Zinc sulfate as an adjunct to methylphenidate for the treatment of attention deficit hyperactivity disorder in children: A double blind and randomized trial [ISRCTN64132371]

Akhondzadeh, Shahin; Mohammadi, Mohammad-Reza; Khademi, Mojgan

doi:10.1186/1471-244x-4-9

Cited by 163 publications

(106 citation statements)

References 15 publications

(28 reference statements)

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“…Zinc has strong antioxidant properties and also has support as a stand-alone treatment in reducing hyperactivity and impulsivity, but not inattention in children and adolescents with ADHD (Bilici et al 2004). As an adjunct treatment to methylphenidate, zinc also enhanced treatment gains compared to methylphenidate and a placebo in children with ADHD (Akhondzadeh et al 2004). …”

Section: The Potential For Antioxidant-related Therapies In Adhdmentioning

confidence: 99%

Oxidative and nitrosative stress in ADHD: possible causes and the potential of antioxidant-targeted therapies

Lopresti

2015

ADHD Atten Def Hyp Disord

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Attention deficit hyperactivity disorder (ADHD) has a complex etiology although theories associated with disturbances in dopaminergic and noradrenergic activity are most commonly cited.The importance of these catecholamines in ADHD is supported by its effective treatment utilising stimulant and non-stimulant medications that modify their activity. Recently there has been interest in oxidative and nitrosative stress (O&NS) in ADHD and its potential to contribute to this condition. In this article, research investigating O&NS in ADHD is reviewed and its impact on catecholaminergic activity and neurological structure is discussed. Lifestyle, environmental, ADHD is most commonly treated with stimulant medications such as methylphenidate and amphetamines, non-stimulants such as atomoxetine, and alpha2-adrenergic agonists such as clonidine and guanfacine. Through their effects on dopamine and noradrenaline transporters, stimulants inhibit the reuptake of dopamine and noradrenaline, thereby increasing the extracellular levels of these neurotransmitters. These stimulants also inhibit monoamine oxidase, the enzyme that metabolises these catecholamines (Wilens et al. 2011). Atomoxetine works as a selective reuptake inhibitor of noradrenaline leading to its increased extracellular concentration (Garnock- Jones and Keating 2009).While effective, these medications are associated with several adverse effects. These include loss of appetite, growth delay and sleep disturbances (Cortese et al. 2013). It is important to note that despite their widely accepted short-term efficacy, the long-term effectiveness of pharmacological treatments on social, educational and occupational functioning in people with ADHD continues to be debated (Huang and Tsai 2011;Langberg and Becker 2012;Nijmeijer et al. 2008). On a positive note, recent analyses using the Swedish national registrar suggests that long-term stimulant use in people with ADHD is associated with reduced rates of substance use, criminality, and serious traffic accidents (Chang et al. 2014a;Chang et al. 2014b;Lichtenstein et al. 2012).Despite wide appreciation of catecholaminergic theories associated with ADHD, there has been increased research into other biological mechanisms associated with ADHD. For example, in psychiatry there has been interest in immune-inflammatory pathways and oxidative and nitrosative stress (O&NS). In particular, it has been confirmed through recent meta-analyses that depression is Increased O&NS has also been found in bipolar disorder (Andreazza et al. 2008;Brown et al. 2014),

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Section: The Potential For Antioxidant-related Therapies In Adhdmentioning

confidence: 99%

Oxidative and nitrosative stress in ADHD: possible causes and the potential of antioxidant-targeted therapies

Lopresti

2015

ADHD Atten Def Hyp Disord

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“…Erythrocyte concentrations of folate in humans have been associated with mania (219) and plasma concentrations of homocysteine have been associated with hostility, anger (220) and schizophrenia (200) , but folate-deficient diets in rats have also been found to result in decreases in DHA in rat plasma (221) and nervous tissue (222) . Mg and Zn deficiency have been reported in children diagnosed with ADHD compared with controls (223,224) , Zn deficiency has been correlated with severity of ADHD symptoms (225) and Mg and Zn supplementation has been found to improve ADHD symptoms in children (224,226) , but Mg and Zn deficiencies have also been found to result in decreased synthesis of n-3PUFA, via reduced activity of desaturase enzymes (227,228) . Hormones and other biological factors may also affect both n-3PUFA status and mood (229,230) .…”

