Wednesday, February 13, 2019

ADHD & Omegas? Where do they work in the brain?


Kurt Schulz*1, Beth Krone1, Lenard Adler2, Stephen Faraone3, Jeffrey Newcorn4
Icahn School of Medicine at Mount Sinai, 2NYU School of Medicine, 3SUNY Upstate Medical
University, 4Mount Sinai Medical Center

Background: The reluctance of patients to rely on pharmacological treatments for attention- deficit/hyperactivity disorder (ADHD) has increased interest in alternative therapies, such as omega-3 fatty acid supplementation. Meta-analyses have revealed small but significant effects of omega-3 fatty acid supplementation on symptoms of ADHD, and possibly emotional lability. These diet-derived fatty acids influence neuronal membrane fluidity and phospholipid composition, which can alter the structure and function of embedded proteins, and thereby may influence dopamine neurotransmission. However, little is known about the mechanisms by which omega-3 fatty acids exert their therapeutic effects for ADHD. This study tested changes in brain activation related to clinical improvement with omega-3 fatty acid supplementation in adults with ADHD.

Methods: Seventy-eight adults with ADHD were scanned twice with event-related functional magnetic resonance imaging while performing an emotional go/no-go task before and after 16 weeks of omega-3 fatty acid supplementation (n=23) or 8 weeks of placebo lead-in followed by 8 weeks of omega-3 fatty acid supplementation (n=27) or placebo (n=28). The current study used an enrichment design to restrict analyses to the 31 of 55 (56%) participants who did not respond to placebo during the lead-in period. Whole-brain activation for affective response inhibition was regressed on clinical response with age, sex, and baseline ADHD severity as covariates.

Results: Following placebo lead-in, 8 weeks of omega-3 supplementation (n=17) was associated with slightly greater clinical improvement than 8 weeks of placebo (n=14) (p<0 .05="" acid="" activation="" and="" associated="" b="" between="" changes="" clinical="" did="" differ="" execution="" fatty="" for="" gains="" go="" groups.="" improvement="" in="" inhibition="" no-go="" not="" omega-3="" on="" response="" supplementation="" task-related="" task="" the="" two="" was="" with="">pre-supplementary motor area (pre-SMA) and premotor cortex and reductions in caudate nucleus and precuneus activation compared to placebo (p<0 .001="" b="" kappa="50" voxels="">

Conclusions: These results provide preliminary evidence that inhibitory mechanisms in caudate nucleus and frontally-based visuomotor integration and motor programming processes contribute to the therapeutic actions of omega-3 supplementation in adults with ADHD. These changes in brain activation suggest that clinical improvement for omega-3 supplementation may involve dopaminergic and non-dopaminergic effects.

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