most of the B vitamins.
• Individual B vitamins.
• Bioavailable versions – Bioavailability is a term that refers to the amount (not potency) of active ingredient in a product that is able to carry out its activity in the target cells i.e. amount of supplement that ends up adsorbed. In practical terms this means that a low dosage pill with good bioavailability may produce as good or better results than a high dosage pill with poor bioavailability.

Vitamin B Research Involving Conditions Where Anger Can be a Symptom

Kaplan et al. 2007 ¹ noted that in relation to mood, the most widely studied B vitamin is vitamin B9 (folate or folic acid), with the bulk of other studies covering B1 (thiamine), B6 (pyridoxine) and B12 (cobalamin). The following represents a sample of studies undertaken on this topic over the last few decades:

Goggans 1984 ² noted that the mania experienced by an anemia patient with vitamin B12 deficiency was resolved with monthly B12 injections.

Bell et al. 1992 ³ studied adding vitamins B1, B2 and B6 to antidepressant treatment of geriatric inpatients with depression. Depression and cognitive function improved in those receiving the vitamin supplements compared to those taking a placebo.

Stewart et al. 1994 ⁴ observed that 21% of depressed outpatients in their study had low B6 value. They concluded “the possibility of B6 deficiency must be considered in any patient presenting with depression”.

Abou-Saleh and Coppen 1986 ⁵ study into folate (B9), depression and a nutritional hypotheses of the psychoses suggested that “folate deficiency, with or without deficiencies of other nutritional factors such as monoamine precursors, vitamins B6, B12 and C, may predispose to or aggravate psychiatric disturbances, particularly depression”.

Godfrey et al. 1990 ⁶ found that one-third of patients with major depression or schizophrenia had “borderline or definite folate deficiency”. Supplementation with methylfolate resulted in a significant improvement in clinical and social recovery.

Young 1991 ⁷ noted that deficiencies in folic acid “can cause low brain serotonin and lowered mood” and therefore “Folate supplements may be useful in some depressed patients”.

Fava et al. 1997 ⁸ paper concerning major depressive disorder found that “Subjects with low folate levels were more likely to have melancholic depression” and had a poorer response to antidepressant treatment. However, they found homocysteine (a non-protein α-amino acid) and vitamin B12 “were not associated with depressive subtype or treatment response”.

Hasanah et al. 1997 ⁹ study of reduced red-cell folate in mania found it was “associated with the illness and not due to reduced absorption or dietary deficiency of folate”.

Women whose thiamine (B1) status was deemed to be adequate (by traditional criterion) became “more clearheaded, composed and energetic” when given thiamine supplementation according to Benton et al. 1997 ¹⁰.

Lindenbaum et al. 1998 ¹¹ study concluded neuropsychiatric disorders caused by cobalamin (B12) deficiency in the absence of anemia “occur commonly”.

Bellisle et al. 1998 ¹² noted that a deficiency in niacin (B3) can be associated with psychiatric symptoms.

Benton and Donohoe 1999 ¹³ study into the effects of nutrients on mood found that vitamin B9 (folate) deficiency in the elderly is sometimes associated with depression and that an improvement in vitamin B1 (thiamine) status was associated with improved mood.

Wyatt et al. 1999 ¹⁴ carried out a systematic review on the efficacy of pyridoxine (B6) for treating PMS (premenstrual syndrome). Anger, anxiety, mood swings and moodiness, irritability and depression are just a few symptoms commonly associated with PMS. The study concluded that “doses of vitamin B-6 up to 100 mg/day are likely to be of benefit in treating premenstrual symptoms and premenstrual depression”.

Alpert et al. 2000 ¹⁵ study into folate, nutrition and depression showed that low folic acid (B9) levels may be associated with depression as well as a poor response to antidepressants.

Penninx et al. 2000 ¹⁶ discovered that in community-dwelling older women “metabolically significant vitamin B12 deficiency is associated with a twofold risk of severe depression”.

Bottiglieri et al. 2000 ¹⁷ study of neuropsychiatry disorders, folate and vitamin B12 concluded that “Folate deficiency may specifically affect central monoamine metabolism and aggravate depressive disorders”. They also suggested that the neurologic and psychiatric disturbances associated with folate and vitamin B12 deficiency may be associated with the neurotoxic effects of homocysteine.

