Tag: ADHD

Supplements for Mental Health

We came across this topic some time back and thought it would be good inspiration for a NutriScape.NET article written from the dietitian’s point of view. Here are some quick snippets you can follow.

Nutrition Supplements Studied For Mental Health

Source: UCx: PSY01ucX Course: Mental Health and Nutrition

Nutritional Supplements

The most frequent question I get asked is: based on all of this research, what micronutrient formula should I take?

Below, I have compiled a list of ALL the micronutrient formulas that have been studied to treat a psychiatric or psychological problem. Note I have not included those preparations used for prevention of cognitive decline.

Each product listed below has at least one positive RCT to support its use. I have cited all the research behind the products mentioned (it is listed in ascending date order). PLEASE NOTE I DO NOT RECEIVE ANY MONEY FROM ANY OF THE COMPANIES THAT SELL MICRONUTRIENT PRODUCTS.

1. EMPower™, EMPowerplus™, and EMPowerplus Advanced™ (EMP)

www.truehope.com
For: ADHD, mood dysregulation, PMS, symptoms associated with trauma, aggression, depression, stress, anxiety.

For those taking the current EMP formulation for improving mental health symptoms, the dose stipulated on the bottle is two capsules twice a day (the dose recommended for general health). However, the dose more typically used in current research is at least four capsules twice a day. For those using these products for assisting with managing stress, our research after the earthquakes and floods showed that a therapeutic dose may be lower, such as four a day.

