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[14] A 2018 systematic review and meta-analysis of 12 randomized controlled trials found "supplementation significantly decreases depressive symptoms compared with placebo/no intervention, while offering a comparable effect with that of established antidepressant agents with fewer adverse effects." The review also indicates that "the effect of ALC in younger subjects was not more effective than placebo in improving these symptoms." indicating a need for more research explaining the age/effect relation

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Systemic primary carnitine deficiency: an overview of clinical manifestations, diagnosis, and management