1
|
Caterfino A, Krishna S, Chen V. Novel and complementary treatment approaches in attention-deficit/hyperactivity disorder. Curr Opin Pediatr 2024:00008480-990000000-00196. [PMID: 38957089 DOI: 10.1097/mop.0000000000001378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
PURPOSE OF REVIEW To provide an updated review of novel and complementary treatment approaches for children and adolescents with attention-deficit/hyperactivity disorder. RECENT FINDINGS The evidence for complementary attention-deficit/hyperactivity disorder treatments is often promising, but limited to small, unblinded studies. Recent evidence from larger, more rigorous studies reveals that most of these treatments have modest efficacy. Omega-3 polyunsaturated fatty acids, saffron, broad spectrum micronutrients, and physical exercise have potential benefits that seem to outweigh known risks. However, neurofeedback, cognitive training, and trigeminal nerve stimulation need further research to determine whether specific sub-groups of children/adolescents with attention-deficit/hyperactivity disorder would benefit long-term with their associated tolerable risks. SUMMARY There is not sufficient evidence for complementary treatments to be recommended as substitutes for first-line pharmacological and psychosocial treatment options. Nonetheless, some adjuvant therapies to currently recommended attention-deficit/hyperactivity disorder treatments can be safe. Physicians should be familiar with existing and emerging complementary treatments to help guide families.
Collapse
Affiliation(s)
- Andrew Caterfino
- Northwell, New Hyde Park
- Cohen Children's Medical Center, Queens, New York, USA
| | - Shruthi Krishna
- Northwell, New Hyde Park
- Cohen Children's Medical Center, Queens, New York, USA
| | - Victoria Chen
- Northwell, New Hyde Park
- Cohen Children's Medical Center, Queens, New York, USA
| |
Collapse
|
2
|
Tost G, Srikanth P, Bruton A, Hatsu IE, Leung BM, Ast HK, Eiterman LP, Robinette LM, Williams C, Gracious B, Eugene Arnold L, Johnstone JM. Problems most concerning to parents of children with ADHD and emotional dysregulation in a randomized controlled trial of multinutrients: MADDY secondary analysis. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02463-1. [PMID: 38819662 DOI: 10.1007/s00787-024-02463-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 04/30/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE With dual focus on structured, objective quantification of parent observations of child's behavior and identifying behaviors most amenable to change, this report examines Parent Target Problems (PTP) as a secondary outcome in a randomized clinical trial (RCT) of children with attention-deficit/ hyperactivity disorder (ADHD) in which one primary outcome, Clinical Global Impression-Improvement, showed a significant advantage of multinutrients over placebo and the other, Likert-type parent ratings, showed significant improvement in both groups, without significant difference between them. METHOD In a multisite 8-week RCT of broad-spectrum micronutrients ("multinutrients"), parents of children ages 6-12 (N = 126, 73% male, 88% white) with ADHD and emotional dysregulation nominated their child's most concerning problem(s) at baseline and quantified them by frequency, duration, impairment, and consequences. At subsequent visits, parents re-quantified the problem(s). Blinded child psychiatrists independently reviewed the PTPs and rated change at two timepoints compared to baseline. PTPs were grouped into 9 categories. Mean ratings were compared between active and placebo groups and explored by category. RESULTS By week 8, a significant separation favored multinutrients: 38% of the multinutrient group were "definitely improved" or better, compared to 25% of the placebo group, and ratings of "no change" or "worse" occurred in 35% with placebo versus 23% with multinutrients (p = 0.04). Inattention (72.2%) and emotional dysregulation (69.1%) were the most frequently reported PTP categories. Inattention and internalizing symptoms improved more with multinutrients than placebo (p = 0.01, d = 0.55; p = 0.03, d = 0.80, respectively). The multinutrient advantage was not significant for 7 other symptoms, including hyperactivity/impulsivity, aggression, autistic symptoms, or emotional dysregulation/irritable oppositionality. CONCLUSIONS This secondary analysis found that the multinutrients, compared to placebo, were associated with improvements in parental concerns overall, and in two domains specifically: inattention and internalizing symptoms (anxiety/depression), but not in seven domains: hyperactivity/impulsivity, aggression, autistic symptoms or physiological symptoms, peer relationships or emotional dysregulation/irritable oppositionality.