Research

Kaplan, B. J., Simpson, J. S. A., Ferre, R. C., Gorman, C. P., McMullen, D. M., & Crawford, S. G. (2001). Effective mood stabilization with a chelated mineral supplement: An open-label trial in bipolar disorder. Journal of Clinical Psychiatry, 62(12), 936-944.
Popper, C. W. (2001). Do vitamins or minerals (apart from lithium) have mood-stabilising effects? Journal of Clinical Psychiatry, 62(12), 933-935. https://www.psychiatrist.com/jcp/article/pages/2001/v62n12/v62n1203.aspx
Kaplan, B. J., Crawford, S. G., Gardner, B., & Farrelly, G. (2002). Treatment of mood lability and explosive rage with minerals and vitamins: two case studies in children. Journal of Child and Adolescent Psychopharmacology, 12(3), 205-219.
Simmons, M. (2003). Nutritional approach to bipolar disorder. Journal of Clinical Psychiatry, 64(3), 338.
Kaplan, B. J., Fisher, J. E., Crawford, S. G., Field, C. J., & Kolb, B. (2004). Improved mood and behavior during treatment with a mineral-vitamin supplement: an open-label case series of children. Journal of Child and Adolescent Psychopharmacology, 14(1), 115-122.
Rucklidge, J. J. (2009). Successful treatment of OCD with a micronutrient formula following partial response to CBT: A case study. Journal of Anxiety Disorders, 23, 836–840.
Gately, D., & Kaplan, B.J. (2009). Database analysis of adults with bipolar disorder consuming a micronutrient formula. Clinical Medicine: Psychiatry. http://la-press.com/article.php?article_id=1384
Frazier, E.A., Fristad, M., & Arnold, L.E. (2009). Multinutrient Supplement as Treatment: Literature Review and Case Report of a 12-year-old Boy with Bipolar Disorder. Journal of Child and Adolescent Psychopharmacology, 19, 453-460.
Rucklidge, J. J., & Harrison, R. (2010). Successful treatment of Bipolar Disorder II and ADHD with a micronutrient formula: A case study. CNS Spectrums, 15(5), 289-295.
Mehl-Madrona, L., Leung, B., Kennedy, C., Paul, S. & Kaplan, B. J. (2010). A naturalistic case-control study of micronutrients versus standard medication management in autism. Journal of Child and Adolescent Psychopharmacology, 20(2), 95-103. https://www.ncbi.nlm.nih.gov/pubmed/20415604
Rucklidge, J. J., Gately, D., & Kaplan, B. J. (2010). Database Analysis of Children and Adolescents with Bipolar Disorder Consuming a Micronutrient Formula. BMC Psychiatry, 10, 17. http://www.biomedcentral.com/1471-244X/10/74
Rucklidge, J. J., Taylor, M. R., Whitehead, K. A. (2011). Effect of micronutrients on behaviour and mood in adults with ADHD: Evidence from an 8-week open label trial with natural extension. Journal of Attention Disorders, 15(1), 79-91.
Rucklidge, J. J., Johnstone, J., Harrison, R. (2011). Effect of micronutrients on neurocognitive functioning in adults with ADHD and Severe Mood Dysregulation: A pilot study. Journal of Complementary and Alternative Medicine, 17(12), 1-7. https://www.ncbi.nlm.nih.gov/pubmed/22112202
Rucklidge, J. J., & Blampied, N. M. (2011). Post earthquake functioning in adults with Attention-Deficit/Hyperactivity Disorder: Positive effects of micronutrients on resilience. New Zealand Journal of Psychology, 40(4), 51-57.
Rucklidge, J. J., Johnstone, J., Harrison, R., & Boggis, A. (2011). Micronutrients reduce stress and anxiety following a 7.1 earthquake in adults with Attention-Deficit/Hyperactivity Disorder. Psychiatry Research, 189, 281-287. doi:10.1016/j.psychres.2011.06.016
Simpson, J. S. A., Crawford, S. G., Goldstein, E. T., Field, C., Burgess, E., & Kaplan, B. J. (2011). Systematic review of safety and tolerability of a complex micronutrient formula used in mental health. BMC Psychiatry, 11(62). http://www.biomedcentral.com/1471-244X/11/62
Rodway, M., Vance, A., Watters, A., Lee, H., Bos, E., & Kaplan, B. J. (2012). Efficacy and cost of micronutrient treatment of childhood psychosis. BMJ Case Reports, 10.1136/bcr-2012-007213. https://doi.org/10.1136/bcr-2012-007213
Rucklidge, J. J., Andridge, R., Gorman, B., Blampied, N., Gordon, H. & Boggis, A. (2012). Shaken but unstirred? Effects of micronutrients on stress and trauma after an earthquake: RCT evidence comparing formulas and doses. Human Psychopharmacology: Clinical and Experimental, 27(5), 440-454. https://www.ncbi.nlm.nih.gov/pubmed/22782571
Frazier, E.A., Fristad, M.A. & Arnold, L.E. (2012). Feasibility of a nutritional supplement as treatment for pediatric bipolar spectrum disorders. Journal of Complementary and Alternative Medicine, 18, 678-85.
Harrison, R., Rucklidge, J. J., & Blampied, N. (2013). Use of micronutrients attenuates cannabis and nicotine abuse as evidenced from a reversal design: A case study. Journal of Psychoactive Drugs, 45(2), 1-11. https://www.ncbi.nlm.nih.gov/pubmed/23909004
Frazier, E. A., Gracious, B., Arnold, L. E., Failla, M., Chitchumroonchokchai, C., Habash, D., & Fristad, M. A. (2013). Nutritional and safety outcomes from an open-label micronutrient intervention for pediatric bipolar spectrum disorders. Journal of Child and Adolescent Psychopharmacology, 23(8), 558-567. doi:10.1089/cap.2012.0098
Rucklidge, J. J. (2013). Could yeast infections impair recovery from mental illness? A case study using micronutrients and olive leaf extract for the treatment of ADHD and depression. Advances in Mind-Body Medicine, 27(3), 14-18. https://www.ncbi.nlm.nih.gov/pubmed/23784606
Rucklidge, J. J., Blampied, N., Gorman, B., Gordon, H., & Sole, E. (2014). Psychological functioning one year after a brief intervention using micronutrients to treat stress and anxiety related to the 2011 Christchurch earthquakes: A naturalistic follow-up. Human Psychopharmacology: Clinical and Experimental, 29(3), 230-243. https://www.ncbi.nlm.nih.gov/pubmed/24554519
Rucklidge, J. J., Frampton, C. M., Gorman, B., & Boggis, A. (2014). Vitamin-mineral treatment of attention-deficit hyperactivity disorder in adults: double-blind randomised placebo-controlled trial. British Journal of Psychiatry, 204(4), 306-315. https://doi.org/10.1192/bjp.bp.113.132126
Rucklidge, J. J., Johnstone, J., Gorman, B., & Boggis, A., & Frampton, C. (2014). Moderators of treatment response in adults with ADHD to micronutrients: demographics and biomarkers. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 50, 163–171. https://www.ncbi.nlm.nih.gov/pubmed/24374068
Gordon, H. A., Rucklidge, J. J., Blampied, N. M., & Johnstone, J. M. (2015). Clinically Significant Symptom Reduction in Children with Attention-Deficit/Hyperactivity Disorder Treated with Micronutrients: An Open-Label Reversal Design Study. Journal of Child and Adolescent Psychopharmacology, 25(10), 783-798. doi: 10.1089/cap.2015.0105 https://www.ncbi.nlm.nih.gov/pubmed/26682999
Kaplan, B. J., Hilbert, P., & Tsatsko, E. (2015). Micronutrient treatment for children with emotional and behavioral dysregulation: a case series. Journal of Medical Case Reports, 9:240. http://www.jmedicalcasereports.com/content/pdf/s13256-015-0735-0.pdf
Kaplan, B. J., Rucklidge, J. J., Romijn, A. R., & Dolph, M. (2015). A randomized trial of nutrient supplements to minimize psychological stress after a natural disaster. Psychiatry Research, 228, 373-379. http://www.ncbi.nlm.nih.gov/pubmed/26154816
Kaplan BJ, Leaney C, Tsatsko E (2016). Micronutrient treatment of emotional dyscontrol following traumatic brain injury: A case study. Annals of Psychiatry and Mental Health, 4(5): 1078. https://www.jscimedcentral.com/Psychiatry/psychiatry-4-1078.pdf
Retallick-Brown, H., Rucklidge, J. J., & Blampied, N. (2016). Study protocol for a randomised double blind, treatment control trial comparing the efficacy of a micronutrient formula to a single vitamin supplement in the treatment of premenstrual syndrome. Medicines, 3, 32. http://www.mdpi.com/2305-6320/3/4/32
Rucklidge, J. J., Frampton, C., Gorman, B., & Boggis, A. (2017). Vitamin-mineral treatment of ADHD in adults: A one year follow up of a randomized controlled trial. Journal of Attention Disorders, 21(6), 522-532. http://journals.sagepub.com/doi/pdf/10.1177/1087054714530557
Sole, E. J., Rucklidge, J. J., & Blampied, N. M. (2017). Anxiety and Stress in Children Following an Earthquake: Clinically Beneficial Effects of Treatment with Micronutrients. Journal of Child and Family Studies, 1-10. doi: 10.1007/s10826-016-0607-2 https://link.springer.com/article/10.1007%2Fs10826-016-0607-2
Kaplan, B. J., Isaranuwatchai, W., & Hoch, J. S. (2017). Hospitalization cost of conventional psychiatric care compared to broad-spectrum micronutrient treatment: literature review and case study of adult psychosis. International Journal of Mental Health Systems, 11, 14. https://link.springer.com/article/10.1186/s13033-017-0122-x
Mehl-Madrona, L., & Mainguy, B. (2017). Adjunctive Treatment of Psychotic Disorders with Micronutrients. Journal of Alternative and Complementary Medicine. 23(7): 526-533. http://online.liebertpub.com/doi/10.1089/acm.2016.0215
Retallick-Brown, H., Blampied, N., & Rucklidge, J. J. (2020). A Pilot Randomized Treatment-Controlled Trial Comparing Vitamin B6 with Broad-Spectrum Micronutrients for Premenstrual Syndrome. Journal of Alternative and Complementary Medicine. doi:10.1089/acm.2019.0305. https://www.ncbi.nlm.nih.gov/pubmed/31928364