Coppen and Bailey 2000 ¹⁸ studied the effect on major depression of adding folic acid supplementation to the antidepressant action of fluoxetine. They concluded that “Folic acid is a simple method of greatly improving the antidepressant action of fluoxetine and probably other antidepressants”. Although further investigation was required to determine the optimum dose of folic acid, they did observe that “Men require a higher dose of folic acid to achieve this than women”.

Shiloh et al. 2001 ¹⁹ researched the effects of adding pyridoxine (B6) to existing treatments for depressive schizophrenic patients. They concluded that for some people in this group, pyridoxine may be a helpful addition to existing treatments for improving depressive symptoms.

Bryan et al. 2002 ²⁰ investigation into short-term supplementation with vitamin B6 (75 μg), B9 (750 μg) and B12 (15 μg) for 35 days found a “significant positive effect on some measures of memory performance only, and no effect on mood”.

Tiemeier et al. 2002 ²¹ studied vitamin B12, folate, and homocysteine in depression. They concluded “The association of vitamin B12 and folate with depressive disorders may have different underlying mechanisms. Vitamin B12 may be causally related to depression, whereas the relation with folate is due to physical comorbidity”.

Successful diagnosis and treatment can be complicated in the case of people who have mood disorders with mixed features that are the result of them having multiple deficiencies. For example, Fafouti et al. 2002 ²² reported the case of a woman with a mood disorder (mixed depressed/manic features) due to folate (B9) and cobalamin (B12) deficiency. Full clinical remission was achieved with intramuscular B12 injections and oral folate and the condition was stable at the 1-year follow-up.

Morris et al. 2003 ²³ studied folate deficiency/low folate status and depression in the US general population. After adjusting for a variety of factors e.g. sociodemographic or smoking and illegal drug usage, they found people with a lifetime diagnosis of major depression had lower serum and red blood cell folate concentrations than those who had never had depression. Furthermore, they concluded “Low folate status was detectable in depressed members of the general US population” and suggested that “Folate supplementation may be indicated during the year following a depressive episode”.

Bjelland et al. 2003 ²⁴ investigated the effect of folate, vitamin B12, homocysteine, and a genotype (C677T MTHFR ) in anxiety and depression. They found “Neither folate nor vitamin B12 was significantly related to anxiety disorder or depression”. Incidentally, plasma levels of homocysteine were “not significantly associated with anxiety disorder but were significantly related to depression”. In the case of the C677T MTHFR genotype, “Depression but not anxiety disorder was related…”.

Tolmunen et al. 2003 ²⁵ studied the association between dietary folate and depression symptoms in a general population (Finnish men). Having adjusted for a variety of other factors e.g. smoking or BMI, they found “Those in the lowest third of energy-adjusted folate intake had a higher risk of being depressed…than those in the highest folate intake third”. They discovered no such association with B2 (riboflavin), B6 (pyridoxine) or B12 (cobalamin) intake and depression.

Morris et al.2003 ²⁶ studied the association between depression and folate status in a general population (US) aged 15 to 39 years of age. They took into account a range of factors including alcohol and illegal drug usage, overweight status and vitamin/mineral supplementation etc. and found “subjects who met criteria for a lifetime diagnosis of major depression had folate concentrations in serum and RBCs that were lower than those of subjects who had never been depressed”.

Hvas et al. 2004 ²⁷ randomized placebo controlled study of vitamin B12 deficiency and impaired cognitive function and depression concluded “vitamin B-12 treatment did not improve cognitive function or symptoms of depression within the 3-months study period”.

Papakostas et al. 2004 ²⁸ study into the relationship of serum folate, vitamin B12, and homocysteine levels in patients who had failed treatment with a conventional drug (SSRI antidepressant called fluoxetine 20) for major depressive disorder (MDD) concluded that the condition was associated with low serum folate levels.

Hvas et al. 2004 ²⁹ study of vitamin B6 and depression suggested “a low level of plasma PLP [pyridoxal phosphate i.e. vitamin B6] is associated with symptoms of depression”.

Coppen and Bolander-Gouaille 2005 ³⁰ review of folic acid and vitamin B12 on major depression concluded “On the basis of current data, we suggest that oral doses of both folic acid (800 µg daily) and vitamin B12 (1 mg daily) should be tried to improve treatment outcome in depression”.

Williams et al. 2005 ³¹ paper concerning mood, serotonin and folic acid supplementation in healthy males found that vitamin B9 (folate) supplementation (100 μg for 6 weeks followed by 200 μg for a further 6 weeks) did not alter subjective mood or the levels of the biochemical marker of mood, serotonin ( 5-hydroxytryptamine i.e. 5-HT) in healthy males.