Section: Other Mood and Behavioural Disordersmentioning

confidence: 99%

Is there a role forn-3 long-chain polyunsaturated fatty acids in the regulation of mood and behaviour? A review of the evidence to date from epidemiological studies, clinical studies and intervention trials

2008

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Selected biochemical evidence suggests a potential role for n-3 long-chain PUFA (n-3PUFA) in the regulation of mood and behaviour. The present paper reviews the relevant evidence, to date, from epidemiological studies, clinical studies and intervention trials. Most evidence is available investigating a role for n-3PUFA in depression, depressive illness and suicidal behaviour, but work is also available on anxiety and anxiety-related disorders, fatigue and fatigue-related disorders, aggression, hostility and anti-social behaviour, inattention, impulsivity and attention deficit hyperactivity disorder and schizophrenic disorders. For all these aspects of mood and behaviour, the evidence available is currently limited and highly inconsistent, both in terms of study methodology and study findings. There is a clear need for further work in this area.

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“…Zinc is an essential trace element in the body (6,7), which is required for development of the brain and also for its function (9)(10)(11). So far, positive effects of supplemental Zn on depression (15,36,37), OCD (6), ADHD (14,31), and AD (11) have been reported in other studies.…”

Section: Discussionmentioning

confidence: 96%

“…While Zn deficiency is reported in patients with Alzheimer's Disease (AD), cognitive improvement has also been demonstrated in these patients after supplementation with Zn in some preliminary studies (11). Some studies, however, few in number, have also shown the efficacy of Zn in improvement of Attention Deficit Hyperactivity Disorder (ADHD) in children and adolescents (12)(13)(14). Antidepressant effects of Zn have also been reported in a number of experimental and some clinical studies (15,16).…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Zinc Sulfate as an Add-on Therapy to Risperidone versus Risperidone Alone in Patients With Schizophrenia: A Double-Blind Randomized Placebo-Controlled Trial

Mortazavi

Farzin

Zarhghami

et al. 2015

Iran J Psychiatry Behav Sci

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Background: Zinc can modulate fast-excitatory transmission, facilitate the release of amino butyric acid and potentiate nicotinic acetylcholine receptors. There are also emerging evidences discussing the implication of these neurotransmitters in pathophysiology of schizophrenia. Objectives: The purpose of this study was to evaluate the efficacy of Zn sulfate as an add-on therapy in the treatment of schizophrenia in a 6-week, double-blind and placebo-controlled trial. Patients and Methods: Eligible participants were 30 inpatients with schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria. Patients were randomly allocated into two equal groups; one group of patients received risperidone 6 mg/day plus capsules of Zn sulfate (each containing 50 mg elemental Zn) three times a day and another group received risperidone 6 mg/day plus placebo. The Positive and Negative Syndrome Scale (PANSS) was applied to assess the psychotic symptoms and aggression risk at baseline, week 2, 4, and 6 of the study. Results:The results of this study showed that both protocols significantly decreased the scores on all subscales of the PANSS and supplemental aggression risk subscale as well as PANSS total score over the study. However, this improvement was significantly higher in Zn sulfate receiving group compared to the placebo group. No major clinical side-effects were detected. Conclusions: It may be concluded that Zn is an effective adjuvant agent in the management of patients with schizophrenia.

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Zinc sulfate as an adjunct to methylphenidate for the treatment of attention deficit hyperactivity disorder in children: A double blind and randomized trial [ISRCTN64132371]

Cited by 163 publications

References 15 publications

Oxidative and nitrosative stress in ADHD: possible causes and the potential of antioxidant-targeted therapies

Oxidative and nitrosative stress in ADHD: possible causes and the potential of antioxidant-targeted therapies

Is there a role forn-3 long-chain polyunsaturated fatty acids in the regulation of mood and behaviour? A review of the evidence to date from epidemiological studies, clinical studies and intervention trials

Efficacy of Zinc Sulfate as an Add-on Therapy to Risperidone versus Risperidone Alone in Patients With Schizophrenia: A Double-Blind Randomized Placebo-Controlled Trial

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