2. Daily Essential Nutrients*™ (DEN)

www.hardynutritionals.com

For: ADHD, smoking cessation, emotional dysregulation, symptoms associated with trauma, aggression, depression, stress, anxiety

*Prior to 2013, there was just one formula and it was manufactured by TrueHope. From 2013 onward, Hardy Nutritionals produced Daily Essential Nutrients while TrueHope continued to produce EMP+. Therefore, the ingredients of DEN are very similar to EMP+ in both breadth and dose. Some modifications have been made to both formulas over the ensuing decade. For updated information on current formulas, see the manufacturers’ websites.

A full daily dose for improving psychiatric symptoms with DEN is four capsules three times a day (twelve/day) and this is the dose that has been the most used in the cited research. Hardy Nutritionals has a product called Optimal Balance® designed for people just seeking a little additional nutrient support to manage stress or insomnia. The typical daily dose is three twice a day (six/day).

DEN is a better choice than Optimal Balance® for those with more serious psychiatric problems and/or if taking the nutrients alongside psychiatric medications, where they may want to consult with the company product specialists regarding their own situation.

Research

Lothian, J., Blampied, N., & Rucklidge, J. (2016). Effect of Micronutrients on Insomnia in Adults: A Multiple-Baseline Study. Clinical Psychological Science, 4(6), 1112-1124. https://doi.org/10.1177/2167702616631740
Blampied, M., Bell, C., Gilbert, C., Boden, J., Nicholls, R., Rucklidge, J. J. (2018) Protocol for a Randomized Double Blind, Placebo Control Trial Exploring the Effectiveness of a Micronutrient Formula in improving symptoms of Anxiety and Depression. Medicines. 5(2), 56. http://www.mdpi.com/2305-6320/5/2/56
Rucklidge, J. J., Eggleston, M., Johnstone, J. M., Darling, K., & Frampton, C. M. (2018). Vitamin-mineral treatment improves aggression and emotional regulation in children with ADHD: A fully-blinded, randomized, placebo-controlled trial. Journal of Child Psychology and Psychiatry, 59(3), 232-246. http://onlinelibrary.wiley.com/doi/10.1111/jcpp.12817/full
Stevens, A., Rucklidge, J. J., Eggleston, M., Darling, K., & Kennedy, M. (2018). Methylomic changes in response to micronutrient supplementation and MTHFR genotype. Epigenomics, 10(8), 1201-1214. https://www.futuremedicine.com/doi/10.2217/epi-2018-0029
Reihana, P., Blampied, N., & Rucklidge, J. (2018). Novel Mineral–Vitamin Treatment for Reduction in Cigarette Smoking: A Fully Blinded Randomized Placebo-Controlled Trial. Nicotine & Tobacco Research, 21(11), 1496-1505. https://doi.org/10.1093/ntr/nty168
Rucklidge, J. J., Eggleston, M. J. F., Ealam, B., Beaglehole, B., & Mulder, R. T. (2019). An Observational Preliminary Study on the Safety of Long-Term Consumption of Micronutrients for the Treatment of Psychiatric Symptoms. Journal of Alternative and Complementary Medicine. doi:10.1089/acm.2018.0352 https://www.liebertpub.com/doi/10.1089/acm.2018.0352
Rucklidge, J. J., Eggleston, M., Johnstone, J. M., Darling, K., Stevens, A. J., Kennedy, M. A., & Frampton, C. M. (2019). Can we predict treatment response in children with ADHD to a vitamin-mineral supplement? An investigation into pre-treatment nutrient serum levels, MTHFR status, clinical correlates and demographic variables. Progress in Neuropsychopharmacology & Biological Psychiatry, 89, 181-192. https://www.sciencedirect.com/science/article/pii/S027858461830407X?via%3Dihub
Borlase, N., Melzer, T. R., Eggleston, M. J. F., Darling, K. A., & Rucklidge, J. J. (2019). Resting-state networks and neurometabolites in children with ADHD after 10 weeks of treatment with micronutrients: results of a randomised placebo-controlled trial. Nutritional Neuroscience, 1-11. doi:10.1080/1028415X.2019.1574329 https://www.tandfonline.com/doi/full/10.1080/1028415X.2019.1574329
Stevens, A. J., Purcell, R. V., Darling, K. A., Eggleston, M. J. F., Kennedy, M. A., & Rucklidge, J. J. (2019). Human gut microbiome changes during a 10 week Randomised Control Trial for micronutrient supplementation in children with attention deficit hyperactivity disorder. Scientific Reports, 9(1), 10128. doi:10.1038/s41598-019-46146-3 https://www.nature.com/articles/s41598-019-46146-3
Darling, K. A., Eggleston, M. J. F., Retallick-Brown, H., & Rucklidge, J. J. (2019). 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. Journal of Child and Adolescent Psychopharmacology. doi:10.1089/cap.2019.0036 https://www.ncbi.nlm.nih.gov/pubmed/31343273
Johnstone, J. M., Leung, B., Gracious, B., Perez, L., Tost, G., Savoy, A., . . . Arnold, L. E. (2019). 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. Contemporary clinical trials communications, 16, 100478-100478. doi:10.1016/j.conctc.2019.100478 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6859218/
Bradley, H. A., Campbell, S. A., Mulder, R. T., Henderson, J. M. T., Dixon, L., Boden, J. M., & Rucklidge, J. J. (2020). Can broad-spectrum multinutrients treat symptoms of antenatal depression and anxiety and improve infant development? Study protocol of a double blind, randomized, controlled trial (the ‘NUTRIMUM’ trial). BMC Pregnancy and Childbirth, 20(1), 488. https://doi.org/10.1186/s12884-020-03143-z
Hughes, S., Rondeau, M., Shannon, S., Sharp, J., Ivins, G., Lee, J., Taylor, I., & Bendixsen, B. (2020). A Holistic Self-learning Approach for Young Adult Depression and Anxiety Compared to Medication-Based Treatment-As-Usual. Community Mental Health Journal. https://doi.org/10.1007/s10597-020-00666-9
Rucklidge, J. J., Afzali, M. U., Kaplan, B. J., Bhattacharya, O., Blampied, F. M., Mulder, R. T., & Blampied, N. M. (2021). Massacre, Earthquake, Flood: Massacre, Earthquake, Flood: Translational science evidence that the use of micronutrients post-disaster reduces the risk of post-traumatic stress in survivors of disasters. International Perspectives in Psychology, 10(1), 39-54. https://doi.org/10.1027/2157-3891/a000003

