The Trouble With ADHD/ Omega 3's

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March 20, 2001 Search www.feat.org/search/news.asp

Also: * On Omega 3's & Autism & Stoll's Book

The Trouble With ADHD

[Excerpts are from the March 18, Washington Post. Commentary is by

associated editor .]

http://www.washingtonpost.com/wp-dyn/articles/A16392-2001Mar16.html

The Washington Post has published quite a good article on ADHD,

although you should be forewarned that it also includes positive coverage of

Breggin, whose work and philosophy I flatly reject.

I once saw Breggin on the Phil Donahue Show, I believe it was; I'm

fairly certain he was on stage with Courchesne. He came pretty close to

saying that he personally had not ruled out the refrigerator mother theory

of autism.

Breggin is no danger to the autism community, but he is a grave danger

to those who suffer mental illnesses rather than developmental disabilities.

In any case, I just want you to know that I'm not sending this to

endorse Breggin. Apart from the passage on Breggin it has both

terrific information and affecting portraits of individual children and

their families. Even the Breggin section is important, because it shows the

quandaries parents of children with ADHD face.

Because the article is very long, I've pulled the two passages I found

especially interesting. One is on genetics and is terrific: it demonstrates

the way in which complex behavioral disorders like ADHD or autism may be

made up of a cluster of normal gene variants that, together, create trouble.

I also pulled the passage on behavior problems being created by

medication, not just treated by medication, because it mentions the drug

clonidine which we've found makes our two children with autism--as well as

our niece with bipolar disorder and Asperger syndrome--extremely irritable.

That side effect has now been reported in the literature, though I have no

idea how common it is. Still, I think it's suggestive that this particular

psychiatrist chose clonidine as the medication to name in a quotation about

a child ending up irritable as a result of meds . . . . .

>From The Article:

Castellanos and others have found that the brains of children with

carefully diagnosed ADHD are approximately 4 percent smaller, on average,

than those of healthy children. Some parts of the brains of ADHD children

can be particularly small-- the posterior-inferior vermis, a tiny segment of

the cerebellum, for instance, is 10 to 15 percent smaller, on average.

Castellanos doesn't want to make too much of that -- or too little.

For the record, he doesn't know what that teaspoon-size region of the brain

does.

But he was extremely excited when a study published last May found

that in macaque monkeys the posterior-inferior vermiswas packed with

dopamine receptors. That's interesting to Castellanos because an inadequate

supply of dopamine is believed to hamper attention and self-control. So the

smallness of the posterior-inferior vermis in ADHD kids might mean a

shortage of the right neural circuitry.

The smaller the brain size in these children, the worse the ADHD

symptoms tend to be. But there's an awful lot of variation, Castellanos

says.

Two-thirds of the brains of ADHD children are indistinguishable, in

size, from those of healthy kids. If you're a skeptic, you say size has

nothing to do with it. Similar caveats cover the genetic work on ADHD so

far. " My favorite nightmare is there are going to turn out to be 300 or 500

genes, each of which contributes a couple percent of risk here and there, "

Castellanos says. The leading candidate gene for ADHD is a variant of the

gene known as DRD4. This variant apparently causes a receptor on certain

brain cells to have trouble sucking dopamine out of brain synapses. That

presumably slows the feedback messages in the brain that inhibit impulses.

But you can't call it a defective gene because it turns out fully 30 percent

of the U.S. population has it, and not all of those people have been

diagnosed with ADHD.

And not everyone with ADHD has that particular DRD4 gene variant.

Passage On Medication:

Others wonder if some of the " co-morbidities " described by the

psychiatrists are caused by the medicines themselves. " Here's the

conundrum -- I put you on stimulants because you're running around the

classroom too much and you're too impulsive and in people's faces, " says

Magno Zito, a professor at the University of land School of

Pharmacy who tracks the growing tendency to prescribe mind drugs

forpreschoolers. " About three months later, it looks like the treatment

works, and then you go home at night and need medication to go to sleep.

Enter Clonidine to help you sleep. Now we've gone from one drug to two. I

have to worry about interactions, a wider spectrum of side effects. Then

after a couple months it becomes apparent that you cry more easily, you're

more sensitive. Now somebody says, 'He needs an antidepressant.' Now you're

on three drugs. We could call it co-morbid depression. But to me it's

equally possible that it's behavioral medicine toxicity. You probably

wouldn't have the insomnia and crying if the other drugs were not on board.

You can't just keep treating symptom by symptom. "

* * *

On Omega 3's & Autism & Stoll's Book

[This one is also from . FEAT has no financial

relationship with Amazon.com.]

Stoll is the physician who published the study showing positive

effects with Omega 3 treatment on bipolar disorder in the Archives of

General Psychiatry, which is one of the two two journals of psychiatry in

America.

I've just discovered that he has published a book for lay people, and

am ordering it today.

My writing partner, Ratey, tells me that Stoll is now conducting

clinical trials delivering intravenous Omega 3s to children with autism. (I

haven't fact-checked this, and these things can suffer in the translation,

so do take this with a grain of salt.)

Probably most of you know that several epidemiological studies have

linked autism to bipolar disorder in families. My understanding is that this

connection is now widely accepted. Again: I haven't called up autism

researchers around the country to confirm this impression. Rather, two major

researchers have told me that they believe this correlation is now widely

accepted!

I'm including the abstract from the Archives study; after that is the

Amazon.com write-up of the book.

Omega 3 Fatty Acids in Bipolar Disorder

A Preliminary Double-blind, Placebo-Controlled Trial

L. Stoll, MD; W. Emanuel Severus, MD, PhD; P. Freeman, MD;

Rueter; Holly A. Zboyan; Eli Diamond; K. Cress, MD;

B. Marangell, MD

Background: 3 Fatty acids may inhibit neuro nalsignal transduction

pathways in a manner similar to that of lithium carbonate and valproate, 2

effective treatments for bipolar disorder. The present study was performed

to examine whether 3 fatty acids also exhibit mood-stabilizing properties in

bipolar disorder. Methods: A 4-month, double-blind, placebo-controlled

study, comparing 3 fatty acids (9.6 g/d) vs placebo (olive oil), in addition

to usual treatment, in 30 patients with bipolar disorder.

Results: A Kaplan-Meier survival analysis of the cohort found that the

3 fatty acid patient group had a significantly longer period of remission

than the placebo group (P=.002; Mantel-). In addition, for nearly every

other outcome measure, the 3 fatty acid group performed better than the

placebo group.

Conclusion: 3 Fatty acids were well tolerated and improved the

short-term course of illness in this preliminary study of patients with

bipolar disorder.

Arch Gen Psychiatry. 1999;56:407-412

Full text available at:

http://www.ama-assn.org/sci-pubs/journals/most/recent/issues/psyc/yoa8185.ht

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The Omega-3 Connection: The Groundbreaking Anti-depression Diet and

Brain Program by L. Stoll MD, Stoll

List Price: $24.00 Our Price: $19.20