Collapse
Affiliation(s)
- Gabriella Tost
- Center for Mental Health Innovation, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, DC7P, Portland, Oregon, 97239, United States
| | - Priya Srikanth
- OHSU-Portland State University School of Public Health, Portland, Oregon, United States
| | - Alisha Bruton
- Center for Mental Health Innovation, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, DC7P, Portland, Oregon, 97239, United States
| | - Irene E Hatsu
- Center for Mental Health Innovation, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, DC7P, Portland, Oregon, 97239, United States
- The Ohio State University, Columbus, Ohio, United States
| | | | - Hayleigh K Ast
- Center for Mental Health Innovation, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, DC7P, Portland, Oregon, 97239, United States
| | | | | | - Craig Williams
- The Ohio State University, Columbus, Ohio, United States
| | - Barbara Gracious
- The Ohio State University, Columbus, Ohio, United States
- Orange Park Medical Center, Florida, Florida, United States
- Edward Via College of Osteopathic Medicine, Auburn, Alabama, United States
| | | | - Jeanette M Johnstone
- National University of Natural Medicine, Helfgott Research Institute, Portland, Oregon, United States.
| |
Collapse
|
3
|
Johnstone JM, Arnold LE, Villagomez A, Robinette LM, Gracious BL, Ast HK, Bruton AM, Hatsu IE. Dr. Johnstone et al. Reply to Dr. Elmrayed. J Am Acad Child Adolesc Psychiatry 2023; 62:1171-1175. [PMID: 37543077 DOI: 10.1016/j.jaac.2023.07.994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/27/2023] [Indexed: 08/07/2023]
Abstract
We thank Dr. Elmrayed and colleagues1 for highlighting clinical cautions in using broad-spectrum micronutrients to treat attention-deficit/hyperactivity disorder (ADHD) in children, in particular manganese (Mn) levels. We appreciate the opportunity to provide additional information and rationale for the vitamin and mineral doses contained in the studied formula.
Collapse
Affiliation(s)
- Jeanette M Johnstone
- Oregon Health & Science University, Portland, Oregon; National University of Natural Medicine, Helfgott Research Institute, Portland, Oregon.
| | | | | | | | - Barbara L Gracious
- HCA Florida Orange Park Hospital, Orange Park, Florida; Edward Via College of Osteopathic Medicine, Spartanburg, South Carolina
| | | | | | | |
Collapse
|
4
|
Morales-Suárez-Varela M, Peraita-Costa I, Llopis-Morales A, Llopis-González A. Athletic Burnout and Its Association with Diet in Children and Adolescents. Life (Basel) 2023; 13:1381. [PMID: 37374163 DOI: 10.3390/life13061381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Children today are constantly exposed to several risk factors and high levels of stress that can impact their mental, emotional, and physical health, which can trigger burnout. The objective of this study was to determine the prevalence and frequency of burnout in young amateur athletes and to study the role of the Mediterranean diet on burnout risk. An observational, cross-sectional, and descriptive study of 183 basketball players between 8 and 15 years old was carried out. Adherence to the Mediterranean diet was assessed using the KIDMED questionnaire and the risk of burnout was assessed with the Athlete Burnout Questionnaire. Medians, minimums and maximum values for quantitative variables and absolute frequencies and percentages for qualitative variables were obtained. The results show a higher percentage of burnout among girls. The children who meet the established threshold for burnout spend more time watching television. Participants with better adherence to the Mediterranean diet have lower burnout values in both genders and those with a higher risk of burnout have a worse adherence to the Mediterranean diet. Therefore, it is important to implement a balanced diet appropriate to the individual needs of the athlete.