NOTES on DEN and EMP: Both are available as powders for mixing into juice, for those who cannot swallow capsules. Also, some people are very sensitive to the smell of dietary supplements. If the smell of the capsules is a problem, try keeping them in the fridge or freezer. Pre-pubertal children may take a lower dose (4 twice a day), although research studies have sometimes gone up to the full adult dose for treating childhood ADHD. As children enter their teenage years, research has shown that the dose may need to be increased to maintain symptom control.Finally, the doses mentioned above are mostly based on research with people who were not taking any psychiatric medications (e.g., antidepressants, anxiolytics, stimulants) because up to this point, most studies have excluded people taking these medications. The large number of pills does not imply that the micronutrient dosing is high. Many commercial products contain a broad spectrum of micronutrients in one or two capsules daily, but the nutrients are present in chemical forms that are poorly absorbed. One way to enhance bioavailability of the minerals is to deliver them in chelated forms (chelation promotes passage from the gut into the blood stream, where the minerals dissociate from the chelates), but the chelated minerals are bulky and cannot be condensed into one or two capsules. Furthermore, some broad-spectrum formulations also provide macro-minerals, such as calcium, magnesium, and phosphorus, which are often under-represented in diets and are required in much larger bulk quantities than micronutrients. Products containing chelated microminerals and bulky macrominerals require more pills each day, are more expensive, but will likely be more effective than regular formulations.

3. Brain Child Spectrum Support/ANRC Essentials

http://www.brainchildnutritionals.com/spectrum-support-vitamins.html/ or http://www.autismnrc.org/anrc-essentials

For: autism

Professor Jim Adams at Arizona State University has conducted a number of studies using nutrients for the treatment of autism, using three products: Spectrum Support II/IIITM, SyndionTM, and ANRC Essentials PlusTM (a revised version of SyndionTM). Spectrum Support comes as a capsule or colloidal suspension–the standard dose is two capsules (or two teaspoons) twice a day. For ANRC Essentials PlusTM, the company provides information on how to gradually increase to the optimal dose based on body weight. The formula comes either as capsules or a powder to mix with your favorite juice (they suggest orange, mango, or cranberry).

Research

Adams, J. B., & Holloway, C. (2004). Pilot study of a moderate dose multivitamin/mineral supplement for children with autism spectrum disorder. Journal of Alternative and Complementary Medicine, 10(6), 1033-1039. http://online.liebertpub.com/doi/abs/10.1089/acm.2004.10.1033
Adams, J. B., Audhya, T., McDonough-Means, S., Rubin, R. A., Quig, D., Geis, E., Gehn, E., Loresto, M., Mitchell, J., Atwood, S., Barnhouse, S., & Lee, W. (2011). Effect of a vitamin/mineral supplement on children and adults with autism. BMC Pediatrics, 11, 111. https://doi.org/10.1186/1471-2431-11-111
Adams, J. B., Audhya, T., Geis, E., Gehn, E., Fimbres, V., Pollard, E., Mitchell, J., Ingram, J., Hellmers, R., Laake, D., Matthews, J., Li, K., Naviaux, J., Naviaux, R., Adams, R., Coleman, D., & Quig, D. (2018). Comprehensive Nutritional and Dietary Intervention for Autism Spectrum Disorder—A Randomized, Controlled 12-Month Trial. Nutrients, 10(3), 369. http://www.mdpi.com/2072-6643/10/3/369

4. Forceval

http://www.forceval.co.uk

For: aggression in prisoners

Forceval is available in a capsule or in effervescent tablets and is a licensed medicine in the UK. The recommended dose is one capsule daily. The main target for the formula is to combat malnutrition. However, Forceval has been used along with fish oil for omega 3s to successfully reduce aggression in people incarcerated in prisons. There were no adverse reactions.

Research

Gesch CB., Hammond SM, Hampson SE, et al. (2002). The British Journal of Psychiatry, 181(1) 22-28; doi: 10.1192/bjp.181.1.22

5. Bayer’s Berocca

http://www.berocca.com/en/home.php

For: stress/anxiety

Berocca is the most studied B-complex formula for reduction of stress. It can be taken as a capsule or an effervescent tablet that you add to water. It has been studied primarily in people drawn from the general population. No concerning side effects have been reported.

