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Successful Treatment of Bipolar Disorder II and ADHD with a Micronutrient Formula: A Case Study

  • Julia J. Rucklidge (a1) and Rachel Harrison (a1)
Abstract

Bipolar disorder with co-occurring attention-deficit/hyperactivity disorder (ADHD) is a challenge to treat. Ten previous reports have shown potential benefit of a micronutrient treatment (consisting mainly of vitamins and minerals) for various psychiatric symptoms, including mood and ADHD. This case study aimed to investigate the longer term impact of the micronutrients on both psychiatric and neurocognitive functioning in an off-on-off-on (ABAB) design with 1 year follow-up. A 21-year-old female with bipolar II disorder, ADHD, social anxiety, and panic disorder entered an open-label trial using a nutritional treatment following a documented 8 year history of ongoing psychiatric symptoms not well managed by medications. After 8 weeks on the formula she showed significant improvements in mood, anxiety, and hyperactivity/impulsivity. Blood test results remained normal after 8 weeks on the formula. She did not report any adverse side effects associated with the treatment. She then chose to come off the formula; after 8 weeks her depression scores returned to baseline, and anxiety and ADHD symptoms worsened. The formula was reintroduced, showing gradual improvement in all psychiatric symptoms. This case represents a naturalistic ABAB design showing on-off control of symptoms. After 1 year, the patient is now in remission from all mental illness. Neurocognitive changes mirrored behavioral changes, showing improved processing speed, consistency in response speed, and verbal memory. A placebo response and expectancy effects cannot be ruled out although previous poor response to treatment and the duration of the current positive response decrease the likelihood that other factors better explain change. These consistently positive outcomes alongside an absence of side effects indicate that further research, particularly larger and more controlled trials, is warranted using this multinutrient approach.

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Corresponding author
Julia J. Rucklidge, PhD, University of Canterbury - Psychology, Private Bag 4800, Christchurch Canterbury 8140, New Zealand; Tel: 643-364-2987, ext. 7959, Fax:, 643-364-2181; E-mail:, Julia.rucklidge@canterbury.ac.nz.
References
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1.Findling, RL, Gracious, BL, McNamara, NK, et al.Rapid, continuous cycling and psychiatric co-morbidity In pediatric bipolar I disorder. Bipolar Disord. 2001;3:202210.
2.West, SA, McElroy, SL, Strakowski, SM, Keck, PE Jr, McConvllle, BJ. Attention deficit hyperactivity disorder in adolescent mania. Am J Psychiatry. 1995;152:271273.
3.Winokur, G, Coryell, W, Keller, M, Endicott, J, Leon, A. A family study of manic-depressive (bipolar I) disease. Arch Gen Psychiatry. 1995;52:367373.
4.Tamam, L, Karakus, G, Ozpoyraz, N. Comorbidity of adult attention-deficit hyperactivity disorder and bipolar disorder: prevalence and clinical correlates. Eur Arch Psychiatry Clin Neurosci. 2008;258:385393.
5.Wingo, AP, Ghaemi, SN. A systematic review of rates and diagnostic validity of comorbld adult attention deficit/hyperactivity disorder and bipolar disorder. J Clin Psychiatry. 2007;68:17761784.
6.Sachs, GS, Baldassano, CF, Truman, CJ, Guille, C. Comorbidity of attention deficit hyperactivity disorder with early- and late-onset bipolar disorder. Am J Psychiatry. 2000; 157:466468.
7.Rucklidge, JJ. Impact of ADHD on the neurocognitlve functioning of adolescents with Bipolar Disorder. Biol Psychiatry. 2006;60:921928.
8.Henin, A, Mick, E, Biederman, J, et al.Can bipolar disorder-specific neuropsychological Impairments In children be identified? J Consult Clin Psychol. 2007;75:210220.
9.State, RC, Frye, MA, Altshuler, LL, et al.Chart review of the impact of Attention-Deficit/ Hyperactivity Disorder comorbidity on response to lithium or Divalproex Sodium in adolescent mania. J Clin Psychiatry. 2004;65:10571063.
10.Consoli, AI, Bouzamondo, A, Guile, J-M, Lechat, P, Cohen, D. Comorbidity with ADHD decreases response to pharmacotherapy in children and adolescents with acute mania: Evidence from a meta-analysis. Can J Psychiatry. 2007;52:323328.