Collapse
Affiliation(s)
- María Morales-Suárez-Varela
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot, València, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute, Av. Monforte de Lemos 3-5 Pabellón 11 Planta 0, 28029 Madrid, Madrid, Spain
| | - Isabel Peraita-Costa
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot, València, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute, Av. Monforte de Lemos 3-5 Pabellón 11 Planta 0, 28029 Madrid, Madrid, Spain
| | - Agustín Llopis-Morales
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot, València, Spain
| | - Agustín Llopis-González
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estelles s/n, 46100 Burjassot, València, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute, Av. Monforte de Lemos 3-5 Pabellón 11 Planta 0, 28029 Madrid, Madrid, Spain
| |
Collapse
|
5
|
Rucklidge JJ, Blampied FM, Manna L, Sherwin A, Bagshaw S, Mulder RT, Boden J. Protocol for a randomised placebo-controlled trial investigating the efficacy and safety of a vitamin-mineral formula targeting dysregulated emotions in teenagers: The balancing emotions of adolescents with micronutrients (BEAM) study. Contemp Clin Trials Commun 2022; 30:101027. [PMID: 36340698 PMCID: PMC9634271 DOI: 10.1016/j.conctc.2022.101027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 10/08/2022] [Accepted: 10/26/2022] [Indexed: 11/21/2022] Open
Abstract
Background Emotional dysregulation (ED) is a significant contributing factor to psychological distress in young people. ED is a transdiagnostic dimension characterized by an excessive reactivity to negative emotional stimuli with affective (anger) and behavioral (aggression) components, and is present across anxiety, mood and behavioral disorders. Due to early onset, high prevalence and persistence, ED in childhood is one of the most psychosocially impairing and cost-intensive mental health conditions, with not enough children improving with conventional treatments. Clinical trials have established preliminary efficacy of micronutrients (vitamins and minerals) in the treatment of ED. This project expands the research to examine micronutrient efficacy for teenagers with ED. Methods This study is the first double-blind (participant and investigators) 8 week randomized controlled trial (with 8 week open-label extension and one year follow-up) designed to explore the efficacy and safety of micronutrients compared with placebo in 150 medication-free emotionally dysregulated youth (12–17 years), referred via self-referral, delivered remotely throughout New Zealand, using a website for monitoring symptoms, with a psychologist available online via text, email and video for assessment and monitoring. The primary outcome measures will be the Clinical Global Impression (CGI-I), the reactivity subscale of the Emotion Dysregulation Inventory (EDI) and the Clinician Rated Temper and Irritability Scale (CL-ARI). Discussion Micronutrient intervention delivered alongside online assessment and monitoring has the potential to transform delivery of mental health care to young people who may not be willing or able to access traditional therapies. We also hope that this intervention shows acceptability across different ethnicities.
Collapse
Affiliation(s)
- Julia J. Rucklidge
- School of Psychology, Speech and Hearing, University of Canterbury, New Zealand
- Corresponding author. University of Canterbury, Christchurch, New Zealand.
