May 29, 2021
If you've been reading my blogs about ADHD, you know that I play by the rules of evidence-based medicine. My view is that the only way to be sure that a treatment 'works' is to see what researchers have published in scientific journals. The highest level of evidence is a meta-analysis of randomized controlled clinical trials. For my lay readers, that means that many rigorous studies have been conducted and summarized with a sophisticated mathematical method. If you are interested in fish oil as a treatment for ADHD, there is some good news. Many good studies have been published and these have been subjected to meta-analysis. To be more exact, we're discussing omega-3 polyunsaturated fatty acids (PUF As), which are found in many fish oils. Omega-3 PUF As reduces inflammation and oxidative stress, which is why they had been tested as treatments for ADHD. When these studies were meta-analyzed, it became clear that omega-3 PUFAs high in eicosapentaenoic acid (EPA) helped to reduce ADHD symptoms. For details see: Bloch, M. H. and J. Mulqueen (2014). "Nutritional supplements for the treatment of ADHD." Child Addles Psychiatry Clin N Am23(4): 883-897. So, if omega-3 PUF helps reduce ADHD symptoms, why are doctors still prescribing ADHD drugs? The reason is simple. Omega-3supplements work, but not very well. On a scale of one to 10 where 10 is the best effect, drug therapy scores 9 to 10but omega-3 therapy scores only 2. Some patients or parents of patients might want to try omega-3 therapy first, in the hopes that it will work well for them. That is a possibility, but if that is your choice, you should not delay the more effective drug treatments for too long in the likely event that omega-3 therapy is not sufficient. What about combining ADHD drugs with omega-3 supplements? We don't know. I hope that future research will see if combined therapy might reduce the number of drugs required for each patient. Keep in mind that the treatment guidelines from professional organizations point to ADHD drugs as the first-line treatment for ADHD. The only exception is for preschool children where medication is only the first-line treatment for severe ADHD; the guidelines recommend that other preschoolers with ADHD be treated with non-pharmacologic treatments, when available. You can learn more about non-pharmacologic treatments for ADHD from a book I recently edited: Faraone, S. V. & Antshel, K. M. (2014). ADHD: Non-Pharmacologic Interventions. Child Addles psychiatry Clin N Am 23, xiii-xiv.