While there is no cure for attention deficit hyperactivity disorder (ADHD), there are several treatment options available to help relieve symptoms. Usually, a comprehensive approach, which can include medication, behavioral therapy, and education can help best.
And one tool that researchers find could be part of that arsenal is fish oil – or more specifically, the omega-3 fatty acids found in fish oil.
Fish oil is found in fresh fish and seafood and is also available in the form of dietary supplements. It is made up of two main omega-3 fatty acids, namely polyunsaturated fatty acids: EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), according to the National Center for Complementary and Integrative Health (NCCIH).
The consumption of omega-3 fatty acids is known to be important for brain health and function. “These fatty acids are an essential part of nerve cell membranes [the cells’ outer layer], Support in cell communication and regulation of inflammation, “explains Dr. Eugene Arnold, Professor Emeritus in the Department of Psychiatry and Behavioral Health at Ohio State University Medical College, Columbus.
It’s worth noting that in addition to fish oil, there is another type of omega-3 fatty acid, alpha-linolenic acid (ALA), found in plant foods like walnuts and flax seeds. It is converted to EPA and DHA in the brain, but this process isn’t as efficient at delivering DHA and EPA to your brain as eating fish or fish oil supplements. This emerges from an overview published in the journal Nutrients in 2020.
Fish oil is not yet on treatment guidelines for ADHD, but there is evidence that ingesting omega-3s from fish or plant sources for people with this disorder may have some benefit when it comes to managing symptoms improve, explains Scott Kollins. PhD, professor in the Department of Psychiatry and Behavioral Sciences and director of the Duke ADHD program at Duke University Medical School in Durham, North Carolina.
“Overall, research in well-conducted, randomized, controlled trials shows that the benefits of omega-3s are small, but better than placebo,” he says. (A 2019 review in the International Journal of Molecular Science found the same result.)
Since it is overall safe, easily accessible, and relatively inexpensive, as a clinician, he may recommend fish oil in addition to the existing treatment, with the thought that it could potentially add value for certain patients.
However, it is important to note that people with ADHD should not use fish oil to replace their current treatments or medications. If you are ready to give it a try, the first thing to do is to check with your doctor to make sure you are choosing an appropriate dose and it won’t interfere with other medications you are taking.
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Does Fish Oil Help With ADHD? What is the evidence?
ADHD can affect both children and adults and is defined by the inability to focus, hyperactivity, and impulsivity, notes the American Psychiatric Association.
According to a nutrient review in August 2020, it was found that lower omega-3 levels were linked to behavioral and learning difficulties. As a result, researchers have begun to investigate whether reversing these nutritional deficiencies – either through supplements or through diet – can help with the behavioral and learning symptoms of ADHD.
In a meta-analysis of randomized controlled trials published in Neuropsychopharmacology in February 2018, researchers found that children with ADHD are omega-3 deficient in DHA and EPA. Overall, the review of seven clinical trials involving more than 500 children found that children who took a combined EPA and DHA supplement showed improvements in their ADHD symptoms and alertness scores, according to parents’ reports.
Dr. Arnold and his colleagues conducted a study in children with depression or bipolar disorder, most of whom also had ADHD. (About two-thirds of children with ADHD also have another condition, including anxiety, depression, and bipolar disorder, according to the National Alliance on Mental Illness.) For Arnold’s research, one group was given an omega-3 supplement (a combination of EPA), DHA and other omega-3 fatty acids) twice a day for 12 weeks while the other was taking a placebo. That study, published in the Journal of Child Psychology and Psychiatry in June 2018, found that those in the omega-3 group had improved executive function and those with ADHD responded particularly well to supplementing over the placebo, he says .
It is not yet known exactly why omega-3 fatty acids can be useful. Dr. Kollins says that omega-3 fatty acids have anti-inflammatory properties. Since research suggests that inflammation may contribute to the development of ADHD symptoms (a 2017 review by Frontiers in Psychiatry concluded), the fatty acids may disrupt that trajectory. But there is still not enough evidence to show exactly what is going on.
Kollins, who treats patients with ADHD, notes that taking a fish oil supplement from a trusted, reputable brand is safe and relatively inexpensive. So if his patients wanted to try, he would recommend it. However, he notes that people should check with their doctor before trying to make sure it won’t interact with other drugs they are taking and to confirm the correct dose for them. Also note that fish oil or other types of omega-3 supplements should be used in addition to medications (such as stimulants) or behavioral therapy and not as a treatment on its own.
How Much Fish Oil Should I Take for ADHD?
If you’re looking to take a fish oil supplement for ADHD, talk to your doctor. He or she can advise you on the best dose.
Usually a supplement that contains 1 gram of EPA-DHA fish oil is enough, Arnold says. Look for one that has higher levels of EPA – research has shown that one with at least 500 mg of EPA is beneficial, according to the 2018 Neuropsychopharmacology Review.
If you eat oily fish (like salmon, tuna, or mackerel) three times a week, you can skip the omega-3 supplement, Arnold says. However, it’s worth noting that children with ADHD are less likely to consume seafood than children without ADHD, according to a study published in Brain Sciences in May 2019.
How soon will I see benefits after taking fish oil or omega-3 supplements for ADHD?
If you increase your omega-3 intake (either through supplements or diet), don’t expect symptoms to improve overnight, Arnold says. Give it up to three months, he says.
When you start with an omega-3 deficit in the brain, the brain gets by on arachidonic acid, a polyunsaturated fatty acid that isn’t as efficient in the brain. “It’s like running a high-performance, low-octane gas engine,” explains Arnold.
As you consume more omega-3s over time, DHA and EPA begin to replace arachidonic acid. And as omega-3s build up, improvements should be on the horizon, Arnold adds.
Monitoring the progress of symptoms can be a challenge, says Kollins. Check with your ADHD health care team first before taking any new supplement (including fish oil). Determine the goal of ADHD treatment together. Do you want your child to be able to get ready independently in the morning? Would you like to be able to get ready in a certain time? “Think of a specific goal for the surveillance that will give you an idea of whether the treatment is having a meaningful effect,” says Kollins.
Are There Other Supplements That Help With ADHD?
There are a number of other complementary therapies, including nutritional supplements, that your doctor may recommend for treating ADHD, including a broad spectrum micronutrient supplement.
“USDA data shows that, on average, American food intake is deficient in several vitamins and minerals,” explains Arnold. Since people don’t necessarily lack the same, he recommends buying a multivitamin with at least 20 nutrients to fill any potential gaps.
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A 10-week randomized, placebo-controlled study in children found that supplementing with a multivitamin improved overall ADHD symptoms. This was found in a study published in the Journal of Child and Adolescent Psychopharmacology in July 2019. In addition, this applies to children who then started taking ADHD medications. Those who also took a multivitamin fared better. Studies have also shown similar success in adults taking a multivitamin supplement.
Other complementary approaches include regular exercise and a consistent sleep routine. “Exercise promotes the same type of neurotransmission as stimulants used to treat ADHD, but more naturally and with no side effects,” says Arnold.
Sleep deprivation can worsen and mimic ADHD symptoms. (You might think you or your child has ADHD, but what you really need is more sleep.) School-age children should get at least 10 hours of sleep a night, while adults should aim for eight, he says, numbers that are in line with those who do National Sleep Foundation Recommendations.
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