Research

Carroll, D., Ring, C., Suter, M., & Willemsen, G. (2000). The effects of an oral multivitamin combination with calcium, magnesium, and zinc on psychological well-being in healthy young male volunteers: a double-blind placebo-controlled trial. Psychopharmacology, 150(2), 220-225. https://doi.org/doi:10.1007/s002130000406
Schlebusch, L., Bosch, B. A., Polglase, G., Kleinschmidt, I., Pillay, B. J., & Cassimjee, M. H. (2000). A double-blind, placebo-controlled, double-centre study of the effects of an oral multivitamin-mineral combination on stress. South African Medical Journal, 90(12), 1216-1223. https://www.ncbi.nlm.nih.gov/pubmed/11234653
Kennedy, D. O., Haskell, C. F., Robertson, B., Reay, J., Brewster-Maund, C., Luedemann, J., Maggini, S., Ruf, M., Zangara, A., & Scholey, A. B. (2008). Improved cognitive performance and mental fatigue following a multi-vitamin and mineral supplement with added guarana (Paullinia cupana). Appetite, 50(2-3), 506-513. https://doi.org/10.1016/j.appet.2007.10.007
Kennedy, D., Veasey, R., Watson, A., Dodd, F., Jones, E., Maggini, S., & Haskell, C. (2010). Effects of high-dose B vitamin complex with vitamin C and minerals on subjective mood and performance in healthy males. Psychopharmacology, 211(1), 55-68. https://doi.org/doi:10.1007/s00213-010-1870-3
Rucklidge, J. J., Andridge, R., Gorman, B., Blampied, N., Gordon, H., & Boggis, A. (2012). Shaken but unstirred? Effects of micronutrients on stress and trauma after an earthquake: RCT evidence comparing formulas and doses. Human Psychopharmacology, 27(5), 440-454. https://doi.org/10.1002/hup.2246
Scholey, A., Bauer, I., Neale, C., Savage, K., Camfield, D., White, D., Maggini, S., Pipingas, A., Stough, C., & Hughes, M. (2013). Acute effects of different multivitamin mineral preparations with and without Guarana on mood, cognitive performance and functional brain activation. Nutrients, 5(9), 3589-3604. https://doi.org/10.3390/nu5093589
White, D., Cox, K., Peters, R., Pipingas, A., & Scholey, A. (2015). Effects of Four-Week Supplementation with a Multi-Vitamin/Mineral Preparation on Mood and Blood Biomarkers in Young Adults: A Randomised, Double-Blind, Placebo-Controlled Trial. Nutrients, 7(11), 5451. http://www.mdpi.com/2072-6643/7/11/5451

6. Swisse Ultivite

http://www.swisse.com/au/vitamins-and-supplements/mens-health/73/swisse-mens-ultivite-f1

For: stress

Swisse UltiviteTM is available in both a women and men’s version and is taken as one capsule daily with a meal. Several studies support its use for reduction of stress in otherwise healthy people. No side effects were reported.

Research

Harris, E., Kirk, J., Rowsell, R., Vitetta, L., Sali, A., Scholey, A., & Pipingas, A. (2011). The effect of multivitamin supplementation on mood and stress in healthy older men. Human Psychopharmacology, 26(8), 560-567. https://doi.org/10.1002/hup.1245
Harris, E., Macpherson, H., Vitetta, L., Kirk, J., Sali, A., & Pipingas, A. (2012). Effects of a multivitamin, mineral and herbal supplement on cognition and blood biomarkers in older men: A randomised, placebo‐controlled trial. Human Psychopharmacology: Clinical and Experimental, 27(4), 370-377. https://doi.org/10.1002/hup.2236
Sarris J, Cox, KH M, Camfield DA, et al. (2012). Participant experiences from chronic administration of a multivitamin versus placebo on subjective health and wellbeing: A double-blind qualitative analysis of a randomized controlled trial. Nutrition Journal, 11, 110. http://doi.org/10.1186/1475-2891-11-110
Pipingas, A., Camfield, D. A., Stough, C., Cox, K. H., Fogg, E., Tiplady, B., Sarris, J., White, D. J., Sali, A., Wetherell, M. A., & Scholey, A. B. (2013). The effects of multivitamin supplementation on mood and general well-being in healthy young adults. A laboratory and at-home mobile phone assessment. Appetite, 69, 123-136. https://doi.org/10.1016/j.appet.2013.05.016
Camfield, D. A., Wetherell, M. A., Scholey, A. B., Cox, K. H., Fogg, E., White, D. J., Sarris, J., Kras, M., Stough, C., Sali, A., & Pipingas, A. (2013). The effects of multivitamin supplementation on diurnal cortisol secretion and perceived stress. Nutrients, 5(11), 4429-4450. https://doi.org/10.3390/nu5114429
Macpherson, H., Rowsell, R., Cox, K. H., Scholey, A., & Pipingas, A. (2015). Acute mood but not cognitive improvements following administration of a single multivitamin and mineral supplement in healthy women aged 50 and above: a randomised controlled trial. Age (Dordr), 37(3), 9782. https://doi.org/10.1007/s11357-015-9782-0

7. Blackmores Executive B

http://www.blackmores.com.au/products/executive-b-stress-formula

For: stress

Blackmores is taken as one capsule twice a day with meals. One study showed improved work-related stress. It is also available as an immediate-release and sustained-release capsule. No side effects have been reported.

Research

Stough, C., Scholey, A., Lloyd, J., Spong, J., Myers, S., & Downey, L. A. (2011). The effect of 90 day administration of a high dose vitamin B-complex on work stress. Human Psychopharmacology: Clinical and Experimental, 26(7), 470-476. https://doi.org/10.1002/hup.1229

8. Enlyte

https://www.enlyterx.com/

For: depression

There has been one study using Enlyte to treat people with a variant of the MTHFR gene who also had major depression. The treatment consists of one capsule taken on an empty stomach. It is available by prescription and may be covered by insurance in the US. No reported side effects.

Research

Mech A, Farah A. Correlation of clinical response with homocysteine reduction during therapy with reduced B vitamins in patients with MDD who are positive for MTHFR C677T or A1298C polymorphism: a randomized, double-blind, placebo-controlled study. Journal of Clinical Psychiatry. 2016 May;77(5):668-71. doi:10.4088/JCP.15m10166.