Fallon and Enig 2005 ³² noted in their article concerning vitamin B12 that one of the symptoms, especially early symptoms, of vitamin B12 deficiency is “Irrational or chronic anger”.

Dennehy 2006 ³³ review of the use of herbs and dietary supplements in gynecology noted that therapies that carry a higher level of support from randomized controlled trial evidence include calcium and vitamin B6 for premenstrual syndrome (PMS).

Murakai et al. 2008 ³⁴ found that a “Higher dietary intake of folate [B9] was associated with a lower prevalence of depressive symptoms in Japanese men but not women”.

Dogan et al. 2009 ³⁵ reported the case of a 12 year old boy with vitamin B12 (cobalamin) deficiency who exhibited psychotic and extrapyramidal (movement disorders) symptoms. His symptoms responded to IV vitamin B12 therapy.

Naghashpour et al. 2010 ³⁶ study into clinical nurses with depression showed a “higher prevalence of marginal riboflavin deficiency in depressed subjects”.

Stough et al. 2011 ³⁷ paper concerning work stress and administering high dose vitamin B-complex for 3 months reported that “the vitamin B complex treatment groups reported significantly lower personal strain and a reduction in confusion and depressed/dejected mood”. Given the rising cost and incidence of workplace stress, the authors noted that their findings pointed to a “cost-effective treatment for the mood and psychological strain effects of occupational stress”.

Lewis et al. 2012 ³⁸ concluded vitamin B complex supplementation (‘Max Stress B’) “improve mood symptoms and mental health quality of life in adults with depression”.

Long and Benton 2013 ³⁹ evaluated databases and 8 studies looking at the influence of diet supplementation on mood in the general population. One of their conclusions was “Supplements containing high doses of B vitamins may be more effective in improving mood states”.

de Koning et al. 2016 ⁴⁰ undertook a 2 year study of vitamin B9 (folic acid) and B12 (cobalamin) supplementation of older adults (65+ years old) with elevated homocysteine concentrations. They concluded lowering plasma homocysteine concentrations using vitamin B12 and folic acid did not lower depressive symptoms, however it may have had a small positive impact on health-related quality of life.

Summary

There is increasing evidence concerning the effects of certain micronutrients on brain and behavioral functioning including their role in treating mood, depression and various psychiatric illnesses.

In relation to the above, the vast majority of studies cited in this article suggest B vitamins, in particular B9 (folate or folic acid) but also B1 (thiamine), B6 (pyridoxine), and B12 (cobalamin), appear to be beneficial. The effect is often notable when supplementing individuals who have a deficiency in certain B vitamins. Deficiencies can be caused by various reasons such as poor diet, infections, intestinal problems and other medical conditions or disorders, prescription medications, alcohol, smoking or recreational drugs, aging and pregnancy.

However, not all studies are in agreement concerning the degree of benefit gained or whether the effect is universal e.g. Murakai et al. 2008 ³⁴ found a higher intake of B9 was beneficial to men but not women. Also, some studies found no effect on mood e.g. Bryan et al. 2002 ²⁰ (vitamin B6, B9 and B12) or Williams et al. 2005 ³¹ (vitamin B9), or depression e.g. Hvas et al. 2004 ²⁷ (vitamin B12).

So what is the take away from the above?

An optimal intake of B vitamins through diet/suplementation is essential for maintaining good health, especially brain and nervous system function. Aside from a wealth of anecdotal evidence, a significant number of studies over many decades suggest B vitamins play a positive role in treating mood, depression and various psychiatric illnesses – all of which can have anger as a symptom.

Resources:

