Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-25T20:16:57.032Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  07 November 2014

Julia J. Rucklidge  and
Rachel Harrison
Julia J. Rucklidge*
Affiliation:
University of Canterbury
Rachel Harrison
Affiliation:
University of Canterbury
*
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:, [email protected].
Get access Rights & Permissions [Opens in a new window]

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.

Type
Case Report
Information
CNS Spectrums , Volume 15 , Issue 5 , May 2010 , pp. 289 - 295
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Findling, RL, Gracious, BL, McNamara, NK, et al.Rapid, continuous cycling and psychiatric co-morbidity In pediatric bipolar I disorder. Bipolar Disord. 2001;3:202–210.CrossRefGoogle ScholarPubMed
2.West, SA, McElroy, SL, Strakowski, SM, Keck, PE Jr, McConvllle, BJ. Attention deficit hyperactivity disorder in adolescent mania. Am J Psychiatry. 1995;152:271–273.Google ScholarPubMed
3.Winokur, G, Coryell, W, Keller, M, Endicott, J, Leon, A. A family study of manic-depressive (bipolar I) disease. Arch Gen Psychiatry. 1995;52:367–373.CrossRefGoogle ScholarPubMed
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;258:385–393.CrossRefGoogle ScholarPubMed
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;68:1776–1784.CrossRefGoogle ScholarPubMed
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; 157:466–468.CrossRefGoogle ScholarPubMed
7.Rucklidge, JJ. Impact of ADHD on the neurocognitlve functioning of adolescents with Bipolar Disorder. Biol Psychiatry. 2006;60:921–928.CrossRefGoogle ScholarPubMed
8.Henin, A, Mick, E, Biederman, J, et al.Can bipolar disorder-specific neuropsychological Impairments In children be identified? J Consult Clin Psychol. 2007;75:210–220.CrossRefGoogle ScholarPubMed
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;65:1057–1063.CrossRefGoogle ScholarPubMed
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;52:323–328.CrossRefGoogle Scholar
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;4:203–207.CrossRefGoogle ScholarPubMed
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;12:758–762.CrossRefGoogle ScholarPubMed
13.Singh, J, Zarate, C. Pharmacological treatment of psychiatric comorbidity in bipolar disorder: a review of controlled trials. Bipolar Disord. 2006;8:696–709.CrossRefGoogle ScholarPubMed
14.Waxmonsky, J. Assessment and treatment of attention deficit hyperactivity disorder in children with comorbid psychiatric illness. Curr Opin Pediatr. 2003;15:476–482.CrossRefGoogle ScholarPubMed
15.Wozniak, J. Recognizing and Managing Bipolar Disorder In Children. J Clin Psychiatry. 2005;66:18–23.Google ScholarPubMed
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;30:209–213.CrossRefGoogle ScholarPubMed
17.Blader, JC, Kafantaris, V. Pharmacological treatment of bipolar disorder among children and adolescents. Expert Rev Neurother. 2007;7:259–270.CrossRefGoogle ScholarPubMed
18.Baumgaertel, A. Alternative and controversial treatments for attention-deficit/hyper-activity disorder. Pediatr Clin North Am. 1999;46:977–992.CrossRefGoogle Scholar
19.Kaplan, BJ, Crawford, SG, Field, CJ, Simpson, JS. Vitamins, minerals, and mood. Psychol Bull. 2007;133:747–760.CrossRefGoogle ScholarPubMed
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;62:936–944.CrossRefGoogle ScholarPubMed
21.Popper, CW. Do vitamins or minerals (apart from lithium) have mood-stabilising effects? J Clin Psychiatry. 2001;62:933–935.CrossRefGoogle ScholarPubMed
22.Simmons, M. Nutritional approach to bipolar disorder. J Clin Psychiatry. 2003;64:338.CrossRefGoogle ScholarPubMed
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.2002:12:205–219.CrossRefGoogle ScholarPubMed
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;14:115–122.CrossRefGoogle ScholarPubMed
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;23:836–840.CrossRefGoogle Scholar
