And one tool that researchers are finding may 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 it is also available in supplement form. It’s made up of two main omega-3s, which are polyunsaturated fatty acids: EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), according to the National Center for Complementary and Integrative Health (NCCIH). Consuming omega-3s is known to be important for brain health and functioning. “These fatty acids are an essential part of nerve cell membranes [the cells’ outer layer], assist in cell communication, and help regulate inflammation,” explains Eugene Arnold, MD, MEd, professor emeritus in the department of psychiatry and behavioral health at The Ohio State University College of Medicine in Columbus. It’s worth noting that in addition to fish oil there is another type of omega-3 fatty acid, alpha-linolenic acid (ALA), which is found in plant-based foods like walnuts and flaxseed. It gets converted into EPA and DHA in the brain, but this process isn’t as efficient in delivering DHA and EPA to your brain as consuming fish or fish oil supplements, according to a 2020 review published in the journal Nutrients. Fish oil isn’t yet included in treatment guidelines for ADHD, but there is evidence that taking omega-3 fatty acids from either fish or plant sources may have some benefit for people with the disorder when it comes to improving symptoms, explains Scott Kollins, PhD, professor in the department of psychiatry and behavioral sciences and director of the Duke ADHD Program at Duke University School of Medicine in Durham, North Carolina. “Overall, research on well-conducted, randomized-controlled studies shows that the benefits of omega 3s are small, but they are better than placebo,” he says. (A 2019 review in the International Journal of Molecular Science came to the same conclusion.) Given it is overall safe, easy to access, and relatively inexpensive, he says as a clinician he may recommend fish oil alongside existing treatment with the thought that it can possibly add value for certain patients. But it’s important to note that people with ADHD shouldn’t use fish oil to replace any of their current treatments or medications — and if you want to try it, you should check with your doctor first to make sure you’re choosing an appropriate dose and it won’t interfere with any other drugs you’re taking. RELATED: Can Fish Oil Help With Depression?
Does Fish Oil Help With ADHD? What’s the Evidence?
ADHD can affect both children and adults and is defined by an inability to focus, hyperactivity, and impulsivity, notes the American Psychiatric Association. Having lower levels of omega-3s has been found to be associated with behavioral and learning difficulties, according to an August 2020 review in Nutrients. So researchers have begun to investigate whether reversing these nutrient deficiencies — either via supplement or diet — may help with the behavioral and learning symptoms of ADHD. In one meta-analysis on randomized controlled trials published in Neuropsychopharmacology in February 2018, researchers found that children with ADHD have an omega-3 deficiency of DHA and EPA. Overall, the review of seven clinical trials including more than 500 children concluded that children taking a combined EPA and DHA supplements showed improvements on their symptoms of ADHD, as well as attention scores, according to parent reports. Dr. Arnold and his colleagues conducted a study in children who had depression or bipolar disorder, the majority 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 received an omega-3 supplement (a combination of EPA, DHA, and other omega 3s) twice daily for 12 weeks, while the other took 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 functioning, and those with ADHD responded particularly well to the supplement over the placebo, he says. Exactly why omega-3s may be useful isn’t yet well understood. Dr. Kollins says omega-3s have anti-inflammatory properties and because research indicates inflammation may contribute to the development of ADHD symptoms (a 2017 Frontiers in Psychiatry review came to that conclusion), the fatty acids may interfere with that trajectory. But there’s still not enough evidence to show exactly what’s 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 it, he would recommend it. But he notes that people should check in with their healthcare provider before trying it to make sure it won’t interact with any other medications they’re taking and confirm the right dose for them. And note that fish oil or other types of omega-3 supplements should be used in addition to medication (such as stimulants) or behavioral therapy, not as a standalone treatment.
How Much Fish Oil Should I Take for ADHD?
If you’d like to consider taking a fish oil supplement for ADHD, talk with your doctor. He or she can advise on the best dose for you. Usually, a supplement that contains 1 gram of EPA-DHA fish oil is adequate, says Arnold. Look for one that contains higher levels of EPA — research suggests one with at least 500 mg of EPA is beneficial, according to the 2018 Neuropsychopharmacology review. If you are eating oily fish (like salmon, tuna, or mackerel) three times per week, you can skip the omega-3 supplement, Arnold says. However, it’s worth noting evidence suggests that children with ADHD consume fish and seafood less often than children who do not have ADHD, per a study published in Brain Sciences in May 2019.
How Quickly Will I See Benefits After Taking Fish Oil or Omega-3 Supplements for ADHD?
If you up your omega-3 intake (either via supplement or diet), don’t expect to see an improvement in symptoms overnight, Arnold says. Give it up to about three months, he says. If you’re starting with an omega-3 deficit in the brain, the brain has been making do with arachidonic acid, a polyunsaturated fatty acid that’s not as efficient in the brain. “It’s like running a high-performance engine on low-octane gas,” Arnold explains. By consuming more omega-3s over time, the DHA and EPA will begin to substitute for arachidonic acid. And as the omega-3s build up, you should start to see improvements, Arnold adds. It can be a challenge to monitor progress on symptoms, Kollins says. First, consult with your ADHD medical team before taking any new supplement (including fish oil). Together determine the goal of ADHD treatment. Is it that you want your child to be able to get ready independently in the morning? Do you want to be able to get yourself ready in a specified amount of time? “Come up with a concrete target to monitor, which will provide an idea if 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 supplements, that your clinician might recommend to help with ADHD, including a broad-spectrum micronutrient supplement. “USDA data shows the dietary intake for Americans is, on average, deficient in several vitamins and minerals,” Arnold explains. Because people aren’t necessarily deficient in the same ones, he recommends buying a multivitamin with at least 20 nutrients to fill potential gaps. RELATED: What Are Some ADHD-Friendly Healthy Snacks to Incorporate Into My Child’s Diet? A 10-week randomized placebo-controlled trial on kids found that supplementing with a multivitamin improved ADHD symptoms overall, per a study published in the Journal of Child and Adolescent Psychopharmacology in July 2019. What’s more, for kids who then began taking medications for ADHD, those also taking a multivitamin fared better. Studies have also shown similar success for adults taking a multivitamin. Other complementary approaches include regular exercise and a consistent sleep routine. “Exercise promotes the same kind of neurotransmission that stimulant drugs used to treat ADHD do, but more naturally and without side effects,” says Arnold. Sleep deprivation, he says, can exacerbate ADHD symptoms and mimic them, too. (You may think you or your child have ADHD, but in reality, you need more sleep.) School age children should get at least 10 hours of sleep per night, while adults should aim for eight, he says, numbers that are aligned with the National Sleep Foundation’s recommendations. RELATED: How Much Sleep Do You Really Need?