| | | | - Leona Manna
- School of Psychology, Speech and Hearing, University of Canterbury, New Zealand
| | - Angela Sherwin
- School of Psychology, Speech and Hearing, University of Canterbury, New Zealand
| | - Sue Bagshaw
- Psychological Medicine, University of Otago, New Zealand
| | | | - Joseph Boden
- Psychological Medicine, University of Otago, New Zealand
| |
Collapse
|
6
|
Johnstone JM, Hatsu I, Tost G, Srikanth P, Eiterman LP, Bruton AM, Ast HK, Robinette LM, Stern MM, Millington EG, Gracious BL, Hughes AJ, Leung BMY, Arnold LE. Micronutrients for Attention-Deficit/Hyperactivity Disorder in Youths: A Placebo-Controlled Randomized Clinical Trial. J Am Acad Child Adolesc Psychiatry 2022; 61:647-661. [PMID: 34303786 PMCID: PMC8782920 DOI: 10.1016/j.jaac.2021.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/11/2021] [Accepted: 07/15/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To evaluate whether micronutrients (vitamins/minerals) benefit attention-deficit/hyperactivity disorder (ADHD) and irritability in a North American pediatric sample. METHOD A 3-site, 8-week, placebo-controlled, randomized clinical trial of micronutrients was conducted in nonmedicated children aged 6 to 12 years with ADHD and at least 1 impairing irritability symptom by parent report on the Child and Adolescent Symptom Inventory-5 (CASI-5). A priori-defined primary outcomes were Clinical Global Impression-Improvement (CGI-I) (CGI-I of 1 or 2 = treatment responder) and parent-rated CASI-5 composite score of ADHD, oppositional defiant, disruptive mood dysregulation, and peer conflict symptoms, including impairment scores. RESULTS Of 135 randomized (mean age 9.8 years), 126 youths (93%) comprised the modified intention-to-treat population. Blinding was maintained. For the CGI-I, 54% of the micronutrient and 18% of the placebo group were responders (risk ratio = 2.97, 97.5% CI = 1.50, 5.90, p < .001). CASI-5 composite scores improved significantly for both groups (p < .01), with a mean change of -0.31 (95% CI = -0.39, -0.23) in the micronutrient group and a mean change of -0.28 (95% CI = -0.38, -0.19) in the placebo group. However, the between-group difference was not significant (mean change = -0.02; 97.5% CI = -0.16, 0.12, effect size = 0.07, p = .70). The micronutrient group grew 6 mm more than the placebo group (p = .002). No serious adverse events or clinically significant changes from baseline in blood and urine tests occurred. CONCLUSION Micronutrients showed global benefit over placebo by blinded clinician rating, but not by parent-report CASI-5 composite rating in a population with ADHD and irritability. Micronutrients showed greater height growth. Micronutrients were well tolerated, and the majority of participants adhered to the number of capsules prescribed. This randomized controlled trial replicates safety and efficacy reported for ADHD in 2 smaller trials of a similar formula containing all vitamins and known essential minerals in amounts between the Recommended Dietary Allowance and Upper Tolerable Intake Level. CLINICAL TRIAL REGISTRATION INFORMATION Micronutrients for ADHD in Youth (MADDY) Study; https://clinicaltrials.gov; NCT03252522.
Collapse
Affiliation(s)
- Jeanette M Johnstone
- Oregon Health & Science University, Portland; National University of Natural Medicine, Helfgott Research Institute, Portland, Oregon.
| | | | | | - Priya Srikanth
- OHSU-Portland State University School of Public Health, Oregon
| | | | | | | | | | | | | | - Barbara L Gracious
- The Ohio State University, Columbus; Orange Park Medical Center, Florida, and the Edward Via College of Osteopathic Medicine, Spartanburg, South Carolina
| | | | | | | |
Collapse
|
7
|
Rucklidge JJ, Eggleston MJF, Boggis A, Darling K, Gorman B, Frampton CM. Do Changes in Blood Nutrient Levels Mediate Treatment Response in Children and Adults With ADHD Consuming a Vitamin-Mineral Supplement? J Atten Disord 2021; 25:1107-1119. [PMID: 31707909 DOI: 10.1177/1087054719886363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective: We investigated whether changes in serum nutrient levels mediate clinical response to a micronutrient intervention for ADHD. Method: Data were compiled from two ADHD trials (8-10 weeks), one in adults (n = 53) and one in children (n = 38). Seven outcomes included change in ADHD symptoms, mood, overall functioning (all clinician-rated) as well as response status. Change in serum/plasma nutrient levels (vitamins B12 and D, folate, ferritin, iron, zinc, and copper) were considered putative mediators. Results: A decrease in ferritin and an increase in copper were weakly associated with greater likelihood of being identified as an ADHD responder; none of the other nutrient biomarkers served as mediators. Conclusion: Further research looking at nutrients more broadly from other tissues are required to confirm these initial observations of the limited value of nutrient levels in deciphering mechanism of action. Monitoring these biomarkers on their own is unlikely helpful in understanding clinical response to a broad-spectrum micronutrient approach.