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;19:453–460.CrossRefGoogle ScholarPubMed
27.Gately, D, Kaplan, BJ. Database analysis of adults with bipolar disorder consuming a multinutrient formula. Clin Med Psychiatry. 2009;4:3–16.Google Scholar
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.Google Scholar
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;73:159–171.CrossRefGoogle Scholar
30.Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR, 4th ed, Text revision. Washington, DC: American Psychiatric Association; 2000.Google Scholar
31.Young, RC, Biggs, JT, Ziegler, VE, Meyer, DA. A rating scale for mania: Reliability, validity, and sensitivity. Br J Psychiatry. 1978;133:429–435.CrossRefGoogle ScholarPubMed
32.Montgomery, SA, Asberg, M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979;134:382–389.CrossRefGoogle ScholarPubMed
33.Umphress, VJ, Lambert, MJ, Smart, DW, Barlow, SH, Clouse, G. Concurrent and construct validity of the outcome questionnaire. J Psychoeducational Assess. 1997;15:40–55.CrossRefGoogle Scholar
34.Conners, CK, Erhardt, D, Sparrow, MA. Conners' Adult ADHD Rating Scales (CAARS). Arch Clin Neuropsychol. 2003;18:431–437.Google Scholar
35.Wechsler, D.Manual for the WAIS-III. New York, NY: Psychological Corporation; 1997.Google Scholar
36.Adams, W, Sheslow, D. Wide Range Assessment of Memory and Learning Administration Manual - II. Wilmington, DE: Jastak; 2003.Google Scholar
37.Wilkinson, GS. WRAT3 Administration Manual. Delaware: Wide Range; 1993.Google Scholar
38.Connors, CK. Connors Continuous Performance Test II: Technical Guide. Toronto, Canada: Multi-Health Systems; 2000.Google Scholar
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.Google Scholar
40.Epstein, J, Johnson, D, Conners, C. Conners' Adult ADHD Diagnostic Interview for DSM-IVTM(CAADID): Technical Manual. New York, NY: MHS; 2002.Google Scholar
41.Rucklidge, JJ, Tannock, R. Neuropsychological profiles of adolescents with ADHD: Effects of reading difficulties and gender. J Child Psychol Psychiatry. 2002;43:988–1003.CrossRefGoogle ScholarPubMed
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; 1999:105–138.CrossRefGoogle Scholar
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;42:199–201.CrossRefGoogle ScholarPubMed
44.McGee, RA, Clark, SE, Symons, DK. Does the Conners' Continuous Performance Test aid in ADHD diagnosis? J Abnorm Child Psychol. 2000;28:415–424.CrossRefGoogle ScholarPubMed
45.Epstein, JN, Conners, CK, Hervey, AS, et al.Assessing medication effects in the MTA study using neuropsychological outcomes. J Child Psychol Psychiatry. 2006;47:446–456.CrossRefGoogle ScholarPubMed
46.Quraishl, S; Frangou, S. Neuropsychology of bipolar disorder: A review. J Affect Disord. 2002;72:209–226.CrossRefGoogle Scholar
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;10:479–494.CrossRefGoogle ScholarPubMed
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;15:628–636.CrossRefGoogle ScholarPubMed
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;44:297–314.Google ScholarPubMed
50.Saavedra, JM. Probiotics plus antibiotics: Regulating our bacterial environment, J Pediatr. 1999;135:535–537.CrossRefGoogle ScholarPubMed
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;10:165–169.CrossRefGoogle Scholar
52.Levy, J. The effects of antibiotic use on gastrointestinal function. Am J Gastroenterol. 2000;95:S8–S10.CrossRefGoogle ScholarPubMed
53.Young, LT. Is bipolar disorder a mitochondrial disease? J Psychiatry Neurosci. 2007;32:160–161.Google ScholarPubMed
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.CrossRefGoogle ScholarPubMed
55.Gardner, A, Boles, RG. Is a “Mitochondrial Psychiatry” in the future? A review. Cur Psychiatry Rev. 2005;1:255–271.CrossRefGoogle Scholar
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;41:414–430.Google Scholar
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.Google Scholar