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Micronutrient Supplement May Ease Adult ADHD, Boost Mood
Medscape Psychiatry & Mental Health
January 30, 2014

A nutritional supplement packed with vitamins and minerals helped reduce symptoms of attention-deficit/hyperactivity disorder (ADHD) in adults and improved mood in a subset with moderate depression, new research shows.

A double-blind, randomized, placebo-controlled trial conducted by investigators at the University of Canterbury, Christchurch, New Zealand, showed that a micronutrient formula consisting of vitamins and minerals was significantly better than placebo in reducing ADHD symptoms.

"Our study provides preliminary evidence of the effectiveness of micronutrients in the treatment of ADHD symptoms in adults. This could open up treatment options for people with ADHD who may not tolerate medications or do not respond to first-line treatments," lead investigator Julia Rucklidge, PhD, clinical psychology professor, University of Canterbury, Christchurch, New Zealand, said in a statement.

The study was published online January 30 in the British Journal of Psychiatry.

Area of Growing Interest
The role of nutrition in the treatment of ADHD is gaining interest. However, the focus has largely been on diet restriction or supplementing with 1 nutrient at a time, the investigators note.

They conducted the first double-blind, randomized, placebo-controlled trial of a broad-spectrum micronutrient formula called EMPowerplus in adults with ADHD.

EMPowerplus contains 36 ingredients (14 vitamins, 16 minerals, 3 amino acids, and 3 antioxidants). According to its makers, TrueHope Nutritional Support, EMPowerplus "works by giving the brain the right balance of vitamins and trace minerals on a regular basis."

"This micronutrient formula has been examined in over 20 published studies for treating various mental conditions, has documented evidence of both short- and long-term safety data, and has been more extensively examined in psychiatric conditions than any other multivitamin/multimineral formula; however, as of yet, no masked trials have been conducted on it," the investigators note.

"I simply got interested in whether the claims could be substantiated with a double-blind clinical trial," Dr. Rucklidge told Medscape Medical News.

The study involved 80 adults with untreated ADHD. For 8 weeks, 42 took the micronutrient supplement (15 capsules per day, in 3 doses of 5 capsules, taken with food and water), and 38 took matching placebo.

According to the investigators, the micronutrient treatment induced "statistically robust improvements in several indices, from ADHD symptoms to global assessment of functioning, compared with placebo, with effect sizes ranging from 0.46 to 0.67."

Adults taking the micronutrient formula reported greater improvement in both inattention and hyperactivity/impulsivity compared with those taking a placebo. Improvement in hyperactivity/impulsivity was also noted by observers ― typically, a friend, partner, or parent.

Clinicians did not observe group differences on ADHD rating scales, but they did rate the individuals taking the micronutrients as functioning better in terms of their work, social relationships, and global psychological functioning.

In post hoc analyses, adults with moderate/severe depression at baseline had a greater change in mood favoring micronutrient treatment over placebo. This finding is consistent with other randomized controlled trials that show benefit of micronutrients in improving mood, the investigators note. There were no group differences in adverse events.

Novel and Noteworthy
"There is much research linking diet and also nutrient supplements to mental health, but this new study is noteworthy and novel for many reasons," Bonnie Kaplan, PhD, from the University of Calgary in Alberta, Canada, told Medscape Medical News.

"First, it's placebo-controlled. Even though there is a growing body of more than 20 peer-reviewed publications on this broad-spectrum formula (actually developed in Alberta), this is the first trial that was placebo-controlled," said Dr. Kaplan. She was not involved in the study but has long studied the relationship between nutrition and mental health.

"Another important aspect that is novel is that the researchers are independent academic scientists, and the study was not funded by any manufacturers. One could not make this statement about most medication trials," Dr. Kaplan said.

"Another very important novelty is that they studied a broad-spectrum vitamin plus mineral formula, which is likely the way in which humans have evolved to need nutrients. Single-nutrient research does not respect the fact that we need all these vitamins and minerals every day, and in balance. This means this vitamin plus mineral intervention is more ecologically valid than many studies," Dr. Kaplan said.

Jerome Sarris, PhD, MHSc, senior research fellow, Department of Psychiatry, University of Melbourne, Australia, agrees.

"Minerals and vitamins work in synergy, and combinations are often required for the body to utilize to perform many neurochemical activities (such as those that influence maintaining concentration or mood)," Dr. Sarris told Medscape Medical News.

"This new study is novel and of value, due to the common issue of most nutraceutical studies using only isolated nutrients," added Dr. Sarris, who also was not involved in the research.

He cautioned that more randomized controlled trials are needed in the field to "truly assess the potential benefits of nutrient-based formulas. These results, while positive, are preliminary and need to be repeated in a larger sample for a longer period of time to be fully validated."

Dr. Rucklidge and colleagues have just started recruitment for a similar trial in children with ADHD.

"We plan to recruit 100 children 8 to 12 to see whether the micronutrients may be helpful in reducing ADHD symptoms as compared with placebo," she said.

"We hope to move further towards understanding mechanisms of action, although with all the ingredients, this can be a challenge. We are also running other studies in the lab, looking at the effect of micronutrients on sleep, anxiety, and addictions. We are also investigating other ways forward for treating mental illness, including the use of probiotics," she said.

The authors, Dr. Kaplan, and Dr. Sarris report no relevant financial relationships.

Br J Psychiatry. Published online January 30, 2014. Abstract
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