TY - JOUR
T1 - Moderators of treatment response in adults with ADHD treated with a vitamin-mineral supplement
AU - Rucklidge, Julia J.
AU - Johnstone, Jeanette
AU - Gorman, Brigette
AU - Boggis, Anna
AU - Frampton, Christopher M.
N1 - Funding Information:
None of the authors have any financial disclosures or competing interests to declare. Thanks to the Vic Davis Memorial Trust ( E5672 ), Marie Lockie for her private donation, the Department of Psychology, University of Canterbury for ongoing research support, and three summer studentships awarded by the University of Canterbury . Thanks also to Dr Nic Ward, Rachel Harrison, Heather Gordon, Ellen Sole, Sarah Anticich, Sarah Dymond and Dr Petra Hoggarth for assistance with data collection and entry; the CDHB, Pegasus Health and other private referrers and all the families who participated. We thank Truehope for providing the micronutrient formula and matching placebo. The 36-ingredient formula has been modified slightly on several occasions, with each change resulting in a new name. Sold variously as EMPower, EMPowerplus, and Daily Essential Nutrients, manufacturer information can be found at Truehope.com and HardyNutritionals.com .
PY - 2014/4/3
Y1 - 2014/4/3
N2 - Background: To date there has been no research investigating moderators of response to micronutrient treatment of mental illness, specifically baseline nutrient levels. Method: We conducted analyses of data from a randomized placebo-controlled trial (RCT) of 80 adults (≥. 16. years) with Attention-Deficit/Hyperactivity Disorder (ADHD), whereby participants were treated acutely (8. weeks) with micronutrients or placebo followed by an open-label (OL) phase of 8. weeks whereby all participants received micronutrients. To ensure that all participants had been exposed to the micronutrients for 8. weeks, only those 64 who had adhered to the treatment protocol and completed 8. weeks on nutrients were included in the data analysis: 34 from the group that had been randomized to the micronutrient arm, and 30 from the group that had been randomized to the placebo group and hence had only received nutrients in the OL phase. Six outcomes were examined: change in ADHD symptoms (self/clinician), ADHD responder, Clinical Global Impression-Improvement (CGI-I), change in mood, and change in Global Assessment of Functioning (GAF). Demographic, developmental and psychiatric history, current clinical characteristics, and baseline nutrient levels were all considered as putative predictors. Results: There were significant changes in all outcome variables after 8weeks exposure to the micronutrients. Among the nutrients recorded at baseline, substantial deficiencies (27%) were only observed for vitamin D. However, other than an association showing that higher iron at baseline was correlated with higher baseline depression scores, baseline nutrient levels were not correlated with baseline psychiatric variables/current clinical characteristics. Regression analyses revealed that higher baseline ferritin and lower baseline copper and vitamin D levels were associated with a better response to treatment for some but not all outcomes. None of the other nutrient levels was found to be associated with outcome, including zinc, vitamin B12, iron, and folate. There were no childhood risk factors, demographic variables or clinical correlates that contraindicated micronutrient treatment; more severe symptoms at baseline and greater number of developmental risk factors predicted greater treatment response. Conclusions: Further research looking at nutrients more broadly is required to confirm these initial observations about ferritin, vitamin D and copper; however, the results suggest that serum nutrient levels have limited value for identifying who will respond to treatment.
AB - Background: To date there has been no research investigating moderators of response to micronutrient treatment of mental illness, specifically baseline nutrient levels. Method: We conducted analyses of data from a randomized placebo-controlled trial (RCT) of 80 adults (≥. 16. years) with Attention-Deficit/Hyperactivity Disorder (ADHD), whereby participants were treated acutely (8. weeks) with micronutrients or placebo followed by an open-label (OL) phase of 8. weeks whereby all participants received micronutrients. To ensure that all participants had been exposed to the micronutrients for 8. weeks, only those 64 who had adhered to the treatment protocol and completed 8. weeks on nutrients were included in the data analysis: 34 from the group that had been randomized to the micronutrient arm, and 30 from the group that had been randomized to the placebo group and hence had only received nutrients in the OL phase. Six outcomes were examined: change in ADHD symptoms (self/clinician), ADHD responder, Clinical Global Impression-Improvement (CGI-I), change in mood, and change in Global Assessment of Functioning (GAF). Demographic, developmental and psychiatric history, current clinical characteristics, and baseline nutrient levels were all considered as putative predictors. Results: There were significant changes in all outcome variables after 8weeks exposure to the micronutrients. Among the nutrients recorded at baseline, substantial deficiencies (27%) were only observed for vitamin D. However, other than an association showing that higher iron at baseline was correlated with higher baseline depression scores, baseline nutrient levels were not correlated with baseline psychiatric variables/current clinical characteristics. Regression analyses revealed that higher baseline ferritin and lower baseline copper and vitamin D levels were associated with a better response to treatment for some but not all outcomes. None of the other nutrient levels was found to be associated with outcome, including zinc, vitamin B12, iron, and folate. There were no childhood risk factors, demographic variables or clinical correlates that contraindicated micronutrient treatment; more severe symptoms at baseline and greater number of developmental risk factors predicted greater treatment response. Conclusions: Further research looking at nutrients more broadly is required to confirm these initial observations about ferritin, vitamin D and copper; however, the results suggest that serum nutrient levels have limited value for identifying who will respond to treatment.
KW - ADHD
KW - Micronutrients
KW - Minerals
KW - Predictors
KW - Treatment
KW - Vitamins
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U2 - 10.1016/j.pnpbp.2013.12.014
DO - 10.1016/j.pnpbp.2013.12.014
M3 - Article
C2 - 24374068
AN - SCOPUS:84892185053
SN - 0278-5846
VL - 50
SP - 163
EP - 171
JO - Progress in Neuro-Psychopharmacology and Biological Psychiatry
JF - Progress in Neuro-Psychopharmacology and Biological Psychiatry
ER -