Micronutrient Treatment
In contrast to a large literature demonstrating the effects of medications for adult ADHD, a small but growing literature is beginning to document the value of naturopathic treatments. A good example was recently published by Rucklidge et al. (2014, British Journal of Psychiatry, Epub). These investigators evaluated the efficacy and safety of a micronutrient formula comprised of vitamins and minerals, without omega fatty acids. It is the first double-blind randomized controlled trial to assess the effects of micronutrients (N = 42) compared with placebo (N = 38) on ADHD symptoms. It found that, compared with placebo, the micronutrient formula led to greater improvements in ADHD symptoms for self-ratings and observer-ratings but not for clinician ratings. The effect size of the clinical response ranged from 0.46 to 0.67, which is less than what is typically seen for ADHD medications (Faraone & S. J. Glatt (2010) J Clin Psychiatry 71 754-763). Only 48% of patients in the micronutrient group were rated as improved or very much improved. Although this was greater than the 21% rate in the placebo group, it is about half the response rate seen with stimulant medications. Importantly, the micronutrient and placebo groups did not differ in rates of adverse events. They authors wisely concluded that their results, albeit intriguing, provide only preliminary evidence for the value of micronutrients in treating adult ADHD. This work, and related studies of children and adolescents, will likely motivate more research into micronutrient treatments. Such treatments are especially appealing to patients due to their low side effect burden but given the small evidence based, they should be used with caution if their use will delay the use of treatments whose efficacy has been established. Of note, Rucklidge et al. reported treatment effects after eight weeks. Thus, if patients insist on monotherapy with micronutrients, they should not delay other treatments for longer than eight weeks without evidence that the micronutrients are working.
