Magnesium: An Essential Supplement for Psychiatric Patients
Magnesium: An Essential Supplement for Psychiatric Patients
Studies proclaiming the benefits various micronutrient supplements for mental health appear on a daily basis. Commonly mentioned supplements include omega 3 fatty acids, N-acetylcysteine, tryptophan, methylfolate, methylcobalamin, dehydroepiandrosterone (DHEA), coconut oil, inositol, vitamin D, vitamin B6, choline, and many others.
However, clinicians may be less familiar with another key nutrient for mental stability – magnesium. Although small, the existing body of research on magnesium and mental health is promising.
Treatment with magnesium supplements has been shown to induce rapid recovery from depression,2 improve
symptoms of premenstrual syndrome,3 and reduce hyperactivity in children with ADHD.4 In addition, patients with schizophrenia have lower erythrocyte magnesium levels than controls.5
Magnesium plays a major role in calming the nervous system due to it's ability to block brain N-methyl D-aspartate receptors (NMDA), thereby inhibiting excitatory neurotransmission.1
Other benefits of magnesium sulfate supplementation include prevention of eclamptic seizures in pregnant women with pre-eclampsia.14 Patients with migraines have been found to have lower magnesium levels than controls,15 and have responded positively to intravenous magnesium sulfate.16
Magnesium is critical to more than 300 metabolic reactions. To name a few, the nutrient is necessary for neurotransmitter, enzyme, and hormonal activity; mitochondrial protein, DNA and RNA synthesis; and glucose homeostasis, active transport, and glutathione and ATP production.
Conversely, inadequate magnesium levels can contribute to insomnia, seizures, anxiety, pain, and other neuropsychiatric problems.
Low dietary intake and low magnesium serum levels are associated with numerous critical health conditions6 including, hypertension, elevated C-reactive protein levels, TNF alpha, triglycerides, and fasting glucose; decreased high-density lipoprotein;7 sudden cardiac death;8 type 2 diabetes;9 metabolic syndrome10 asthma;11 and osteoporosis.12 In one study, dietary-induced magnesium deficiency (longer than four weeks) in lean subjects led to a reduction in insulin sensitivity.13
Despite its benefits, many people are magnesium are deficient due to the frequent consumption of highly processed foods in the standard American diet and modern water treatment processes that remove magnesium from the water supply.
About half of Americans ingest less than the 400 mg daily requirement of magnesium from food, researchers in one study estimated.17 Dietary sources high in magnesium include nuts and seeds, particularly sunflower seeds, almonds and sesame seeds.18
The adverse effects of magnesium deficiency are cumulative, especially when magnesium-depleting foods, beverages, and medications are consumed, such as alcohol, coffee and diuretics.
The good news is that magnesium deficiency can be easily corrected for merely pennies a day. Supplementation can restore the nutrient to healthy levels and reverse many devastating health problems associated with deficiency.
Standard multivitamins only contain about one quarter of the recommended daily dietary intake. But additional magnesium supplements may be taken orally as magnesium oxide, hydroxide, sulfate, chloride, gluconate, citrate, or other forms. Transdermal magnesium supplements are also available in the form of topical creams, gels, and Epsom salt baths.
Dosages should be titrated to bowel tolerance, because magnesium has a stool softening effect. If this occurs, the dose may be reduced, or an amino acid-chelated formulation (magnesium glycinate, malate, taurate, etc) may be substituted.
Clinicians can monitor magnesium levels in the serum, or erythrocyte/red blood cells (RBCs). Serum readings measure extracellular magnesium, which represents only 1% of the total body magnesium, and are often inaccurate. RBC magnesium levels are more precise, and are available at most commercial laboratories.
If serum magnesium is less than 2.0 mEq/L, deficiency is likely. Ideally, RBC magnesium should be close to the upper limits of the reference range.
The risk for magnesium overdose is negligible, except for cases of severe renal disease. Patients with severe renal disease retain magnesium and require medical supervision if they use supplements.19
Magnesium can also interfere with absorption of certain antibiotics, medications for osteoporosis, and oral diabetic medications, and should be avoided in patients taking such medications.
