ADHD Adults: Improving Time Management Skills

The core symptoms of ADHD predispose adults with ADHD to have difficulties with planning, organizing, and managing time. Here's some help.

Gee Whiz, I Missed It Again: How Can I Improve My Time Management Skills?

The core symptoms of ADHD predispose adults with ADHD to have difficulties with planning, organizing, and managing time. Here's some help.Bill told his wife to meet him for lunch, only to discover, after his wife was already at the restaurant, that he had a meeting with his boss. Sandra stayed up all night for two nights in a row finishing a major sales report that was assigned three months ago, and got to the sales meeting late. Peter aimlessly drifts through his day, feeling like he is getting nothing accomplished.

These three adults with ADHD are experiencing significant problems with time management. The core symptoms of ADHD- inattention and poor behavioral inhibition- predispose adults with ADHD to have such difficulties planning, organizing, and managing time. For most busy non-ADHD adults, a key element of effective time management is the use of a day planner. Many of you reading this sentence will lament, "But I have owned hundreds of day planners, calendars, etc., and I can never get myself to use them, if I can even find them." This may be because you went about using a day planner in the wrong way, perhaps trying to bite off more than you could chew all at once.

Forget about these past failures. Wipe them out of your mind. I am going to give you a simple, step-by-step approach for successfully using a day planner and taking charge of time rather than letting time pass you by. The key to this approach is that you take one small step at a time. Continue that step for one or more weeks and become comfortable with it. Only when you have mastered each step should you move onto the next step. Also, make a list of rewards or privileges which you can indulge yourself with for successfully completing each step. These might be special activities or purchases. After you have successfully carried out each step of this program for one week, pick one activity from your list and reward yourself for your efforts.

If you still find that it is too difficult to carry out these steps, ask a spouse or friend to help you. If that is not sufficient, seek out the help of a coach or a therapist, who will help you break tailor this type of program to your special situation.

  1. Select a compatible day-planner. At a minimum, a day-planner is a device that includes a calendar, space to write "to-do" lists, and space to write telephone numbers, addresses, and other basic identifying/ reference information. It can be a paper-and-pencil model, as with Franklin Planner or Day Timer brands. It can be a fancy electronic organizer such as a Palm Pilot, or it can be time management software on a laptop or desktop computer. Electronic organizers do have a number of advantage. They are compact; they provide audible reminders that can serve as memory management aides; they can sort, organize, and store more information more efficiently than paper and pencil planners; and they can easily exchange information with office and home computers.

    If you are a gadget-oriented person who learns new technology easily, pick an electronic organizer. If you are not technology oriented, pick a paper and pencil model. Go on an outing to an office supply store and carefully review a number of different types of day planners to see which one you feel most comfortable with. They come in all sizes, shapes, and colors, with different types of daily, weekly, and monthly views. Carefully inspect the different types of daily, weekly, and monthly pages. Do you schedule many appointments on the hour or half-hour? Then, you need a clear daily view. Are you making "to do"lists but not scheduling many appointments? Perhaps you need a weekly view with a lot of space for lists.

  2. Find a single, accessible place to keep the day-planner. After selecting a planner, the next step is to start keeping it in a single, accessible location at home and at work, so you will always know where to find it. The location should be clearly visible from a distance, even in a cluttered room or on a messy desk. Convenient locations might be next to the telephone, on a table near the front door, on the desk at the office. If the day-planner has a strap, it might be hung on a hook next to the front door, above the telephone, or together with the car keys. Select a place to keep your day planner at work and at home. Carry to and from work, and practice keeping it in the designated locations for a week.

  3. Enter the basics in the day-planner. You are now ready to enter basic information into your day planner. Gather the most common names, addresses, and phone numbers which you use. Enter them into the planner in the alphabetical name/ address section, or in the case an electronic planner, into its memory. Consider what vital information it might be helpful to have in the planner- insurance policy numbers, computer passwords, equipment serial numbers, birthdays and anniversaries, etc., and enter this information.

  4. Carry the day-planner at all times. Now that there is some information in your planner, you should carry it with you at all times. Many of my patients tell me that they have carried their planner with them at all times, but they forgot the great idea they thought of while shopping. "At all times" means whenever you leave the car to go into a store or whenever you leave your desk to attend a meeting. Work for several days on carrying your planner with you at all times.

  5. Refer to the day-planner regularly. Many adults with ADHD write things in their planners but rarely look at what they wrote, relying instead on memory, with disastrous consequences. Before you can use the planner as a calendar or for "to do" lists, you need to develop the habit of checking it regularly. You should start by checking your planner a minimum of three times per day- once in the morning to plan/review the day's upcoming events, once in the middle of the day to make any mid-course corrections and/ refresh your memory about the remaining day's events, and once in the evening, to plan/ review the next day's events.

    What can you do to help you remember to check your planner? First, if you have an alarm wrist watches or alarms on your electronic planner, set them to go off at regular intervals when you wish to check your planner. Second, you could associate checking your planner with habitual activities that you always do at approximately the same time each day, e.g eating meals, getting dressed in the morning or ready for bed at night, entering or exiting the office, etc. Third, you could leave yourself reminder notes in strategic locations (on the desk in the office, on the mirror in the bathroom, on the dashboard or door handle of the car) to remind you to look at the planner.

    You should practice checking your planner at least three times per day, using the reminder methods outlined above if necessary, for at least one week, before going onto the next step.

  6. Use the day-planner as a calendar. You are now ready to learn to use your planner as a calendar. Make a list on scrap paper of all the appointments which you have scheduled at any time in the future. Then, write these appointments in the appropriate time slots on the pages of the planner for the particular days and months. Review the scheduled appointments for that day each time you check the planner. As you go through your day with your planner by your side, write in any additional appointments as soon as you schedule them. Use your planner as a calendar for the next week.




  1. Construct a daily "to-do" list and refer to it often. "To do" lists are lists of things which you need to get done. Only after you experience success using your planner as a calendar should you start making a daily "to do" list. Most planners have a place to put "to do" lists adjoining the calendar for each day. During the first review of your planner in the morning, make a list of everything you need to get done that day. Keep the list relatively short, e.g. 5-8 items, so that you can experience success completing all of the items. State the items in language which clearly tells you the action you need to take. "Buy my wife flowers" would be a more specific item than "Be nice to my wife."

    Examine the list and decide which items you can assign to a particular time during the day. Write these items into your schedule at the designated times. Try to complete them as scheduled. Refer to your list often as you go through your day. Check off any completed items and review the items which remain to be completed.

    At the end of the day, compute the percentage of items on the list that you completed, analyzing the reasons why you did not complete every item. If there are a few unfinished, items move them forward to the next day's list. However, if you have many unfinished items, then you need to consider whether you have unrealistic expectations for how much you can get done. You either must scale back your expectations or find other approaches to getting tasks done (delegate, streamline, eliminate, etc.).

  2. Prioritize your "to-do" list and act in accordance with your priorities. Now you are ready to prioritize the items on your daily "to do" list. There are many ways to prioritize a "to do list." You could number all of the items on the list in order of decreasing priorities. Alternatively, you could classify the items into one of three categories: "Essential," "Important," and "Do only if I have extra time." Pick the method that fits your style best. Begin prioritizing your daily "to do" list.

    As you go through your day, carry out the items on your "to do" list in order of decreasing priorities. If you are like most adults with ADHD, you will often be tempted to ignore your priorities. An exhaustive discussion of methods for sticking to your priorities is beyond the scope of this article, but I will give few suggestions. Make sure that you are taking an effective dose of stimulant medication that lasts throughout the day. Set the alarms on your wrist watch, electronic planner, computer task management software, or beeper to go off at regular intervals as a signal to check whether you are on task following your priorities. Use self-talk to help avoid distractions. Train yourself to repeat reminders such as "I have to keep from getting distracted," "I have to stick with my priorities," "Don't switch now, I am almost done,"etc.
    Work on prioritizing your "to do" list and following your priorities for at least two weeks before going onto the next step.

  3. Conduct a daily planning session. By the time you have completed the first eight steps, you will be conducting "ad hoc" daily planning sessions when you construct and prioritize your daily "to do" list. It is time to formalize this process as "the daily planning session." Consider the time when you construct and prioritize your lists as your daily planning session. Your goal at this time is to plan the upcoming day's activities and develop a plan of attack to carry them out. In addition to listing priorities and reviewing schedules, the planning session is the time to consider exactly how each task will be accomplished. What materials will be needed? What individuals will have to be consulted? What obstacles are likely to be encountered? How can these obstacles be overcome? You should ask yourself these questions as you prioritize the items on your "to do" list. You want to emerge from the planning session with a mental map to guide you in carrying out the tasks on your list.

    When you have reached this point in the program, congratulate yourself! You have mastered the basic steps to using a day planner to manage time! Continue to follow these steps. As they become habitual, you may want to consider trying the last step, which bridges the gap between short-term and long-term planning, but understand that it is more challenging and may require the assistance of a coach or therapist.

  4. Generate a list of long-term goals and break the long-term goals into small, manageable chunks, allocating these chunks to monthly and weekly planning sessions. I can only touch on this briefly here; readers interested in a more detailed discussion of it should consult sources such as Covey (1990). First, you generate a list of all of your long-term goals. These are broad goals which you want to accomplish over many months and years. Then, you take one goal at a time and break it into small chunks or sub-goals which might be accomplished on a monthly basis. You assign one sub-goal to each month of the year. At the beginning of the month, you conduct a monthly planning session, during which you decide how to accomplish the sub-goal over the course of the month. You assign various tasks to each week of the month. At the beginning of each week, you conduct a weekly planning session, during which you decide how to assign aspects of that week's sub-goal to the daily task lists for the entire week. During each daily planning session, you plan the details of the assigned task, which you then carry out that day.

    For example, one of my adult ADHD patients had as his long-term goal to write a historical non-fiction book. He already had much of the factual material which he needed collected. We divided this goal into the following sub-goals which we tentatively assigned to various months of the year: (1) January- make an outline of the book, specifying 10 major chapters and topics; (2) February to November- write the first draft of one chapter during each month; (3) December- review all of the chapters and prepare the book to send to the publisher by the end of the year. At the beginning of January, we further divided the task of making the outline into portions to be done each week; at the beginning of each week, the patient decided when he was going to work on the outline and assigned it to each of his daily task lists. He continued in this manner for the remainder of the year.

Conclusion

I understand that it is easy for me to give you the suggestions given in this article, but hard for you to carry them out. As stated at the outset, you need to develop a list of strong rewards, and give yourself these rewards on a regular basis as you accomplish small steps towards using a day planner effectively. Enlist your spouse, relatives, or friends to praise you as you experience success at each step. You may need to creatively break these steps down into even smaller steps to tailor them to your particular form of procrastination.

If you experience difficulty following this advice, don't give up. Remember that it took a lifetime of ADHD to get to the point that you are at now; it will take more than a short time to start making meaningful changes. Do as many of these steps as you can on your own, then seek the assistance of a friend, a coach, or a therapist to help you complete the process. Good luck!

Ten Steps For Learning To Use a Day- Planner

  1. Select a compatible day-planner.
  2. Find a single, accessible place to keep your day-planner.
  3. Enter basic information into your day-planner.
  4. Carry your day-planner at all times.
  5. Refer to your day-planner regularly.
  6. Use your day-planner as a calendar, writing in appointments and time-locked activities.
  7. Construct a daily to-do list and refer to it often.
  8. Prioritize your daily to-do list and act in accordance with your priorities.
  9. Conduct daily planning sessions.
  10. Generate long-term goals. Break your long-term goals into small, manageable chunks, and allocate these chunks to the monthly and weekly task lists and planning sessions.


next: ADHD Adults: Tips for Making Good Career Choices
~ adhd library articles
~ all add/adhd articles

Reference

Covey, S. (1990). The 7 habits of highly effective people. New York: Simon and Schuster.

Dr. Robin is a member of the CH.A.D.D. Professional Advisory Board and a Professor of Psychiatry and Behavioral Neurosciences at Wayne State University in Detroit, Michigan. He also maintains a private practice in Beverly Hills, Michigan.

Re-Printed Attention Magazine (http://www.chadd.org./)

APA Reference
Staff, H. (2008, December 22). ADHD Adults: Improving Time Management Skills, HealthyPlace. Retrieved on 2024, March 29 from https://www.healthyplace.com/adhd/articles/adhd-adults-improving-time-management-skills

Last Updated: February 14, 2016

Warning Signs of Teen Suicide - What to Look For

Many times, there are warning signs that someone is seriously depressed and may be thinking about or planning a suicide attempt. Here are some of them:

  • pulling away from friends or family and losing the desire to go out
  • trouble concentrating or thinking clearly
  • changes in eating or sleeping habits
  • major changes in appearance (for example, if a normally neat person looks very sloppy - as if they're not taking the usual care of themselves )
  • talk about feeling hopeless or feeling guilty
  • talk about suicide
  • talk about death
  • talk about "going away"
  • self-destructive behavior (drinking alcohol, taking drugs, or driving too fast, for example)
  • no desire to take part in favorite things or activities
  • the giving away of favorite possessions (like offering to give away a favorite piece of jewelry, for example)
  • suddenly very happy and cheerful moods after being depressed or sad for a long time (this may mean that a person has decided to attempt suicide and feels relieved to have found a "solution")

Don't Blow Off the Warning Signs of Suicide

Paying attention to and responding to these clues can sometimes save a life and prevent a tragedy. Most of the time, teens who are considering suicide are willing to discuss it if someone asks them out of concern and care. Some people (teens and adults) are reluctant to ask teens if they have been thinking about suicide or hurting themselves for fear that, by asking, they may plant the idea of suicide. This is a myth. It is always a good thing to ask and to initiate the conversation with someone you think may be considering suicide.

First, it allows you to get help for the person. Second, just talking about it may help the person to feel less alone, less isolated, more cared about and understood - the opposite of many feelings that may have led to suicidal thinking to begin with. Third, it may give the person an opportunity to consider that there may be another solution.

Sometimes, a specific event, stress, or crisis can trigger suicidal behavior in someone who's at risk. Common triggers are a parent's divorce, a breakup with a boyfriend or girlfriend, or the death of a friend or relative, for example. It's always good to ask a friend who's going through a crisis how they're doing, if they're getting any support, how they're coping, and if they need some more support. There are plenty of adults who can help you or a friend find the support you need. Everyone deserves that support.

Sometimes, teens who make a suicide attempt - or who die as a result of suicide - seem to give no clue beforehand. This can leave loved ones feeling not only grief-stricken but guilty and wondering if they missed something. It is important for family members and friends of those who die by suicide to know that sometimes there is no warning and they should not blame themselves.

next: What Else Puts Teens at Risk for Suicide?
~ depression library articles
~ all articles on depression

APA Reference
Tracy, N. (2008, December 22). Warning Signs of Teen Suicide - What to Look For, HealthyPlace. Retrieved on 2024, March 29 from https://www.healthyplace.com/depression/articles/warning-signs-of-teen-suicide-what-to-look-for

Last Updated: May 3, 2019

The Signs of an Eating Disorders Relapse

Perhaps you're wondering how you can tell if you are even relapsing or not. Here's a list of signs to look for. If you, or someone you know is experiencing these signs of an eating disorders relapse, then it's time to get help.

  • Thoughts continue to turn back to weight and food.
  • Increasing need to be in control over many things.
  • Perfectionistic thinking returns or becomes stronger.
  • Feelings of needing to escape from stress and problems.
  • Feeling hopelessness and/or increasing sadness.
  • Increasing belief that you can only be happy if you are thin.
  • Increasing belief that you are out of control if you are not on a "diet."
  • Dishonesty with treatment coordinators and/or friends and family.
  • Looking in mirrors often.
  • Weighing yourself more and determining whether today will be good or bad depending on what shows up on the scale.
  • Skipping meals, or purging them.
  • Avoiding food and/or get-togethers that involve food.
  • Increasing need to exercise continually.
  • Thoughts of suicide.
  • Feeling guilt after eating.
  • Feeling the need to isolate yourself from those around you.
  • Feeling "fat" even though people say otherwise.

when.you.have.most.of.the.signs.of.an.eating.disorders.relapse

Here are the signs of an eating disorders relapse. They can occur even during recovery from an eating disorder.If you are currently going through an eating disorders relapse, sit down and try to figure out how you were feeling before the relapse occurred and what was going on at the time that could have triggered you. Make a plan of how you can deal with the trigger in better ways the next time it comes around. Recognize how you are feeling right now and how you can change those feelings through helpful reactions. Know that you can talk to someone about what is going on in your life, whether it involves the relapse or things that triggered the relapse.

Most importantly, realize that you do not need to be hard on yourself for this relapse! Guilt and beating yourself up for slipping gets you nowhere and is not needed. All beating yourself up over this will do is make you feel bad and will give even more fuel to the eating disorder to use against you. You are not a failure. Recovery from an eating disorder is not meant to be perfect, and you are not meant to be perfect. There is no shame with having an eating disorder or a relapse. I cannot stress enough that when a relapse occurs it does not mean that you have "failed once again," but what it does mean is that there are feelings inside that still need to be dealt with.

When all we wanted was the dream
to have and to hold that precious little thing
like every generation yields
the newborn hope unjaded by their years-Sarah McLachlan

Once again, relapses - they can and will happen during recovery from an eating disorder. This doesn't mean that you shouldn't try at all or that you are a failure if you relapse. Recovery takes a long, long time to reach and it involves dealing with a lot of painful issues that can leave you susceptible to relapsing into old "comforts" like starving or purging. Please, reach out for help if you suspect that you have relapsed or that you are close to doing so, and then recognize what caused you to relapse in the beginning. You deserve help and you deserve to get better, no matter what.

next: Welcome to Triumphant Journey Homepage
~ all peace, love and hope articles
~ eating disorders library
~ all articles on eating disorders

APA Reference
Staff, H. (2008, December 22). The Signs of an Eating Disorders Relapse, HealthyPlace. Retrieved on 2024, March 29 from https://www.healthyplace.com/eating-disorders/articles/the-signs-of-an-eating-disorders-relapse

Last Updated: April 18, 2016

Prevention of an Eating Disorder Relapse

So how do you prevent eating disorder relapses? Realize that a relapse can come on quickly by the smallest trigger, and that not just one trigger can cause a relapse. Anything from stress from school or your family, to coping with something that a friend is going through, to having just talked about a difficult thing that occurred in your life with a therapist can trigger the onset of an eating disorder relapse. Recognize ahead of time the things that could trigger you to a relapse. Here are some things that I've noticed tend to trigger relapses within myself and those who I know:

  • Mid-terms and finals at school, or any major exams that are in the near future.
  • Increasing pressure from family (especially parents), or problems with them are increasing.
  • Going through a painful break-up with a girlfriend or boyfriend, or being rejected.
  • Problems with a husband or wife.
  • Problems at work.
  • A competition in a sport coming up (spec. gymnastics, ballet and/or dance)
  • The loss of a friend or family member.
  • Having a friend that is going through a rough time.
  • Recently talking to a therapist about past trauma (sexual/mental/physical abuse, rape, etc.)
  • Just being released from inpatient treatment.
  • Being around those that are engrossed with their own eating disorders while you are trying to recover.
  • Fear of recovering.
  • Believing that you are fully recovered when there are still underlying issues that have not been properly dealt with in a non-destructive way.

Eating Disorder relapses can be triggered by different things. Here's a list of causes and how to prevent eating disorder relapses.These are just some of the things that can trigger an eating disorder relapse. Look at your own life and make your own list ahead of time of things that can trigger you to turn back to trying to starve or purge your problems away. Recognizing ahead of time what can harm you and what you can do to help deal with those problems in a non-self-destructive way when they come.

I really want to point out that many relapses occur when someone has begun talking with a therapist about past traumas like abuse or rape, but that this does not mean that you should not talk about it just because it triggers you. With something as horrific as abuse or rape you must talk about it so that you can learn to move on from it. Otherwise, if you just continue to run from dealing with those issues, they will continue to haunt you and cause pain in your life. The only way to finally relieve yourself of those problems is by dealing with them. If you are talking with your therapist about issues that are triggering, please, please, please let the therapist know that this is very hard for you to talk about and that your other problems, whether they be an eating disorder, depression, self mutilation, OCD, etc., are at high risk of getting worse from talking and finally having to deal with it.

"Loving yourself takes work, patience and hope. Treat yourself like a friend whenever you're about to take a dive..." SushiJunkie

Before an eating disorder relapse it is also helpful to have a list of people and their phone numbers for you to call during the times that you are triggered or when you suspect that you will be triggered. If possible, you might also want to have a sponsor, a person who can keep track of your behaviors and reactions, so that you have someone to warn you ahead of time when it is suspected that you are relapsing. No matter what your head tells you, it really is okay to have extra support during the rough times. You are not weak or greedy. You are, however, going through a rough time and just need some help coping. There is nothing wrong with that!

Sometimes what helps people from relapsing is making a list of things they can do instead of starving or purging. Things like cleaning, playing with an animal, going on the computer, talking with a friend, going camping, listening to your favorite CD, and so on can help.

next: Self-Mutilation: The Truth Behind the Shame
~ all peace, love and hope articles
~ eating disorders library
~ all articles on eating disorders

APA Reference
Staff, H. (2008, December 22). Prevention of an Eating Disorder Relapse, HealthyPlace. Retrieved on 2024, March 29 from https://www.healthyplace.com/eating-disorders/articles/prevention-of-an-eating-disorder-relapse

Last Updated: January 14, 2014

Requesting an Assessment of Special Educational Needs

Explanation of how to request an Assessment of Special Educational Needs for your child with ADHD and the subsequent process.

SEN Code of Practice 2001 Statutory Assessment

Before we start on the process of obtaining a Statutory Assessment of Special Educational Needs, please bare in mind that this information is for England. For Scotland, go to http://www.childrenofscotland.org.uk/ and for The United States please check out the website http://www.wrightslaw.com/

According to the Education Act 1996 Chapter 54 a child has learning difficulties if:

  1. he has a significantly greater difficulty in learning than the majority of children his age
  2. He has a disability which either prevents or hinders him from making use of educational facilities of a kind generally provided for children of his age in schools, within the area of the local education authority.
  3. He is under the age of 5 and is, or would be if special educational provision were not made for him, likely to fall within the above (a) & (b) when of or over that age.

For your information a child includes any person under 19 that is still a registered pupil in his school.

Requesting an assessment

In order to get a Statement of Special Educational Needs there first needs to be a statutory assessment made by the Local Education Authority, more commonly known as the LEA. This can be done ideally with parents and school working together, by the school or by the parent independently.

The special educational needs of the majority of children should be met effectively in mainstream schools through Early Years Action, Early Years Action Plus, School Action and School Action Plus, depending on the age and severity of the problems, without the need for the LEA to make an assessment.

In a small number of cases the LEA will need to make the Statutory Assessment and then consider whether or not to issue a Statement. This involves consideration by the LEA, working co-operatively with parents, schools and if appropriate other agencies involved to determine whether an assessment is needed. Please be aware that if the LEA decides an assessment is needed, this doesn't necessarily mean it will lead to a statement!

Referrals can be made by another agency such as Social Services or the Health Authority; this can happen particularly with children under the age of 5 with complex needs not yet attending school but maybe in an early educational setting

When requesting an assessment the evidence that should be provided by the school should include:

  • The views of parents recorded at Early Years Action and Action Plus or School Action and Action Plus.
  • The ascertainable views of the child
  • Copies of IEP's
  • Evidence of progress over time
  • Copies of advice where obtained from health services and social services
  • Evidence of involvement and views of professionals and relevant specialists outside of the school setting
  • Evidence of the extent the school has followed advice provided by professionals and relevant specialists.

A Request by a Parent

Parents may request an assessment under section 328 or 329 of the education act. The LEA must comply unless an assessment has been made within 6 months of the date of the request or if they conclude after examining the evidence that it is not necessary.

Once the request has been made the LEA must decide within 6 weeks whether or not to carry out the assessment and should contact the parents. They must also inform the Head Teacher and obtain any written evidence from the school about the child's learning difficulties and the schools account of any special educational provisions made. The Educational Psychology Service, the designated officer of Social Services department, Health Authority and any other agencies involved must also be informed.

Suggested format for a letter of request:

The letter should be addressed to:-

Additional Educational Needs Manager

Local Education Authority

(Address)

Childs name and Date of Birth

Name of child's school (if of school age)

Dear Sir/Madam

I am writing to request that the LEA carry out a Statutory Statement of Special Educational Needs for my Son/Daughter under Section 323 of the Education Act of 1996 Chapter 54 , as is my right under section 329.

2nd paragraph: enter a description of your child's difficulties, past history, medical diagnosis and anything else relevant.

3rd paragraph: enter the current provisions your child receives, for example Individual Education Plan, helper, portage, outside agencies, speech therapy, physiotherapy, health and social services, one to one support and for how long etc.

4th paragraph: enter detailed account of why you think current provisions are not meeting your child's needs with evidence of lack of progress.

Yours Sincerely

Remember the LEA must take all parental requests seriously and take immediate action.

If a child attends an independent school or is being home educated, a request for an assessment must follow the same procedure.




What Happens Next?

The LEA before deciding to make an assessment must issue a notice under section 323(1) or 329A (3) of the education act and:

  1. Must write to parents giving them notice
  2. Must set out for parents the procedures to be followed if an assessment is considered necessary and for subsequently drawing up a statement, if considered necessary.
  3. Should explain the precise timing of each stage of the assessment within the overall 6 months time limit, and indicate ways the parent can assist in meeting the time limits, and explaining the exceptions to any.
  4. Must tell parents the name of the officer from LEA whom they can contact for any further information needed.
  5. Must tell parents of their right to submit written evidence and oral representations as to why their child should be assessed. The LEA must set a time limit for receiving these, which must not be less then 29 days.
  6. Parents should be encouraged to respond and submit evidence. Any oral representations should be put into a written summary agreed by both the LEA and parents. Parents should indicate formally if they do not wish to make or add to previous representations so the assessment can start immediately.
  7. Must inform parent of local Parent Partnership Services which should provide information about other sources of independent advice.
  8. Should ask parents if they want the LEA to consult anyone in addition to those who they must approach for Educational, medical, psychological and social services advice if they proceed.
  9. Should tell parents that they can provide any private advice or opinions that they have or can obtain.

This notice must make clear that at this stage the LEA has not made the decision to go ahead with the assessment, but is considering whether to do so or not.

The Decision is No!!

If the decision is made that an assessment is not necessary, the LEA must write to the parents and school explaining the reasons. They should also set out the provisions they consider will meet the child's needs. They should ensure the parent understands the school-based provision and the monitoring and review arrangements. Where parents have requested the assessment under section 328 or 329 or the school has made a request under section 329A, the parents may appeal. LEAs must inform parents of this right to appeal and the time limits.

The Decision is Yes!!

Once it had been decided to go ahead with the assessment, the LEA must seek parental, educational, medical, psychological and social services advice and any other advice they consider appropriate.

Parents must also be informed that, as part of the process, their child may be called for an examination or assessment. If this does happen, the parent must also be informed of their right to be with their child during any interview, test, medical or any other assessment which is being conducted and told of the time, place and purpose of the appointment. They must also be told of the name of an LEA officer who they can contact for further information.

The Next Steps

After receiving all the advice, the LEA must make the decision whether or not to make a statement or amend an existing one. This decision must be made within 10 weeks of serving the notice of assessment.

If it is decided that a statement is necessary, it must draft a proposed statement and send a copy to the parent within 2 weeks along with a copy of any advice received as part of the assessment.

If it is decided it's not necessary for a statement, the LEA must notify the parents and school giving their reasons within 2 weeks. Once again parents must be notified of their right to appeal.


 


next: Requesting Workplace Accommodations for Disability
~ back to adders.org homepage
~ adhd library articles
~ all add/adhd articles

APA Reference
Staff, H. (2008, December 22). Requesting an Assessment of Special Educational Needs, HealthyPlace. Retrieved on 2024, March 29 from https://www.healthyplace.com/adhd/articles/requesting-an-assessment-of-special-educational-needs

Last Updated: February 13, 2016

Omega-3 Fatty Acids

Comprehensive information on omega-3 fatty acids for treating depression, ADHD, bipolar disorder and schizophrenia. Learn about the usage, dosage, side-effects of potassium.

Comprehensive information on omega-3 fatty acids for treating depression, ADHD, bipolar disorder and schizophrenia. Learn about the usage, dosage, side-effects of omega-3 fatty acids.

Also Known As:essential fatty acids (EFAs), polyunsaturated fatty acids (PUFAs)

Overview

Omega-3 fatty acids are considered essential fatty acids, which means that they are essential to human health but cannot be manufactured by the body. For this reason, omega-3 fatty acids must be obtained from food. Omega-3 fatty acids can be found in fish and certain plant oils. It is important to maintain an appropriate balance of omega-3 and omega-6 (another essential fatty acid) in the diet as these two substances work together to promote health. Also known as polyunsaturated fatty acids (PUFAs), omega-3 and omega-6 fatty acids play a crucial role in brain function as well as normal growth and development.

There are three major types of omega 3 fatty acids that are ingested in foods and used by the body: alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). Once eaten, the body converts ALA to EPA and DHA, the two types of omega-3 fatty acids more readily used by the body. Extensive research indicates that omega-3 fatty acids reduce inflammation and help prevent certain chronic diseases such as heart disease and arthritis. These essential fatty acids are highly concentrated in the brain and appear to be particularly important for cognitive and behavioral function. In fact, infants who do not get enough omega-3 fatty acids from their mothers during pregnancy are at risk for developing vision and nerve problems.


 


As mentioned previously, it is very important to maintain a balance between omega-3 and omega-6 fatty acids in the diet. Omega-3 fatty acids help reduce inflammation and most omega-6 fatty acids tend to promote inflammation. An inappropriate balance of these essential fatty acids contributes to the development of disease while a proper balance helps maintain and even improve health. A healthy diet should consist of roughly one to four times more omega-6 fatty acids than omega-3 fatty acids. The typical American diet tends to contain 11 to 30 times more omega-6 fatty acids than omega-3 fatty acids and many researchers believe this imbalance is a significant factor in the rising rate of inflammatory disorders in the United States.

In contrast, however, the Mediterranean diet consists of a healthier balance between omega-3 and omega-6 fatty acids and many studies have shown that people who follow this diet are less likely to develop heart disease. The Mediterranean diet does not include much meat (which is high in omega-6 fatty acids) and emphasizes foods rich in omega-3 fatty acids including whole grains, fresh fruits and vegetables, fish, olive oil, garlic, as well as moderate wine consumption.

 


Omega-3 Uses

Studies suggest that omega-3 fatty acids may be helpful in treating a variety of conditions. The evidence is strongest for heart disease and problems that contribute to heart disease, but the range of possible uses for omega-3 fatty acids include:

High Cholesterol
Those who follow a Mediterranean-style diet tend to have higher HDL ("good") cholesterol levels. Similar to those who follow a Mediterranean diet, Inuit Eskimos, who consume high amounts of omega-3 fatty acids from fatty fish, also tend to have increased HDL cholesterol and decreased triglycerides (fatty material that circulates in the blood). In addition, fish oil supplements containing EPA and DHA have been shown to reduce LDL ("bad") cholesterol and triglycerides. Finally, walnuts (which are rich in ALA) have been shown to lower total cholesterol and triglycerides in people with high cholesterol.

High Blood Pressure
Several studies suggest that diets and/or supplements rich in omega-3 fatty acids lower blood pressure significantly in people with hypertension. Fish high in mercury (such as tuna) should be avoided, however, because they may increase blood pressure.

Heart Disease
One of the best ways to help prevent and treat heart disease is to eat a low-fat diet and to replace foods rich in saturated and trans-fat with those that are rich in monounsaturated and polyunsaturated fats (including omega-3 fatty acids). Evidence suggests that EPA and DHA found in fish oil help reduce risk factors for heart disease including high cholesterol and high blood pressure. There is also strong evidence that these substances can help prevent and treat atherosclerosis by inhibiting the development of plaque and blood clots, each of which tends to clog arteries. Studies of heart attack survivors have found that daily omega-3 fatty acid supplements dramatically reduce the risk of death, subsequent heart attacks, and stroke. Similarly, people who eat an ALA-rich diet are less likely to suffer a fatal heart attack.


Stroke
Strong evidence from population-based studies suggests that omega-3 fatty acid intake (primarily from fish), helps protect against stroke caused by plaque buildup and blood clots in the arteries that lead to the brain. In fact, eating at least two servings of fish per week can reduce the risk of stroke by as much as 50%. However, people who eat more than three grams of omega-3 fatty acids per day (equivalent to 3 servings of fish per day) may be at an increased risk for hemorrhagic stroke, a potentially fatal type of stroke in which an artery in the brain leaks or ruptures.

Diabetes
People with diabetes tend to have high triglyceride and low HDL levels. Omega-3 fatty acids from fish oil can help lower triglycerides and raise HDL, so people with diabetes may benefit from eating foods or taking supplements that contain DHA and EPA. ALA (from flaxseed, for example) may not have the same benefit as DHA and EPA because some people with diabetes lack the ability to efficiently convert ALA to a form of omega-3 fatty acids that the body can use readily.

Weight Loss
Many people who are overweight suffer from poor blood sugar control, diabetes, and high cholesterol. Studies suggest that overweight people who follow a weight loss program including exercise tend to achieve better control over their blood sugar and cholesterol levels when fish rich in omega-3 fatty acids (such as salmon, mackerel, and herring) is a staple in their low fat diet.

Arthritis
Most clinical studies investigating the use of omega-3 fatty acid supplements for inflammatory joint conditions have focused almost entirely on rheumatoid arthritis. Several articles reviewing the research in this area conclude that omega-3 fatty acid supplements reduce tenderness in joints, decrease morning stiffness, and allow for a reduction in the amount of medication needed for people with rheumatoid arthritis.


 


In addition, laboratory studies suggest that diets rich in omega-3 fatty acids (and low in omega-6 fatty acids) may benefit people with other inflammatory disorders, such as osteoarthritis. In fact, several test tube studies of cartilage-containing cells have found that omega-3 fatty acids decrease inflammation and reduce the activity of enzymes that destroy cartilage. Similarly, New Zealand green lipped mussel (Perna canaliculus), another potential source of omega-3 fatty acids, has been shown to reduce joint stiffness and pain, increase grip strength, and enhance walking pace in a small group of people with osteoarthritis. In some participants, symptoms worsened before they improved.

Osteoporosis
Studies suggest that omega-3 fatty acids such as EPA help increase levels of calcium in the body, deposit calcium in the bones, and improve bone strength. In addition, studies also suggest that people who are deficient in certain essential fatty acids (particularly EPA and gamma-linolenic acid [GLA], an omega-6 fatty acid) are more likely to suffer from bone loss than those with normal levels of these fatty acids. In a study of women over 65 with osteoporosis, those given EPA and GLA supplements experienced significantly less bone loss over three years than those who were given a placebo. Many of these women also experienced an increase in bone density.

Omega-3 for depression
People who do not get enough omega-3 fatty acids or do not maintain a healthy balance of omega-3 to omega-6 fatty acids in their diet may be at an increased risk for depression. The omega-3 fatty acids are important components of nerve cell membranes. They help nerve cells communicate with each other, which is an essential step in maintaining good mental health.

Levels of omega-3 fatty acids were found to be measurably low and the ratio of omega-6 to omega-3 fatty acids were particularly high in a study of patients hospitalized for depression. In a study of people with depression, those who ate a healthy diet consisting of fatty fish two to three times per week for 5 years experienced a significant reduction in feelings of depression and hostility.

Omega-3 for Bipolar (Manic/depression)
In a study of 30 people with bipolar disorder, those who were treated with EPA and DHA (in combination with their usual mood stabilizing medications) for four months experienced fewer mood swings and recurrence of either depression or mania than those who received placebo. A similar but larger study is currently underway at the University of California- Los Angeles School of Medicine.

Omega-3 for Schizophrenia
Preliminary evidence suggests that people with schizophrenia experience an improvement in symptoms when given omega-3 fatty acids. However, a recent well-designed study concluded that EPA supplements are no better than placebo in improving symptoms of this condition. The conflicting results suggest that more research is needed before conclusions can be drawn about the benefit of omega-3 fatty acids for schizophrenia. Similar to diabetes, people with schizophrenia may not be able to convert ALA to EPA or DHA efficiently.

Omega-3 for attention deficit/hyperactivity disorder (ADHD)
Children with attention deficit/hyperactivity disorder (ADHD) may have low levels of certain essential fatty acids (including EPA and DHA) in their bodies. In a study of nearly 100 boys, those with lower levels of omega-3 fatty acids demonstrated more learning and behavioral problems (such as temper tantrums and sleep disturbances) than boys with normal omega-3 fatty acid levels. In animal studies, low levels of omega-3 fatty acids have been shown to lower the concentration of certain brain chemicals (such as dopamine and serotonin) related to attention and motivation. Studies that examine the ability of omega-3 supplements to improve symptoms of attention deficit/hyperactivity disorder (ADHD) are still needed. At this point in time, eating foods high in omega-3 fatty acids is a reasonable approach for someone with attention deficit/hyperactivity disorder (ADHD).


Omega-3 for Eating Disorders
Studies suggest that men and women with anorexia nervosa have lower than optimal levels of polyunsaturated fatty acids (including ALA and GLA). To prevent the complications associated with essential fatty acid deficiencies, some experts recommend that treatment programs for anorexia nervosa include PUFA-rich foods such as fish and organ meats (which include omega-6 fatty acids).

Burns
Essential fatty acids have been used to reduce inflammation and promote wound healing in burn victims. Animal research indicates that omega-3 fatty acids help promote a healthy balance of proteins in the body -- protein balance is important for recovery after sustaining a burn. Further research is necessary to determine whether omega 3s benefit people in the same way.

Skin Disorders
In one study, 13 people with a particular sensitivity to the sun known as photodermatitis showed significantly less sensitivity to UV rays after taking fish oil supplements. Still, research indicates that topical sunscreens are much better at protecting the skin from damaging effects of the sun than omega-3 fatty acids.In another study of 40 people with psoriasis, those who were treated with medications and EPA supplements did better than those treated with the medications alone. In addition, many clinicians believe that flaxseed (which contains omega-3 fatty acids) is helpful for treating acne.

Inflammatory Bowel Disease (IBD)
When added to medication, such as sulfasalazine (a standard medication for IBD), omega-3 fatty acids may reduce symptoms of Crohn's disease and ulcerative colitis -- the two types of IBD. More studies to investigate this preliminary finding are under way. In animals, it appears that ALA works better at decreasing bowel inflammation than EPA and DHA. Plus, fish oil supplements can cause side effects that are similar to symptoms of IBD (such as flatulence and diarrhea). Time-release preparations may help reduce these unwanted effects.


 


Asthma
Preliminary research suggests that omega-3 fatty acid supplements (in the form of perilla seed oil, which is rich in ALA) may decrease inflammation and improve lung function in adults with asthma. Omega-6 fatty acids have the opposite effect: they tend to increase inflammation and worsen respiratory function. In a small, well-designed study of 29 children with asthma, those who took fish oil supplements rich in EPA and DHA for 10 months had improvement in their symptoms compared to children who took a placebo pill.

Macular Degeneration
A questionnaire administered to more than 3,000 people over the age of 49 found that those who consumed more fish in their diet were less likely to have macular degeneration (a serious age-related eye condition that can progress to blindness) than those who consumed less fish. Similarly, a study comparing 350 people with macular degeneration to 500 without found that those with a healthy dietary balance of omega-3 and omega-6 fatty acids and higher intake of fish in their diets were less likely to have this particular eye disorder. Another larger study confirms that EPA and DHA from fish, four or more times per week, may reduce the risk of developing macular degeneration. Notably, however, this same study suggests that ALA may actually increase the risk of this eye condition.

Menstrual Pain
In a study of nearly 200 Danish women, those with the highest dietary intake of omega-3 fatty acids had the mildest symptoms during menstruation.

Colon Cancer
Consuming significant amounts of foods rich in omega-3 fatty acids appears to reduce the risk of colorectal cancer. For example, Eskimos, who tend to follow a high fat diet but eat significant amounts of fish rich in omega-3 fatty acids, have a low rate of colorectal cancer. Animal studies and laboratory studies have found that omega-3 fatty acids prevent worsening of colon cancer while omega-6 fatty acids promote the growth of colon tumors. Daily consumption of EPA and DHA also appeared to slow or even reverse the progression of colon cancer in people with early stages of the disease.

However, in an animal study of rats with metastatic colon cancer (in other words, cancer that has spread to other parts of the body such as the liver), omega-3 fatty acids actually promoted the growth of cancer cells in the liver. Until more information is available, it is best for people with advanced stages of colorectal cancer to avoid omega-3 fatty acid supplements and diets rich in this substance.

Breast Cancer
Although not all experts agree, women who regularly consume foods rich in omega-3 fatty acids over many years may be less likely to develop breast cancer. In addition, the risk of dying from breast cancer may be significantly less for those who eat large quantities of omega-3 from fish and brown kelp seaweed (common in Japan). This is particularly true among women who substitute fish for meat. The balance between omega-3 and omega-6 fatty acids appears to play an important role in the development and growth of breast cancer. Further research is still needed to understand the effect that omega-3 fatty acids may have on the prevention or treatment of breast cancer. For example, several researchers speculate that omega-3 fatty acids in combination with other nutrients (namely, vitamin C, vitamin E, beta-carotene, selenium, and coenzyme Q10) may prove to be of particular value for preventing and treating breast cancer.

Prostate Cancer
Laboratory and animal studies indicate that omega-3 fatty acids (specifically, DHA and EPA) may inhibit the growth of prostate cancer. Similarly, population based studies of groups of men suggest that a low-fat diet with the addition of omega-3 fatty acids from fish or fish oil help prevent the development of prostate cancer. Like breast cancer, the balance of omega-3 to omega-6 fatty acids appears to be particularly important for reducing the risk of this condition. ALA, however, may not offer the same benefits as EPA and DHA. In fact, one recent study evaluating 67 men with prostate cancer found that they had higher levels of ALA compared to men without prostate cancer. More research in this area is needed.

Other
Although further research is needed, preliminary evidence suggests that omega-3 fatty acids may also prove helpful in protecting against certain infections and treating a variety of conditions including ulcers, migraine headaches, preterm labor, emphysema, psoriasis, glaucoma, Lyme disease, lupus, and panic attacks.

 

 


Dietary Sources for Omega-3

Fish oils and plant oils are the primary dietary source of omega-3 fatty acids. Another potential source of omega-3 fatty acids is New Zealand green lipped mussels (Perna canaliculus),used for centuries by the Maories to promote good health. EPA and DHA are found in cold-water fish such as salmon, mackerel, halibut, sardines, and herring. ALA is found in flaxseeds, flaxseed oil, canola (rapeseed) oil, soybeans, soybean oil, pumpkin seeds, pumpkin seed oil, purslane, perilla seed oil, walnuts, and walnut oil.

 


Available Forms of Omega-3

In addition to the dietary sources described, EPA and DHA can be taken in the form of fish oil capsules. Flaxseed, flaxseed oil, and fish oil should be kept refrigerated. Whole flaxseeds must be ground within 24 hours of use, otherwise the ingredients lose their activity. Flaxseeds are also available in ground form in a special mylar package so that the components in the flaxseeds stay active.

Be sure to buy omega-3 fatty acid supplements made by established companies who certify that their products are free of heavy metals such as mercury.

 


How to Take Omega-3

Pediatric

The precise safe and effective doses of all types of omega-3 fatty acid supplements in children have not been established.

EPA and DHA

  • EPA and DHA are naturally found in breast milk; therefore, infants that are breastfed should receive sufficient amounts of these substances.
  • Formula for infants should contain less than 0.1% EPA.
  • Formula for infants should contain 0.35% DHA.

 


ALA

  • Infants that are breastfed should receive sufficient amounts of ALA if the mother has an adequate intake of this fatty acid.
  • Infant formula should contain 1.5% ALA.

Flaxseed Oil

  • Flaxseed oil may be added to a child's diet to help balance fatty acids. If an infant is breastfed, the mother may ingest oil or fresh ground seed to increase fat content in breast milk. See adult dosage below.

Flaxseed

  • Children (2 to 12 years): 1 tsp daily of ground flaxseeds or 1 tsp of fresh flaxseed oil for constipation

Adult

EPA and DHA

  • The adequate daily intake of EPA and DHA for adults should be at least 220 mg of each per day.
  • Two to three servings of fatty fish per week (roughly 1,250 mg EPA and DHA per day) are generally recommended to treat certain health conditions.

Fish oil supplements

  • 3,000 to 4,000 mg standardized fish oils per day. (This amount corresponds to roughly 2 to 3 servings of fatty fish per week.)
  • Typically, a 1,000 mg fish oil capsule has 180 mg EPA and 120 mg DHA

ALA

  • The adequate daily intake of ALA for adults should be roughly 2,220 mg per day.

Flaxseed oil

  • One or two Tbsp of flaxseed oil per day is recommended for general health.
  • Doses up to 3,000 mg per day are recommended to prevent certain conditions and doses up to 6,000 mg per day may be recommend to treat these conditions.

Flaxseed

  • 1 Tbsp two to three times per day or 2 to 4 tbsp one time per day. Grind before eating and take with lots of water.
  • Decoction (liquid prepared by boiling down the flaxseed in water): A rounded Tbsp of whole seed simmered in 1 cup water for 10 to 15 minutes, strain and drink.
  • 100 grams of raw flaxseed provides 22,800 mg of ALA

 

 


 


Precautions

Because of the potential for side effects and interactions with medications, dietary supplements should be taken only under the supervision of a knowledgeable healthcare provider.

Omega-3 fatty acids should be used cautiously by people who bruise easily, have a bleeding disorder, or take blood-thinning medications because excessive amounts of omega-3 fatty acids may lead to bleeding. In fact, people who eat more than three grams of omega-3 fatty acids per day (equivalent to 3 servings of fish per day) may be at an increased risk for hemorrhagic stroke, a potentially fatal condition in which an artery in the brain leaks or ruptures.

Fish oil can cause flatulence and diarrhea. Time-release preparations may reduce these side effects, however.

People with either diabetes or schizophrenia may lack the ability to convert ALA to EPA and DHA, the forms more readily used in the body. Therefore, people with these conditions should obtain their omega-3 fatty acids from dietary sources rich in EPA and DHA.

Although studies have found that regular consumption of fish (which includes the omega-3 fatty acids EPA and DHA) may reduce the risk of macular degeneration, a recent study including two large groups of men and women found that diets rich in ALA may substantially increase the risk of this disease. More research is needed in this area. Until this information becomes available, it is best for people with macular degeneration to obtain omega-3 fatty acids from sources of EPA and DHA, rather than ALA.

Similar to macular degeneration, fish and fish oil may protect against prostate cancer, but ALA may be associated with increased risk of prostate cancer in men. More research in this area is needed.


 


It is best to use lipid extracts rather than the powder form of New Zealand green lipped mussels because there is less chance of an allergic reaction. People who are allergic to seafood should avoid New Zealand green lipped mussels. In some individuals who take New Zealand green lipped mussels, arthritis symptoms may worsen before they improve.

 


Possible Interactions

If you are currently being treated with any of the following medications, you should not use omega-3 fatty acid supplements without first talking to your healthcare provider.

Blood-thinning Medications
Omega-3 fatty acids may increase the blood-thinning effects of aspirin or warfarin. While the combination of aspirin and omega-3 fatty acids may actually be helpful under certain circumstances (such as heart disease), they should only be taken together under the guidance and supervision of your healthcare provider.

Cyclosporine
Taking omega-3 fatty acids during cyclosporine therapy may reduce toxic side effects (such as high blood pressure and kidney damage) associated with this medication in transplant patients.

Etretinate and Topical Steroids
The addition of omega-3 fatty acids (specifically EPA) to a drug regimen of etretinate and topical corticosteroids may improve symptoms of psoriasis.

Cholesterol-lowering Medications
Following certain nutritional guidelines, including increasing the amount of omega-3 fatty acids in your diet and reducing the omega-6 to omega-3 ratio, may allow a group of cholesterol lowering medications known as "statins" (such as atorvastatin, lovastatin, and simvastatin) to work more effectively.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
In an animal study, treatment with omega-3 fatty acids reduced the risk of ulcers from nonsteroidal anti-inflammatory drugs (NSAIDs). More research is needed to evaluate whether omega-3 fatty acids would have the same effects in people.

back to: Supplement-Vitamins Homepage


Supporting Research

Al-Harbi MM, Islam MW, Al-Shabanah OA, Al-Gharably NM. Effect of acute administration of fish oil (omega-3 marine triglyceride) on gastric ulceration and secretion induced by various ulcerogenic and necrotizing agents in rats. Fed Chem Toxic. 1995;33(7):555-558.

Albert CM, Hennekens CH, O'Donnell CJ, et al. Fish consumption and risk of sudden cardiac death. JAMA. 1998;279(1):23-28.

Ando H, Ryu A, Hashimoto A, Oka M, Ichihashi M. Linoleic acid and alpha-linolenic acid lightens ultraviolet-induced hyperpigmentation of the skin. Arch Dermatol Res. 1998;290(7):375-381.

Andreassen AK, Hartmann A, Offstad J, Geiran O, Kvernebo K, Simonsen S. