Recommendations

Supplements

Below is a summary of supplements discussed as adjuncts in psychiatric practice, along with the current evidence. Their effects are generally small to moderate, and none of them replaces treatment.

This list is for information only. Use the supplements listed here ONLY if your doctor has specifically recommended them for you. They can interact with your medication; do not start them on your own and do not stop your current treatment.

  • 1) 藏红花

    Note: 如有怀孕的可能，请勿使用。

    一项纳入34项随机对照试验并采用GRADE方法评估证据质量的荟萃分析报告，与安慰剂相比，藏红花可显著降低抑郁量表评分（Mahmoudi等，2026）。另一项纳入8项直接比较藏红花与选择性5-羟色胺再摄取抑制剂（SSRI）的试验的荟萃分析发现，两组间无显著差异，藏红花组的不良反应较少（Shafiee等，2025）——但这些研究规模小、持续时间短，尚不足以得出“可替代SSRI”的结论。

    系统综述显示，与安慰剂相比，藏红花可显著降低焦虑评分（Marx等，2019）。

    研究报告，睡眠质量和失眠评分（PSQI、ISI）有轻至中度改善（Lian等，2022）。

  • 2) NAC（N-乙酰半胱氨酸）

    综述的综合分析认为，其作为抑郁及其他心境障碍的辅助治疗药物具有一定前景（Fernandes等，2016）。

    研究中的每日剂量为1000–3000 mg，治疗持续8–24周（Peng等，2024）。效应较小（标准化均数差 SMD = -0.24），在双相障碍患者中最为明显；其用于辅助治疗，而非单独治疗。

    有达到推荐级别的证据支持其可显著减轻精神分裂症的阴性症状及总体症状严重程度（Yolland等，2020）。

  • 3) Omega-3脂肪酸（以EPA为主）

    在抑郁症中被发现有效的是以EPA为主的制剂。国际营养精神病学研究学会（ISNPR）指南推荐使用纯EPA或EPA/DHA比值大于2的制剂；每日EPA实际摄入量为1–2 g（Guu等，2019）。荟萃分析也显示，EPA占比越高，疗效越明显（Liao等，2019）。以DHA为主的制剂尚未显示出抗抑郁作用。

    证据的局限性：Cochrane综述认为，Omega-3对抑郁症的效应较小，证据确定性较低；应将其视为辅助治疗，而非单独治疗（Appleton等，2021）。

  • 4) 胞磷胆碱

    其在精神科领域的作用限于辅助治疗，证据仍然有限。研究主要集中于抑郁症、精神分裂症的阴性症状及成瘾领域。

    其精神科应用的证据仅限于两项小型随机试验，尚无荟萃分析级别的证据（Roohi-Azizi等，2017；Brown和Gabrielson，2012）。

  • 5) L-甲基叶酸（高剂量）

    研究显示，对于SSRI治疗无应答的重性抑郁障碍患者，在抗抑郁药基础上加用L-甲基叶酸（15 mg/日）可提高治疗应答率（Papakostas等，2012）；荟萃分析发现，其效应为小至中等程度（Maruf等，2022）。

  • 6) 维生素D和B族维生素（尤其是叶酸和B12）

    我们不列出血液浓度目标值：内分泌学会2024年指南不建议普通成年人常规检测维生素D水平，也不建议依据检测水平设定目标值（Demay等，2024）。如发现缺乏，应由医生决定是否进行补充治疗。

    剂量–反应荟萃分析显示，补充维生素D对抑郁评分的影响较小，且证据确定性有限（Ghaemi等，2024）。没有证据表明单用叶酸或B12可以治疗抑郁症；其作用主要见于存在相应缺乏的人群，以及作为辅助治疗使用时（Almeida等，2015；Young等，2019）。

  • 7) 益生菌

    越来越多的证据表明，在重性抑郁障碍的治疗中加用益生菌，可能使抑郁症状获得小至中等程度的减轻，并改善认知功能，但证据仍不一致（Asad等，2025；Liu等，2019）——共23项随机试验、1401名患者；效应较小，研究间的一致性较低。

  • 8) 镁

    观察性研究显示，镁营养状况与睡眠质量存在关联，但随机试验的结果相互矛盾，证据确定性较低（Arab等，2023；Mah和Pitre，2021）。

    • 研究报告，老年失眠患者每日服用500 mg氧化镁，持续8周后，睡眠时长、睡眠效率、入睡潜伏期及褪黑素水平均有显著改善（Abbasi等，2012）。
    • 在自述睡眠不佳的健康青年及中年成年人中，每日服用250 mg双甘氨酸镁后，与安慰剂相比，失眠评分显著降低，但效应较小（Schuster等，2025）。
    • 研究报告，每日服用1 g L-苏糖酸镁，持续21天后，深睡眠、快速眼动（REM）睡眠、日间精力及工作效率均有所改善（Hausenblas等，2024）。
    剂型主要研究情境
    氧化镁老年原发性失眠、术后患者
    柠檬酸镁老年失眠
    双甘氨酸镁睡眠质量不佳的健康成年人
    L-苏糖酸镁睡眠不佳并伴有认知或心境方面困扰的人群

    研究中的剂量通常为每日250–500 mg元素镁；于晚间或睡前服用，持续4–8周。吸收较好的剂型：双甘氨酸镁、柠檬酸镁、L-苏糖酸镁。价格经济且有证据支持的剂型：氧化镁。肾功能衰竭或严重心律失常患者仅可在医生监督下使用。

Reminder: use these supplements only if your doctor recommends them, and never change your current treatment on your own.

Kaynaklar

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Sitenin son güncellemesi: 8 Kasım 2026 · Site editörü: Doç. Dr. Alişan Burak Yaşar, info@alisanburak.com