11.Biederman, J, Hammerness, P, Doyle, R, Joshl, G, Aleardi, M, Mick, E. Risperidone treatment for ADHD in children and adolescents with bipolar disorder. Neuropsychiatr Dis Treat. 2008;4:203207.
12.Tramontina, S, Zeni, CP, Pheula, GF, de Souza, CK, Rohde, LA. Ariplprazole in juvenile bipolar disorder comorbid with attention-deficit/hyperactivity disorder: an open clinical trial. CNS Spectr. 2007;12:758762.
13.Singh, J, Zarate, C. Pharmacological treatment of psychiatric comorbidity in bipolar disorder: a review of controlled trials. Bipolar Disord. 2006;8:696709.
14.Waxmonsky, J. Assessment and treatment of attention deficit hyperactivity disorder in children with comorbid psychiatric illness. Curr Opin Pediatr. 2003;15:476482.
15.Wozniak, J. Recognizing and Managing Bipolar Disorder In Children. J Clin Psychiatry. 2005;66:1823.
16.Ghaemi, SN, Hsu, DJ, Rosenquist, KJ, Pardo, TB, Goodwin, FK. Extrapyramidal side effects with atypical neuroleptics In bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2006;30:209213.
17.Blader, JC, Kafantaris, V. Pharmacological treatment of bipolar disorder among children and adolescents. Expert Rev Neurother. 2007;7:259270.
18.Baumgaertel, A. Alternative and controversial treatments for attention-deficit/hyper-activity disorder. Pediatr Clin North Am. 1999;46:977992.
19.Kaplan, BJ, Crawford, SG, Field, CJ, Simpson, JS. Vitamins, minerals, and mood. Psychol Bull. 2007;133:747760.
20.Kaplan, BJ, Simpson, JSA, Ferre, RC, Gorman, CP, McMullen, DM, Crawford, SG. Effective mood stabilization with a chelated mineral supplement: An open-label trial In bipolar disorder. J Clin Psychiatry. 2001;62:936944.
21.Popper, CW. Do vitamins or minerals (apart from lithium) have mood-stabilising effects? J Clin Psychiatry. 2001;62:933935.
22.Simmons, M. Nutritional approach to bipolar disorder. J Clin Psychiatry. 2003;64:338.
23.Kaplan, BJ, Crawford, SG, Gardner, B, Farrelly, G. Treatment of mood lability and explosive, rage with minerals and vitamins: two case studies in children. J Child Adolesc Psychopharmacol.2002:12:205219.
24.Kaplan, BJ, Fisher, JE, Crawford, SG, Field, CJ, Kolb, B. Improved mood and behavior during treatment with a mineral-vitamin supplement: an open-label case series of children. J Child Adolesc Psychopharmacol. 2004;14:115122.
25.Rucklidge, JJ. Successful treatment of OCD with a micronutrient supplement following partial response to Cognitive Behavioral Therapy (CBT): A case study. J Anxiety Disord. 2009;23:836840.
26.Frazier, E, Fristad, MA, Arnold, LE. Multinutrient supplement as treatment: Literature review and case report of a 12-year-old boy with bipolar disorder. J Child Adolesc Psychopharmacol. 2009;19:453460.
27.Gately, D, Kaplan, BJ. Database analysis of adults with bipolar disorder consuming a multinutrient formula. Clin Med Psychiatry. 2009;4:316.
28.RuckJidge, JJ, Taylor, M, Whitehead, K. Effect of mlcronutrients on behavior and mood in adults with ADHD: Evidence from an 8-week open label trial with natural extension. J Atten Disord. In press.
29.Spearing, MK, Post, RM, Leverich, GS, Brandt, D, Nolen, W. Modification of the Clinical Global Impressions (CGI) scale for use with bipolar illness (BP): the CGI: BP. Psychiatry Res. 1997;73:159171.
30.Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR, 4th ed, Text revision. Washington, DC: American Psychiatric Association; 2000.
31.Young, RC, Biggs, JT, Ziegler, VE, Meyer, DA. A rating scale for mania: Reliability, validity, and sensitivity. Br J Psychiatry. 1978;133:429435.
32.Montgomery, SA, Asberg, M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979;134:382389.
33.Umphress, VJ, Lambert, MJ, Smart, DW, Barlow, SH, Clouse, G. Concurrent and construct validity of the outcome questionnaire. J Psychoeducational Assess. 1997;15:4055.
