Is micronutrient therapy effective in ADHD? Br Jl Psy.Ahead of print.Jan 30

31.01.2014

Prevalence of ADHD is around  5% in adults.Adult ADHD is less responsive to treatments compared with those in children. Stimulants are the standard treatment of choice. Diet and nutrient interventions have a long history in the search for alternative effective treatments. It is thought that such treatments might help by 1. functioning as cofactors for various metabolic pathways in the brain 2. correcting inborn errors of metabolism 3. Improving mitochondrial  and membrane functioning 4. promoting healthy GI functioning and improved absorption of nutrients.

Julia J. Rucklidge, Chris M. Frampton, Brigette Gorman and Anna Boggis  from New Zealand report the results of the first double-blind, parallel–group RCT designed to assess the efficacy and safety of a broad-spectrum micronutrient formula, EMPowerplus, compared with placebo in adult ADHD.  80 adults with ADHD (meeting criteria using Conners Adult ADHD Diagnostic Interview for DSM-IV)  were assigned in a 1:1 ratio to 8 weeks of treatment with either micronutrients or placebo.Participants were not on psychotropics for  at least 4 weeks. They were assessed at baseline and 1,2,4,6, and 8 weeks.

Results

Self and observer rated scales showed significant benefit with micronutrients. Clinician rated CGI also showed better response in active treatment group. Clinician rated Conners scale did not show any significant benefit. The effect size of observed benefits are of medium to large range (0.46 to 0.67). 64% of those in the micronutrient group showed at least 30% drop on at least one subscale of the Conners scale  from baseline compared to 37% in the placebo group .Micronutrient did not differ from placebo in side effects.

Limitations:  Clinicians did not observe group differences  on rating scales, but reported  greater global functioning. Findings on attention were varied. Attention scores  in the micronutrient group remained elevated.No neurocognitive measures were used. Study recruited only uncomplicated ADHD.Longterm effects unknown.Given the inconsistency across raters larger study is required.

Conclusion:

Micro- nutrient treatment appears to benefit adult ADHD. Benefits with micronutrients are modest compared to medication trials.

Summary of the article:

Vitamin-mineral treatment of attention-deficit hyperactivity disorder in adults: double-blind randomised placebo-controlled trial. Julia J. Rucklidge, Chris M. Frampton, Brigette Gorman and Anna Boggis. BJP published online January 30, 2014 Access the most recent version at DOI: 10.1192/bjp.bp.113.132126 

3 thoughts on “Is micronutrient therapy effective in ADHD? Br Jl Psy.Ahead of print.Jan 30

  1. The trial actually had patients with ADHD of which many of them had co morbid disorders like substance abuse, depression, anxiety disorders. So they were a complicated patient group, not an uncomplicated group. As such, the results are comparable to medication trials when they study ADHD patients with comorbidity. Most medication trials dont assess acros several raters, so this study is relatively unique for collecting this extensive data. But I do agree a larger study is required. Prof Julia Rucklidge, lead investigator.

    • I agree with Prof Rucklidge the lead investigator, the study did not exclude patients based on comorbidity. Of the 56 patients excluded from the 136 patients assessed for eligibility, none were excluded due to comorbidity. I should have highlighted that a strength of the study in the summary as comorbidity is very common in ADHD.Thanks for pointing out this error in the blog. Manoj

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