9. Optivite

www.optimox.com

For: premenstrual symptoms

Optivite was first studied in the 1980s and as far as I am aware, there have been no new studies for the last two decades. The product is still available for purchase. The studies suggested between six and twelve capsules a day. The bottle recommends two-to-six tablets daily with meals. The main concern raised about taking a dose above ten capsules is that it delivers vitamin B6 in a range that can produce some neurological side effects, including tingling of limbs. Fortunately, the side effect is reversible once you stop taking the pills.

Research

Chakmakjian, Z. H., Higgins, C. E., & Abraham, G. E. (1985). The effect of a nutritional supplement, Optivite for women, on premenstrual tension syndromes. II. Effect on symptomatology, using a double blind cross-over design. The Journal of Applied Nutrition, 37(1), 12-17.
London, R. S., Bradley, L., & Chiamori, N. Y. (1991). Effect of a nutritional supplement on premenstrual symptomatology in women with premenstrual syndrome: a double-blind longitudinal study. Journal of the American College of Nutrition, 10(5), 494-499. doi:10.1080/07315724.1991.10718176

Other publications: reviews and letters to editors

Rucklidge, J. J., Johnstone, J., & Kaplan, B. J. (2009). Nutrient supplementation approaches in the treatment of ADHD. Expert Review of Neurotherapeutics, 9(4), 461-476.
Gardner, A., Kaplan, B. J., Rucklidge, J. J., Jonsson, B. H., & Humble, M. B. (2010). The potential of nutritional therapy. Science (letter), 327, 268.
Kaplan, B. J., Nikkel, G., Nikkel, B., & Rucklidge, J. J. (2013). Keeping Academic Psychiatry Relevant. British Journal of Psychiatry (letter). http://bjp.rcpsych.org/content/201/6/421/reply#bjprcpsych_el_53864
Rucklidge, J. J., & Kaplan, B. J. (2013). Broad-spectrum micronutrient formulas for the treatment psychiatric symptoms: A systematic review. Expert Review of Neurotherapeutics, 13(1), 49-73.
Rucklidge, J. J., Johnstone, J., & Kaplan, B. J. (2013). Single bullet madness – why do we continue to perpetuate this fallacy? (letter). British Journal of Psychiatry, 203, 154-155. http://bjp.rcpsych.org/content/202/6/398/reply#bjprcpsych_el_54588
Popper, C. W. (2014). Single-Micronutrient and Broad-Spectrum Micronutrient Approaches for Treating Mood Disorders in Youth and Adults. Child and Adolescent Psychiatric Clinics of North America, 23(3), 591-672. doi:10.1016/j.chc.2014.04.001
Rucklidge, J. J., Harris, A., & Shaw, I. (2014). Are the amounts of vitamins in commercially available dietary supplement formulations relevant for the management of psychiatric disorders in children? New Zealand Journal of Medicine, 127, 73-85. https://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2014/vol-126-no-1392/article-rucklidge
Rucklidge, J. J., & Mulder, R. T. (2015). Could nutrition help behaviours associated with personality disorders? A narrative review. Personality and Mental Health. http://onlinelibrary.wiley.com/doi/10.1002/pmh.1325/epdf
Kaplan, B. J., Rucklidge, J. J., Romijn, A., & McLeod, K. (2015). The Emerging Field of Nutritional Mental Health: Inflammation, the Microbiome, Oxidative Stress, and Mitochondrial Function. Clinical Psychological Science, 3(6), 964-980. https://doi.org/10.1177/2167702614555413
Sarris, J., Logan, A. C., Amminger, G. P., Balanzá-Martínez, V., Freeman, M. P., Hibbeln, J., Matsuoka, Y., Mischoulon, D., Mizoue, T., Nanri, A., Nishi, D., Ramsey, D. Rucklidge, J. J., Sanchez-Villegas, A., Scholey, A., Su, K. P., & Jacka, F. N. (2015). Nutritional Medicine as Mainstream in Psychiatry: A Consensus Position Statement from The International Society for Nutritional Psychiatry Research (ISNPR). Lancet Psychiatry, 2, 271-274. http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14)00051-0/abstract
Rucklidge, J.J., Kaplan, B. J., & Mulder, R. (2015). What if nutrients could treat mental illness? (Debate). Australia and New Zealand Journal of Psychiatry, 49(5), 407-408. http://anp.sagepub.com/content/49/5/407.full.pdf+html
Sarris. J., Logan, A. C., Akbaraly, T. N., Amminger, G. P., Balanzá-Martínez, V., Freeman, M. P., Hibbeln, J., Matsuoka, Y., Mischoulon, D., Mizoue, T., Nanri, A., Nishi, D., Parletta, N., Ramsey, D., Rucklidge, J. J., Sanchez-Villegas, A., Scholey, A., Su, C., Jacka, F. N. (2015). The International Society for Nutritional Psychiatry Research (ISNPR) Consensus Position Statement: Nutritional Medicine in Modern Psychiatry (letter to editor). World Psychiatry, 14(3), 370-371. http://onlinelibrary.wiley.com/doi/10.1002/wps.20223/abstract
Stevens, A., Rucklidge, J. J., & Kennedy, M. A. (2017). Epigenetics, nutrition and mental health. Is there a relationship? Nutritional Neuroscience, 21, 602-613. https://doi.org/10.1080/1028415X.2017.1331524
Popper, C., Kaplan, B. J., & Rucklidge, J. J. (2017). Single and Broad-Spectrum Micronutrient Treatment in Psychiatric Practice. In Complementary and Integrative Treatments in Psychiatric Practice. Edited by Patricia L. Gerbarg, M.D., Philip R. Muskin, M.D., Richard P. Brown, M.D. American Psychiatric Press, Washington, D.C (pp 75-101).
Rucklidge, J. J., Taylor, M. R., & Johnstone, J. (2018). Does diet and nutrition affect ADHD? Facts and clinical considerations for psychiatrists. Psychiatric Times, 35 (9). http://www.psychiatrictimes.com/special-reports/do-diet-and-nutrition-affect-adhd-facts-and-clinical-considerations
Taylor, M.R., Chuang, C., Carrasco, K.D., Rucklidge, J. J. (2018). Dietary and Micronutrient Treatments for Children with Neurodevelopment Disorders. Current Developmental Disorders Reports, 5, 243-252. https://link.springer.com/article/10.1007/s40474-018-0150-5?wt_mc=Internal.Event.1.SEM.ArticleAuthorOnlineFirst&utm_source=ArticleAuthorOnlineFirst&utm_medium=email&utm_content=AA_en_06082018&ArticleAuthorOnlineFirst_20180916
Blampied, M., Bell, C., Gilbert, C., & Rucklidge, J. J. (2020). Broad spectrum micronutrient formulas for the treatment of symptoms of depression, stress and/or anxiety: a systematic review. Expert Review of Neurotherapeutics, 20 (4), 351–371. https://www.tandfonline.com/doi/full/10.1080/14737175.2020.1740595
Johnstone, J., Hughes, A., Goldenberg, J. Z., Romijn, A. R., & Rucklidge, J. J. (2020). Multinutrients for the Treatment of Psychiatric Symptoms in Clinical Samples: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients, 12(11). https://doi.org/10.3390/nu12113394
Rucklidge, J. J., Johnstone, J. J., & Kaplan, B. J. (2021). Nutrition is an essential foundation for optimizing mental health. Evidence Based Practice in Child and Adolescent Mental Health, 6(1), 131-154. http://dx.doi.org/10.1080/23794925.2021.1875342