34.Conners, CK, Erhardt, D, Sparrow, MA. Conners' Adult ADHD Rating Scales (CAARS). Arch Clin Neuropsychol. 2003;18:431437.
35.Wechsler, D.Manual for the WAIS-III. New York, NY: Psychological Corporation; 1997.
36.Adams, W, Sheslow, D. Wide Range Assessment of Memory and Learning Administration Manual - II. Wilmington, DE: Jastak; 2003.
37.Wilkinson, GS. WRAT3 Administration Manual. Delaware: Wide Range; 1993.
38.Connors, CK. Connors Continuous Performance Test II: Technical Guide. Toronto, Canada: Multi-Health Systems; 2000.
39.First, MB, Spitzer, RL, Gibbon, M, Williams, JBW. Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition. New York, NY: Biometrics Research, New York State Psychiatric Institute; 2002.
40.Epstein, J, Johnson, D, Conners, C. Conners' Adult ADHD Diagnostic Interview for DSM-IVTM(CAADID): Technical Manual. New York, NY: MHS; 2002.
41.Rucklidge, JJ, Tannock, R. Neuropsychological profiles of adolescents with ADHD: Effects of reading difficulties and gender. J Child Psychol Psychiatry. 2002;43:9881003.
42.Douglas, VI. Cognitive control processes in attention deficit hyperactivity disorder. In: Quay, HC, Hogan, AE, eds. Handbook of Disruptive Disorders. New York, NY: Plenum Press; 1999:105138.
43.Kuntsi, J, Oosterlaan, J, Stevenson, J. Psychological mechanisms in hyperactivity: I Response inhibition deficit, working memory impairment, delay aversion, or something else? J Child Psychol Psychiatry. 2001;42:199201.
44.McGee, RA, Clark, SE, Symons, DK. Does the Conners' Continuous Performance Test aid in ADHD diagnosis? J Abnorm Child Psychol. 2000;28:415424.
45.Epstein, JN, Conners, CK, Hervey, AS, et al.Assessing medication effects in the MTA study using neuropsychological outcomes. J Child Psychol Psychiatry. 2006;47:446456.
46.Quraishl, S; Frangou, S. Neuropsychology of bipolar disorder: A review. J Affect Disord. 2002;72:209226.
47.Savitz, JB, van der Merwe, L, Stein, DJ, Solms, M, Ramesar, RS. Neuropsychological task performance in bipolar spectrum illness: genetics, alcohol abuse, medication, and childhood trauma. Bipolar Disord. 2008;10:479494.
48.Arnold, LE, Bozzolo, H, Hollway, J, et al.Serum zinc correlates with parent- and teacher-rated inattention In children with Attentlon-Deficit/Hyperactlvity Disorder. J Child Adolesc Psychopharmacol. 2005;15:628636.
49.Starobrat-Hermelin, B. The effect of deficiency of selected bioelements on hyperactivity in children with certain specified mental disorders. Ann Acad Med Stetin. 1998;44:297314.
50.Saavedra, JM. Probiotics plus antibiotics: Regulating our bacterial environment, J Pediatr. 1999;135:535537.
51.Wynnea, AG, McCartneya, AL, Brostoffb, J, Hudspithb, BN, Gibsona, GR. An in vitro assessment of the effects of broad-spectrum antibiotics on the human gut microflora and concomitant isolation of a Lactobacillus plantarum with anti-Candida activities. Anaerobe. 2004;10:165169.
52.Levy, J. The effects of antibiotic use on gastrointestinal function. Am J Gastroenterol. 2000;95:S8S10.
53.Young, LT. Is bipolar disorder a mitochondrial disease? J Psychiatry Neurosci. 2007;32:160161.
54.Russell, VA, Oades, RD, Tannock, R, et al.Response variability in Attention-Deficit/Hyperactivity Disorder: a neuronal and glial energetics hypothesis. Behav Brain Funct 2006;2:30.
55.Gardner, A, Boles, RG. Is a “Mitochondrial Psychiatry” in the future? A review. Cur Psychiatry Rev. 2005;1:255271.
56.Parikh, S, Saneto, R, Falk, MJ, Anselm, I, Cohen, BH, Haas, R. A modern approach to the treatment of mitochondrial disease. Pediatr Neurol. 2009;41:414430.
57.Mehl-Madrona, L, Leung, B, Kennedy, C, Paul, S, Kaplan, BJ. A naturalistic case-control study of micronutrients versus standard medication management In autism. J Child Adolesc Psychopharmacol. In press.
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