Collapse
Affiliation(s)
| | | | - Anna Boggis
- Canterbury District Health Board, Christchurch, New Zealand
| | | | | | | |
Collapse
|
8
|
Johnstone JM, Hughes A, Goldenberg JZ, Romijn AR, Rucklidge JJ. Multinutrients for the Treatment of Psychiatric Symptoms in Clinical Samples: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients 2020; 12:E3394. [PMID: 33158241 PMCID: PMC7694278 DOI: 10.3390/nu12113394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/28/2020] [Indexed: 12/16/2022] Open
Abstract
This systematic review and meta-analysis focused on randomized controlled trials (RCT) of multinutrients consisting of at least four vitamins and/or minerals as interventions for participants with psychiatric symptoms. A systematic search identified 16 RCTs that fit the inclusion criteria (n = 1719 participants) in six psychiatric categories: depression, post-disaster stress, antisocial behavior, behavioral deficits in dementia, attention-deficit/hyperactivity disorder, and autism. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was used to rate the evidence base. Significant clinical benefit was assessed using minimal clinically important differences (MIDs). Due to heterogeneity in participants, multinutrient formulas, outcome measures, and absence of complete data, only the Attention-Deficit/Hyperactivity Disorder (ADHD) category was eligible for meta-analyses. In ADHD populations, statistically and clinically significant improvements were found in global functioning, Mean Difference (MD) -3.3, p = 0.001, MID -3.26; Standardized Mean Difference (SMD) -0.49 p = 0.001 MD -0.5), clinician ratings of global improvement (MD -0.58, p = 0.001, MID -0.5) and ADHD improvement (MD -0.54, p = 0.002, MID -0.5), and clinician (but not observer) measures of ADHD inattentive symptoms (MD -1.53, p = 0.05, MID -0.5). Narrative synthesis also revealed a pattern of benefit for global measures of improvement, for example: in autism, and in participants with behavioral deficits in dementia. Post-natural disaster anxiety and the number of violent incidents in prison populations also improved. Broad-spectrum formulas (vitamins + minerals) demonstrated more robust effects than formulas with fewer ingredients. This review highlights the need for robust methodology-RCTs that report full data, including means and standard deviations for all outcomes-in order to further elucidate the effects of multinutrients for psychiatric symptoms.
Collapse
Affiliation(s)
- Jeanette M. Johnstone
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR 97201, USA;
- Child and Adolescent Psychiatry, Oregon Health & Science University, Portland, OR 97239, USA
| | - Andrew Hughes
- Adult Psychiatry, Oregon Health & Science University, Portland, OR 97239, USA;
| | - Joshua Z. Goldenberg
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR 97201, USA;
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney 2007, Australia
| | - Amy R. Romijn
- Department of Psychology, Swansea University, Swansea SA2 8PP, UK;
| | - Julia J. Rucklidge
- School of Psychology, Speech and Hearing, University of Canterbury, 8140 Christchurch, New Zealand
| |
Collapse
|
9
|
Reiter A, Bengesser SA, Hauschild AC, Birkl-Töglhofer AM, Fellendorf FT, Platzer M, Färber T, Seidl M, Mendel LM, Unterweger R, Lenger M, Mörkl S, Dalkner N, Birner A, Queissner R, Hamm C, Maget A, Pilz R, Kohlhammer-Dohr A, Wagner-Skacel J, Kreuzer K, Schöggl H, Amberger-Otti D, Lahousen T, Leitner-Afschar B, Haybäck J, Kapfhammer HP, Reininghaus E. Interleukin-6 Gene Expression Changes after a 4-Week Intake of a Multispecies Probiotic in Major Depressive Disorder-Preliminary Results of the PROVIT Study. Nutrients 2020; 12:E2575. [PMID: 32858844 PMCID: PMC7551871 DOI: 10.3390/nu12092575] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 12/13/2022] Open