Although definitive research is lacking, there is good evidence to suggest that magnesium should be given routinely and at a higher dosage than the current standard to psychiatric patients given its excellent safety profile, low cost, and many short and long-term health benefits.
Barbara Bartlik, MD, is a psychiatrist at the Manhattan Psychiatric Center. Vanessa Bijlani, MD, is a volunteer at the Manhattan Psychiatric Center. Denisa Musica is a student at Queens College, City University of New York.
The authors thank Janet Mindes, PhD, for her editorial assistance, and Andrea Rosanoff, PhD, Director of Research & Scientific Information Outreach at the Center for Magnesium Education and Research in Pahoa, Hawaii, for her expertise on magnesium.
- Ruppersberg J et al. The mechanism of magnesium block of NMDA receptors. Seminars in Neuroscience. 1994;6(2): 87-96.
- Eby GA, Eby KL. (2006). Rapid recovery from major depression using magnesium treatment. Med Hypotheses. 2006 67(2), 362-70
- Pearlstein T, Steiner M. Non-Antidepressant treatment of premenstrual syndrome. Clinical Psychiatry. 2000; 61(12): 22-7.
- Starobat-Hermelin B, Kozielec T. The effects of magnesium physiological supplementation on hyperactive disorder (ADHD). Magnes Res. 1997; 10: 149-156.
- Nechifor M. Interactions between magnesium and psychotropic drugs. Magnes Res. 2008; 21(2): 97-100.
- Rosanoff A, Weaver C, Rude R. Suboptimal magnesium status in the United States: are the health consequences underestimated? Nutr Rev. 2012; 70(3): 153-164.
- Guerrero-Romero F, Rodriguez-Moran M. Relationship between serum magnesium levels and C-reactive protein among hemodialysis patients. Magnes Res. 2008; 26:167-170.
- Curiel-Garcia J, Rodriguez-Moran M, Guerro-Romero F. (2008). Hypomagnesemia and mortality in patients with type 2 diabetes. Magnes Res. 2008; 21:163-166.
- Lopez-Ridaura R, Willett W, Rimm E et al. Magnesium intake and risk of type 2 diabetes in men and women. Diabetes Care. 2004; 27: 134-140.
- Evangelopoulos A, Vallianou N, Panagiotakos D et al. An inverse relationship between cumulating components of the metabolic syndrome serum magnesium levels. Nutr Res. 2008; 28: 659-663.
- Soutar A, Seaton A. Bronchial reactivity and dietary antioxidants. Thorax. 1997;52(2):166-170.
- Rude Rk, Singer FR, Gruber HE. Skeletal and hormonal effects of magnesium deficiency. J Am Coll Nutr. 2009; 28: 131-41.
- Nadler J et al. Magnesium deficiency produces insulin resistance and increased thromboxane synthesis. Hypertension. 1993; 21: 1024-1029.
- Sibai B. Magnesium sulfate prophylaxis in preeclampsia: evidence from randomized trials. Clin Obstet Gynecol. 2005; 48(2): 478-488.
- Talebi M et al. Relationship between serum magnesium levels and migraine attacks. Neurosciences (Riyadh). 2011;16(4): 320-323.
- Mauskop A, Altura BT , Cracco R et al. Intravenous magnesium sulfate relieves migraine attacks in patients with low serum ionized magnesium levels: a pilot study. Clinical Science. 1995; 89(6): 633-636.
- Moshfegh A, Goldman J, Ahuja J et al. What We Eat in America, NHANES 2005-2006: Usual Nutrient Intakes from Food and water compared to 1997 dietary reference intakes for vitamin D, calcium, phosphorus, and magnesium. U.S. Department of Agriculture, Agricultural Research Service. Available at: http://www.ars.usda.gov/Services/docs.htm?docid=13793.
- Cedars-Sinai Medical Center. Magnesium Rich Foods. Available at: https://www.cedars-sinai.edu/Patients/Programs-and-Services/Documents/CP0403MagnesiumRichFoods.pdf.
- Dirks JH. The Kidney and Magnesium Regulation. Kidney Int. 1983; 23: 771-777.