1. Kaplan et al. 2007 Vitamins, Minerals, and Mood
2. Goggans 1984 A case of mania secondary to vitamin B12 deficiency
3. Bell et al. 1992 Brief communication: Vitamin B1, B2, and B6 augmentation of tricyclic antidepressant treatment in geriatric depression with cognitive dysfunction
4. Stewart et al. 1994 Low B6 levels in depressed outpatients
5. Abou-Saleh and Coppen 1986 Psychiatric progress. The biology of folate in depression: Implications for nutritional hypotheses of the psychoses
6. Godfrey et al. 1990 Enhancement of Recovery From Psychiatric Illness by Methylfolate
7. Young 1991 – The 1989 Borden Award Lecture. Some effects of dietary components (amino acids, carbohydrate, folic acid) on brain serotonin synthesis, mood, and behavior
8. Fava et al. 1997 Folate, vitamin B12, and homocysteine in major depressive disorder
9. Hasanah et al. 1997 Reduced red-cell folate in mania
10. Benton et al. 1997 Thiamine supplementation mood and cognitive functioning
11. Lindenbaum et al. 1998 Neuropsychiatric Disorders Caused by Cobalamin Deficiency in the Absence of Anemia or Macrocytosis
12. Bellisle et al. 1998 Functional food science and behaviour and gpsychological functions
13. Benton and Donohoe 1999 The effects of nutrients on mood
14. Wyatt et al. 1999 Efficacy of vitamin B-6 in the treatment of premenstrual syndrome: Systematic review
15. Alpert et al. 2000 Nutrition and depression: Focus on folate
16. Penninx et al. 2000 Vitamin B12 Deficiency and Depression in Physically Disabled Older Women: Epidemiologic Evidence From the Women’s Health and Aging Study
17. Bottiglieri et al. 2000 Folate, Vitamin B12, and Neuropsychiatry Disorders
18. Coppen and Bailey 2000 Enhancement of the antidepressant action of fluoxetine by folic acid: A randomised, placebo controlled trial
19. Shiloh et al. 2001 Antidepressive effect of pyridoxine (vitamin B6) in neuroleptic-treated schizophrenic patients with co-morbid minor depression – Preliminary open-label trial
20. Bryan et al. 2002 Short-Term Folate, Vitamin B-12 or Vitamin B-6 Supplementation Slightly Affects Memory Performance But Not Mood in Women of Various Ages
21. Tiemeier et al. 2002 Vitamin B12, folate, and homocysteine in depression: the Rotterdam Study
22. Fafouti et al. 2002 Mood disorder with mixed features due to vitamin B(12) and folate deficiency
23. Morris et al. 2003 Depression and Folate Status in the US Population
24. Bjelland et al. 2003 Folate, Vitamin B12, Homocysteine, and the MTHFR 677C→T Polymorphism in Anxiety and Depression
25. Tolmunen et al. 2003 (Dietary folate and depressive symptoms are associated in middle-aged Finnish men)
26. Morris et al. 2003 Depression and Folate Status in the US Population
27. Hvas et al. 2004 No effect of vitamin B-12 treatment on cognitive function and depression: a randomized placebo controlled study
28. Papakostas et al. 2004 Serum Folate, Vitamin B12, and Homocysteine in Major Depressive Disorder, Part 1: Predictors of Clinical Response in Fluoxetine-Resistant Depression
29. Hvas et al. 2004 Vitamin B6 Level Is Associated with Symptoms of Depression
30. Coppen and Bolander-Gouaille 2005 Treatment of depression: time to consider folic acid and vitamin B12
31. Williams et al. 2005 Effect of folic acid supplementation on mood and serotonin response in healthy males
32. Fallon and Enig 2005 Vitamin B12: Vital nutrient for good health
33. Dennehy 2006 The Use of Herbs and Dietary Supplements in Gynecology: An Evidence-Based Review
34. Murakai et al. 2008 Dietary intake of folate, other B vitamins, and omega-3 polyunsaturated fatty acids in relation to depressive symptoms in Japanese adults
35. Dogan et al. 2009 Psychotic Disorder and Extrapyramidal Symptoms Associated with Vitamin B12 and Folate Deficiency
36. Naghashpour et al. 2010 Riboflavin Status and Its Association with Serum hs-CRP Levels among Clinical Nurses with Depression
37. Stough et al. 2011 The effect of 90 day administration of a high dose vitamin B-complex on work stress
38. Lewis et al. 2012 The Effect of Methylated Vitamin B Complex on Depressive and Anxiety Symptoms and Quality of Life in Adults with Depression
39. Long and Benton 2013 Effects of Vitamin and Mineral Supplementation on Stress, Mild Psychiatric Symptoms, and Mood in Nonclinical Samples: A Meta-Analysis
40. de Koning et al. 2016 Effects of Two-Year Vitamin B12 and Folic Acid Supplementation on Depressive Symptoms and Quality of Life in Older Adults with Elevated Homocysteine Concentrations: Additional Results from the B-PROOF Study, an RCT

Disclaimer:
This article is for educational purposes only and has not been evaluated by the FDA. The information is not intended to diagnose, treat, cure, or prevent any disease.