Abstract
Major depressive disorder (MDD) is a prevalent disease, in which one third of sufferers do not respond to antidepressants. Probiotics have the potential to be well-tolerated and cost-efficient treatment options. However, the molecular pathways of their effects are not fully elucidated yet. Based on previous literature, we assume that probiotics can positively influence inflammatory mechanisms. We aimed at analyzing the effects of probiotics on gene expression of inflammation genes as part of the randomized, placebo-controlled, multispecies probiotics PROVIT study in Graz, Austria. Fasting blood of 61 inpatients with MDD was collected before and after four weeks of probiotic intake or placebo. We analyzed the effects on gene expression of tumor necrosis factor (TNF), nuclear factor kappa B subunit 1 (NFKB1) and interleukin-6 (IL-6). In IL-6 we found no significant main effects for group (F(1,44) = 1.33, p = ns) nor time (F(1,44) = 0.00, p = ns), but interaction was significant (F(1,44) = 5.67, p < 0.05). The intervention group showed decreasing IL-6 gene expression levels while the placebo group showed increasing gene expression levels of IL-6. Probiotics could be a useful additional treatment in MDD, due to their anti-inflammatory effects. Results of the current study are promising, but further studies are required to investigate the beneficial effects of probiotic interventions in depressed individuals.
Collapse
Affiliation(s)
- Alexandra Reiter
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Susanne A. Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Anne-Christin Hauschild
- Department of Mathematics & Computer Science, University of Marburg, 35043 Marburg, Germany;
| | - Anna-Maria Birkl-Töglhofer
- Institute for Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (A.-M.B.-T.); (J.H.)
| | - Frederike T. Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Martina Platzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Tanja Färber
- Institute of Psychology, University of Bamberg, 96047 Bamberg, Germany;
| | - Matthias Seidl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Lilli-Marie Mendel
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Renate Unterweger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Melanie Lenger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Armin Birner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Robert Queissner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Carlo Hamm
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Alexander Maget
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Rene Pilz
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Alexandra Kohlhammer-Dohr
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Jolana Wagner-Skacel
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Kathrin Kreuzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Helmut Schöggl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Daniela Amberger-Otti
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Theresa Lahousen
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Birgitta Leitner-Afschar
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Johannes Haybäck
- Institute for Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (A.-M.B.-T.); (J.H.)
| | - Hans-Peter Kapfhammer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| | - Eva Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz 31, 8036 Graz, Austria; (A.R.); (F.T.F.); (M.P.); (M.S.); (L.-M.M.); (R.U.); (M.L.); (S.M.); (N.D.); (A.B.); (R.Q.); (C.H.); (A.M.); (R.P.); (A.K.-D.); (J.W.-S.); (K.K.); (H.S.); (D.A.-O.); (T.L.); (B.L.-A.); (H.-P.K.); (E.R.)
