SYMPOSIA
SYMPOSIA
SYMPOSIA
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Abstracts of the Invited Speakers<br />
Essential fatty acids in ADHD treatment<br />
İbrahim Durukan<br />
Deparment of Child and Adolescent Psychiatry, Gülhane Military Medical School, Ankara, Turkey<br />
E-mail: idurukan2003@yahoo.com<br />
Attention deficit hyperactivity disorder (ADHD) is characterized by problems with attention, hyperactivity and impulsivity. These problems<br />
often severely affect families, relationships and school performance. Although stimulants and atomoxetine are efficacious in many<br />
children, these medications can have side effects such as insomnia, decreased appetite, irritability and impaired growth. The etiology<br />
of ADHD is generally accepted to be complex and multifactorial. Little progress has been made in elucidating predisposing biological<br />
factors. Related contributory factors for ADHD etiology are diet, nutrition and particular abnormalities in the metabolism of the longchain<br />
polyunsaturated fatty acids (LCPUFAs).<br />
Essential fatty acids (EFAs) as a complementary or alternative treatment for ADHD have been used as both a primary and an adjunctive<br />
treatment in many countries. Humans are unable to synthesize linoleic acid (an omega-6 fatty acid), and a-linolenic acid (ALA), an omega-<br />
3 fatty acid. The main dietary sources of linoleic acid and ALA are vegetable oils and their seeds.<br />
Both omega-3 and omega-6 LCPUFAs have critical importance for normal brain development and function. Large amounts of both omega-<br />
6 and omega-3 LCPUFAs are deposited in the central nervous system during fetal life. During infancy, dietary intake of both omega-3 and<br />
omega-6 LCPUFAs continues to be essential for neuronal development. LCPUFAs and their derivates work as facilitators of dopamine,<br />
serotonin and norepinephrine release, as regulators of gene transcription, as modulators of Na+ -K+ ATPase channel function and as the<br />
precursors of pro-inflammatory and anti-inflammatory molecular families. The most abundant LCPUFA in the brain is DHA from the omega-<br />
3 series, which is concentrated at nerve cell synapses and is important for neural cell signalling and neurotransmitter processes.<br />
There is increasing evidence that omega-3 LCPUFAs play a part in many neurodevelopmental and psychiatric disorders. ADHD, dyslexia,<br />
developmental coordination disorder and autistic spectrum disorder are suggested to be related to the omega-6/omega-3 spectrum of<br />
disturbances. Several studies of LCPUFA supplementation in children with ADHD symptoms have been conducted. Open-label EFA trials<br />
in ADHD demonstrate that ADHD symptoms are responsive to EFA supplementation. Despite successful open-label trials, randomized<br />
controlled trials of EFA in ADHD have generally been unsuccessful in demonstrating treatment effects and some of them even displayed<br />
better results for the placebo group. There are three studies with partial positive results but these studies represent a small minority and<br />
two of them have several methodological limitations.<br />
The side effects of EFA are generally related to the gastrointestinal system and usually include diarrhea, nausea, fishy aftertaste, belching<br />
and indigestion. These side effects seem to be mild, transient and infrequent, and also appear in the placebo groups.<br />
Current findings from randomized clinical trials of EFA in children with ADHD are not promising. Most randomized trials have clearly<br />
demonstrated lack of superiority compared to placebo. Moreover, the studies that showed positive findings did not use children properly<br />
diagnosed with ADHD and none of them demonstrated clinical improvement in more than one setting. This delineation does not support<br />
the use of EFA supplements as a treatment for children with ADHD. Future studies should be planned to consider methodological issues<br />
such as proper ADHD diagnosis, blinded controls, adequate sample size and behavioral assessment in more than one setting.<br />
Key words: ADHD, essential fatty acids<br />
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S66<br />
Mechanisms of fish oil (Omega-3 fatty acids), vitamin B12, folate and other add-on treatments<br />
in psychiatric disorders<br />
Mehmet Cemal Kaya<br />
Dicle University School of Medicine, Department of Psychiatry, Diyarbakir, Turkey<br />
E-mail: mcemalkaya@yahoo.com<br />
The need for new treatments has led several investigators to examine the potential role of omega-3 fatty acids, found in marine and plant<br />
sources, in the treatment of psychiatric disorders. Omega-3 fatty acids are associated with normal brain development, neuronal plasticity,<br />
and function (1). Cell biology and molecular studies suggest that omega-3 fatty acids modulate membrane fluidity and dopaminergic<br />
and serotonergic neurotransmission (2). It has been observed that omega-3 fatty acids have effects on the phospholipid cell membrane<br />
and the secondary messenger system similar to mood stabilizing drugs like lithium (3). It has been also demonstrated by recent studies<br />
S66 Bulletin of Clinical Psychopharmacology, Vol: 21, Supplement: 2, 2011 - www.psikofarmakoloji.org