To the Editor: Creatine-containing compounds play an important role in muscle and brain energy homeostasis and may have a beneficial effect on brain functioning (1, 2). Fibromyalgia is characterized by widespread tenderness in specified anatomical locations. The etiology of fibromyalgia is unknown but may involve energy metabolism. A variety of muscle impairments is reported in cases of fibromyalgia, and whether fibromyalgia is a muscle disease remains controversial (3). J.H. Park, Ph.D., and colleagues (4) reported lower than normal phosphocreatine and adenosine 5′-triphosphate levels and a lower than normal phosphcreatine/inorganic-phospate ratio in the quadriceps muscles of fibromyalgia patients.
“Ms. A” was a 52-year-old woman who suffered from posttraumatic stress disorder (PTSD), depression, and fibromyalgia. She had been a highly functioning woman who ran a kindergarten. Her psychiatric condition started after she lost her left eye in a terror bombing scene. Therapy with citalopram, 40 mg/day and tramadolol, 200 mg/day, for more than a year was ineffective, and she continued to suffer from severe symptoms of the aforementioned disorders.
The patient participated in an open study for 4 weeks that examined the effect of creatine monohydrate added to the ongoing psychotropic treatment of PTSD patients (5). In addition to the assessment of her PTSD, Ms. A was evaluated three times during this period (prior to participation and 2 and 4 weeks after) using the Hamilton Rating Scale for Depression and the Short Form 36 Health Status Questionnaire, assessing quality of life. Pain was assessed using the Visual Analog Scale.
Tender-point count was performed manually. The patient was asked to indicate when the sensation altered from pressure to definite pain at predefined anatomical sites according to the American College of Rheumatology classification criteria for fibromyalgia. All points were painful.
The patient was treated with creatine monohydrate for 4 weeks (3 g daily in the first week, then 5 g daily). Ongoing psychotropic treatment was not altered during the study.
The patient showed improvement in the symptoms of depression (Hamilton depression scale scores decreased from 24 to 16) and fibromyalgia (Visual Analog Scale score decreased from 80 to 40). This moderate recovery may be ascribed to the improvement of her sleep patterns and somatic symptoms (directly affecting the outcome of her Hamilton depression scale scores). Her quality of life improved as well, measured by a change of 30% on her total Short Form-36 score. Although the number of her tender points remained constant, they were less tender, and she was able to function more and sleep better, without being disturbed by pain. By request, she continued to consume creatine following the termination of the study, and 8 weeks following recruitment to the study, the beneficial effect remained.
In our case report, a patient with PTSD and comorbid depression and fibromyalgia demonstrated improvement in both conditions following treatment with creatine.
Creatine supplementation has been shown to augment brain utilization of oxygen (6). Lyoo and colleagues (7) demonstrated that oral creatine administration for 2 weeks significantly increased brain creatine levels. A creatine effect reported in fibromyalgia, if true, is indeed not well understood, since energy metabolism was suggested not to be involved in fibromyalgia (8), and one should consider this finding an empirical one at the moment. This report may indicate that creatine may confer a beneficial effect of concomitant depression and fibromyalgia.
1.Wyss M, Kaddurah-Daouk R: Creatine and creatinine metabolism. Physiol Rev 2000; 80:1107–12132.Rae C, Digney AL, McEwan SR, Bates TC: Oral creatine monohydrate supplementation improves brain performance: a double-blind, placebo-controlled, cross-over trial. Proc Biol Sci 2003; 270:2147–21503.Le Goff P: Is fibromyalgia a muscle disorder? Joint Bone Spine (in press)4.Park JH, Phothimat P, Oates CT, Hernanz-Schulman M, Olsen NJ: Use of P-31 magnetic resonance spectroscopy to detect metabolic abnormalities in muscles of patients with fibromyalgia. Arthritis Rheum 1998; 41:406–4135.Amital D, Vishne T, Roitman S, Kotler M, Levine J: Open study of creatine monohydrate in treating resistant post traumatic stress disorder. J Clin Psychiatry (in press)6.Persky AM, Brazeau GA: Clinical pharmacology of the dietary supplement creatine monohydrate. Pharmacol Rev 2001; 53:161–1767.Lyoo IK, Kong SW, Sung SM, Hirashima F, Parow A, Hennen J, Cohen BM, Renshaw PF: Multinuclear magnetic resonance spectroscopy of high-energy phosphate metabolites in human brain following oral supplementation of creatine-monohydrate. Psychiatry Res 2003; 123:87–1008.Simms RW, Roy SH, Hrovat M, Anderson JJ, Skrinar G, Lepoole SR, Zerbini CA, De Luca C, Jolesz F: Lack of association between fibromyalgia syndrome and abnormalities in muscle energy metabolism. Arthritis Rheum 1994; 37:794–800
The authors report no competing interests.