| |
Collapse
|
10
|
Retallick-Brown H, Blampied N, Rucklidge JJ. A Pilot Randomized Treatment-Controlled Trial Comparing Vitamin B6 with Broad-Spectrum Micronutrients for Premenstrual Syndrome. J Altern Complement Med 2020; 26:88-97. [PMID: 31928364 DOI: 10.1089/acm.2019.0305] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objective: Premenstrual syndrome (PMS) affects 20%-30% of women but current medical treatments are limited in their efficacy. The objective of this study was to compare efficacy of a broad-spectrum micronutrient formula (consisting mainly of minerals and vitamins) to a single vitamin (B6) for treatment of PMS, for which B6 has already been shown to be efficacious. Methods: This double-blind, randomized, treatment-controlled trial allocated 78 (72 completed) regularly menstruating women with PMS to consume micronutrients or vitamin B6 (80 mg/day) daily following a two-cycle baseline period, for three menstrual cycles. The primary outcome measure, Daily Record of Severity of Problems (DRSP), established PMS as well as tracked change in five PMS symptoms: psychological, somatic, total symptoms, impact ratings, and worst day ratings. Results: Linear-mixed model analyses indicated both treatments produced comparable reduction in PMS symptoms with medium effect sizes (ES) across all PMS variables as measured by the DRSP (micronutrient ES = 0.50-0.56; B6 ES = 0.43-0.56), with 72% of the micronutrient and 60% of the vitamin B6 group identified as in full remission in PMS symptoms after three cycles. The micronutrient-treated participants showed greater improvement than the B6 group (between group d = 0.51, p < 0.05) in health-related quality of life. For those women (n = 28) who met criteria for premenstrual dysphoric disorder (PMDD), the DRSP ES were larger for those who had been in the micronutrient condition (ES = 1.28-1.67) as compared with those on B6 (ES = 0.50-0.75), although the group differences were not statistically reliable. There were no group differences in side effects, nor any serious adverse effects reported. Conclusions: Both treatments provided similar benefit for reducing PMS symptoms, with greater effect of micronutrients on quality of life as well as potential clinical benefit of micronutrients for PMDD. This study provides further efficacy data on B6 and also identifies the nutritionally broader spectrum intervention as possibly having specific advantages for those whose symptoms are more severe. As this is the first study to investigate these treatments for PMDD, systematic replication is required.
Collapse
Affiliation(s)
- Hāna Retallick-Brown
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Neville Blampied
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Julia J Rucklidge
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| |
Collapse
|
11
|
Darling KA, Eggleston MJF, Retallick-Brown H, Rucklidge JJ. Mineral-Vitamin Treatment Associated with Remission in Attention-Deficit/Hyperactivity Disorder Symptoms and Related Problems: 1-Year Naturalistic Outcomes of a 10-Week Randomized Placebo-Controlled Trial. J Child Adolesc Psychopharmacol 2019; 29:688-704. [PMID: 31343273 DOI: 10.1089/cap.2019.0036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective: This article presents 1-year follow-up of a randomized placebo-controlled trial with open-label extension evaluating the efficacy of a broad-spectrum micronutrient (vitamins and minerals) intervention. The object was to determine if dominant treatment at follow-up was associated with differential psychological outcomes. Methods: Ninety percent of the original sample of 93 children with attention-deficit/hyperactivity disorder (ADHD) were followed 52 weeks postbaseline. Assessments included measures of ADHD, mood, anxiety, and general function based on parent/clinician report. Outcome was considered based on dominant therapy at 52 weeks (trial micronutrients [n = 19], medications [n = 21], and no treatment [n = 35]). Nine children were not categorized due to inconsistent therapies. Results: Based on dominant treatment, more of those who stayed on trial micronutrients (84%) were identified as "Much" or "Very Much" improved overall relative to baseline functioning, compared to 50% of those who switched to psychiatric medications and only 21% of those who discontinued treatment [χ2(2) = 19.476, p < 0.001]. Fifteen (79%) of those still taking micronutrients, 8 (42%) of those using medications, and 7 (23%) of those who discontinued treatment were considered remitters based on parent-reported ADHD [χ2(2) = 15.3, p < 0.001]. Those who stayed on micronutrients were more likely to have failed medication treatment in the past. The micronutrient group also displayed better outcomes on measures of parent-rated hyperactivity and anxiety, and clinician-rated general function and mood, with moderate to large between-group effect sizes (micronutrients vs. medication: ES = 0.73-1.01; micronutrients vs. no treatment: ES = 0.54-1.01). Most common reasons for stopping trial micronutrients were cost and number of pills to swallow. No continued side effects were associated with micronutrients. Conclusions: Children who benefitted from micronutrients in the short term maintained changes at follow-up, without side effects. While both those who continued micronutrients and those who switched to medication showed improved ADHD symptoms, psychiatric medication use was associated with deterioration in mood and anxiety. Inherent selection bias limits generalizability.