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Supplementing For Mental Health: Watch Our for Drug-Nutrient Interactions Causing Side Effects

Combining psychiatric medications with micronutrients can be challenging, and physicians have often reported an increase in side effects when their patients start taking nutrients alongside their psychiatric medications. I will explain why we think this might happen and how to mitigate the problems.

One of the most common questions that I get asked is, “Should I get my nutrient levels tested before trying micronutrients?”. And the answer is ‘No”, unless you might have some specific concerns about your health, or you are at risk for a rare metabolic condition that affects your ability to metabolize nutrients, like copper or iron. Others wonder if it is worth trying supplements if blood tests show that one or several of their nutrient levels are normal,or should they only take specific nutrients based on the ones identified as deficient in blood tests.

Firstly, blood tests are not necessary for deciding on treatment nor are they generally helpful. So let me explain. Our lab looked at whether blood levels of nutrients are predictive of how people would respond clinically to the broad spectrum micronutrient approach. Our studies treated everyone regardless of their blood test results. So in two studies, the pre-treatment blood levels of vitamins and minerals commonly tested as part of blood tests, were measured.We looked at two data sets; the adult and the child RCTS described previously, involving ADHD.

Across both studies, the vast majority of the nutrient levels, at study entry, fell in the normal range. Nutrient levels before treatment did not reliably predict who would do well and who wouldn’t. So then we asked if your nutrient levels were normal when you started the study, did you benefit from taking the supplements? And the answer is yes. About 40 percent of those with normal nutrient levels, benefited greatly when given broad-spectrum nutrients.

But if a deficiency had been used as an inclusion criteria for this study,72 percent of the sample would never have gotten into the study in the first place. Because their blood results showed normal nutrient levels and that’s because our body works really hard, through homeostatic mechanisms, to keep many nutrient levels within a really narrow range. So you see when discussing nutrient levels even the term deficiency can be a problem. Studies often show that people with a psychological problem tend to on average, have lower nutrient levels than others, but lab testing would still show them as being within the normal range. So what I’m saying is that your nutrient levels may be in the normal or low normal range defined for the general population, but you might have a nutrient deficiency relative to your own metabolic needs.

Another question I get asked often, is whether there are any side effects from taking nutrients, particularly because the dose is often above the recommended dietary allowance or RDA. So far they appear to be safe. None of the broad spectrum micronutrient or B complex formulas used in research have produced any serious adverse effects. The most common side effects are headaches or dry mouth, maybe some stomach aches, though they are typically mild, transitory and can be avoided by taking capsules on a full stomach, with plenty of water. Many of the studies have collected safety data before and after exposure to the nutrients, amounting to several hundred blood tests and there is no evidence of clinically meaningful, short-term harm. We’ve also looked at the long-term exposure in people who had taken a broad spectrum micronutrient for up to 12 years and again, there was no recurring pattern of a specific negative effect. Now, no one can ever guarantee 100 safety for anything, but what I can say is that there’s nothing to suggest micronutrients are unsafe, when consumed together in balance. Also remember I’m not recommending these nutrients for people who do nothave mental health issues. Our research is based on people trying to resolve psychological problems.If you are worried the best advice is to see your doctor, get routine blood tests and get any new symptoms checked out. The physicians that we work with recommend people have a screening for metabolic and electrolyte abnormalities before, during and after a new regime.So what if you do take medications? What should you do, given that 17 of the adult population is taking at least one psychiatric medication? This question will likely be relevant to many of you if you are taking any type of medication. Talk to your prescriber first, before taking one of the formulas that has been studied in research. Combining psychiatric medications with the broad spectrum micronutrients at these higher doses, is probably one of the most challenging aspects of this work. Physicians regularly report that medication side effects increase when their patients start adding nutrients to their psychiatric medications. Dr Popper, a Harvard-based psychiatrist, used the term potentiation to explain these observations. The micronutrients seem to potentiate or make stronger, the effect of prescribed psychiatric medications. Potentiation though is good news; it allows people to lower their psychiatric medication while replacing them with nutrients that are safe and ‘free of significant side effects. And this advice is supported by research. The solution is simple, though counter-intuitive to some. Reduce or eliminate the meds after introducing the nutrients. This is often referred to as a ‘cross titration’ or ‘cross tapering’. That means you begin the nutrients and, as you gradually increase the dose of the nutrients, you also begin to gradually decrease the meds. But this is best done with your prescriber after they learn about cross titration. And overall, this is good news for reducing our dependency on medicinal support.

