Creatine
CAM (involved in energy production in brain through ATP cycle)
- Major Depression in Women (as augmentation to SSRIs)3
- Fibromylagia
- Memory in health adults (a possible benefit, mainly in older adults, possibly in bipolar)3
- Long-COVID fatigue (with glucose)3
Features
Dosing
Depression: Start 400 mg qd, raise by 200 mg or 400 mg every 3–7 days to a target dose of 800 mg to 3200 mg daily.
Cognition: Same directions but can go to 3-6 grams.
Long-COVID: Target 8 grams daily with 3 grams glucose.
Management
Works by enhancing energy (ATP) in the brain. Popular as an exercise supplement, where it does indeed promote endurance and muscle strength.
TOLERABILITY: No problems.
RISKS: None.
LAB INTERACTION: Creatine helps muscles produce energy, while creatinine is a waste product formed from the breakdown of creatine. Creatinine is a reliable marker of renal function, but creatine supplements can raise creatinine levels in blood tests by 0.3-0.4 mg/dL, giving a false read of poor renal function.
EMR Text
Depression
Creatine use based on small controlled trials in depression (Lyoo IK et al, Am J Psychiatry. 2012;169(9):937-945).
Creatine side effects reviewed with patient.
Memory
Creatine use based on multiple controlled trials where it improved memory in various populations, including young adults, older adults, Parkinson’s disease, and bipolar disorder (Prokopidis K et al, Nutr Rev. 2023;81(4):416-427).
Creatine side effects reviewed with patient.
Long COVID fatigue
Creatine use based on a randomized controlled trial where it improved fatigue in long COVID (Slankamenac J et al, J Nutr Sci Vitaminol (Tokyo). 2024;70(2):174-178).
Creatine side effects reviewed with patient.