Collapse
Affiliation(s)
- Kathryn A Darling
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | | | | | - Julia J Rucklidge
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| |
Collapse
|
12
|
Johnstone JM, Leung B, Gracious B, Perez L, Tost G, Savoy A, Hatsu I, Hughes A, Bruton A, Arnold LE. Rationale and design of an international randomized placebo-controlled trial of a 36-ingredient micronutrient supplement for children with ADHD and irritable mood: The Micronutrients for ADHD in Youth (MADDY) study. Contemp Clin Trials Commun 2019; 16:100478. [PMID: 31763491 PMCID: PMC6859218 DOI: 10.1016/j.conctc.2019.100478] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/21/2019] [Accepted: 10/24/2019] [Indexed: 12/31/2022] Open
Abstract
Background Attention-Deficit/Hyperactivity Disorder (ADHD) is a chronic neurodevelopmental disorder affecting up to 9% of children and substantial numbers of adults. Existing pharmacologic treatments often improve symptoms, but concerns exist over side effects, stigma, potential long-term health effects, and residual irritability, often treated with adjunctive antipsychotics. To address public and clinician demand for non-pharmacologic evidence-based treatments, this study will examine efficacy of a 36-ingredient micronutrient (vitamin/mineral) supplement as treatment for children with ADHD and irritability. Methods An international team of experts in ADHD, mood dysregulation, nutrition, epidemiology, and clinical trials conferred to develop/refine a protocol powered to detect a medium effect. The study will employ a fully-blind randomized controlled trial (RCT) design, comparing the micronutrient supplement to matched placebo in 135 children aged 6-12 with ADHD symptoms and irritability, based on the parent-rated Child and Adolescent Symptom Inventory-5 (CASI-5). Irritability will be measured by at least one symptom of oppositional defiant disorder (ODD) or disruptive mood dysregulation disorder (DMDD). Based on research suggesting an irritable ADHD subtype, the primary outcome will be a composite score comprised of the CASI-5 subscales: ADHD, ODD, DMDD, and the Peer Conflict Scale, which assesses anger and aggression perpetrated towards peers. Participants will provide biological samples (blood, urine, saliva, hair and stool) to explore the micronutrients' mechanisms of action. Discussion This study is the first adequately powered RCT in North America to examine both behavioral responses to, and biological mechanisms of, micronutrients for ADHD and irritability in children. If found efficacious, broad-spectrum micronutrients, given at therapeutic doses, may provide an evidence-based alternative to prescription medications for ADHD and associated irritability. Trial registration NCT03252522. Registered 26 July 2017.
Collapse
Affiliation(s)
- Jeanette M Johnstone
- National University of Natural Medicine, Helfgott Research Institute, Portland, OR, USA.,Department of Child & Adolescent Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Brenda Leung
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Barbara Gracious
- Department of Psychiatry & Behavioral Health, The Ohio State University, Columbus, OH, USA.,Orange Park Medical Center, Orange Park, FL, USA
| | - Leanna Perez
- Department of Human Sciences, The Ohio State University, Columbus, OH, USA
| | - Gabriella Tost
- Department of Child & Adolescent Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Andrew Savoy
- Department of Child & Adolescent Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Irene Hatsu
- Department of Human Sciences, The Ohio State University, Columbus, OH, USA
| | - Andrew Hughes
- Department of Child & Adolescent Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Alisha Bruton
- National University of Natural Medicine, Helfgott Research Institute, Portland, OR, USA.,Department of Child & Adolescent Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - L Eugene Arnold
- Department of Psychiatry & Behavioral Health, The Ohio State University, Columbus, OH, USA
| |
Collapse
|