Source

Dr. Popper, a psychiatrist, used the term potentiation to explain his observations that patients who had an increase in side effects after they combined medication and nutrient supplements in order to manage mental health symptoms.

To reduce this increase in side effects, a very simple process is recommended – cross-titration. You begin the nutrients, and as you gradually increase the dose, you also begin to gradually decrease the meds. The companies that sell the nutrients can assist you with cross-titration. Do not try this without appropriate medical supervision.

This cross titration then allows people to reduce their dosage of psychiatric medication, safely, while replacing them with nutrients which have much fewer significant side effects.

A database analysis on bipolar disorder was completed based on 358 adults who took a nutritional supplement and tracked their symptoms for a minimum of six months. The people who did cross-titrations, reducing their medications as they increased their nutrients, benefited far more than the people who continued taking their higher doses of medications. In other words, not lowering medications prevents the optimum benefit from nutrient treatments. These same results have been observed in an observational study conducted with children with bipolar disorder. You can read about it here:

Rucklidge, J. J., Gately, D., & Kaplan, B. J. (2010). Database analysis of children and adolescents with bipolar disorder consuming a multinutrient formula. BMC Psychiatry, 10, 74.

Potentiation of metabolic functions

In Module 2 you learned that neurotransmitters in our brains go through many metabolic processes. Each of those processes requires enzymes, which are often dependent on vitamins and minerals to do their jobs. If the micronutrient treatment provides enough minerals and vitamins, enzymes that had previously struggled to function due to lack of available nutrients, can return to near normal functioning. When this happens, medication would no longer be necessary to accommodate for those previously lost functions.

Metabolism through the liver

The second possibility has to do with the effect that the nutrients may have on the liver. Medications are broken down in your liver and small intestine by a specialized group of enzymes called cytochrome P450 (CYPs). Many physicians often tell us not to eat grapefruit or drink grapefruit juice while taking a certain medication, and this is because grapefruit can interfere with certain enzyme processes within your body.

A similar process might occur when you take nutrients along with psychiatric medications. Nutrients such as vitamin D and niacin can inhibit various CYP enzymes, changing the rate of medication breakdown, with a potentially similar action of grapefruit. This reduction in medication breakdown, could cause a build-up of medication in the body, increasing the presentation of side effects.

More research is definitely needed on drug/nutrient interactions, so caution is always advised when combining higher dose micronutrients with psychiatric medications, and please consult your doctor before making any changes to your medications!

The optional reading/s below are provided in case you are unclear, or still curious, about some of the topics covered in this section so far.

This reading provides information on blood vitamin levels in a population with ADHD. As you read, use the knowledge you have gained from this module with respect to the role of vitamins and minerals have in the brain, and think about why participants with lower levels of vitamins and minerals could have increased ADHD symptoms.

Landaas, E, Aarsland, T, Ulvik, A, Halmøy, A, et al. (2016) “Vitamin Levels in Adults with ADHD,” BJPsych Open 2, no. 6 (2016): 377-84.

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Moderators of treatment response in adults with ADHD treated with a vitamin–mineral supplement

To date there has been no research investigating moderators of response to micronutrient treatment of mental illness, specifically baseline nutrient l…

Source: Moderators of treatment response in adults with ADHD treated with a vitamin–mineral supplement

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Research on Treating Mental Illness And ADHD with Nutrients

And I counted the number of studies conducted all over the world; places like New Zealand, Australia,the UK, Canada and the US, on the broad spectrum micronutrient idea, and there are now over 50 RCTs,with 80 percent of those showing benefit of the micronutrients over placebo.For a psychiatric treatment, that’s a remarkable outcome. And it proves that the nutrientsare changing many people’s lives. Finally, a systematic review and meta-analysis can be doneacross several studies, in order to estimate how powerful the treatment is likely to be.A meta-analysis, in combining many studies, allows the much larger sample sizeto provide a better estimate of the overall effect. A recently-published meta-analysisthat I co-authored, confirms the consistent benefit of broad-spectrum micronutrientsfor improving overall functioning and reducing symptom impairment in individuals with ADHD.
Source

A meta-analysis, in combining many studies, allows the much larger sample sizeto provide a better estimate of the overall effect. A recently-published meta-analysisthat I co-authored, confirms the consistent benefit of broad-spectrum micronutrientsfor improving overall functioning and reducing symptom impairment in individuals with ADHD.So, in summary you can see the progression of science and the build-up of evidence acrossdifferent study designs. And collectively, this progression establishes the biological rationale,the strength of the association and clinical significance, the consistency of evidence acrosssites and different studies, the temporal sequence, that is that a must proceed b, and thevariety ofexperimental evidence.

There’s been a wealth of global research looking at the effectsof broad spectrum micronutrients on ADHD. All the experimental designs show substantial reductionin ADHD symptoms and other related behaviours, based on group data. This figure illustrates an exampleof an A, B, A, B design where the individual received the multi-nutrients for 8 weeks,stopped for eight weeks, went back on for eight weeks and then stopped completely. The red barsrepresent him off the micronutrients, and the green bars on the nutrients. And you canobserve the remarkable reversal of his symptoms, as well as on off control of them. And just note,the drop from a t-score of 80 to 40 is a change of four standard deviations in his ADHD symptoms.

ADHD symptoms were still variable in the first eight weeks,but for those who stayed on the nutrients for a year, over 70 percent were in remission, versusonly 40 percent who switched to medications, and 20 percent who were not on any intervention. Andremission means that the person no longer had the symptoms that would lead to a diagnosis of ADHD.So while the treatment takes a while to consistently reduce ADHD symptoms, after a yearthe benefit is considerable.
Source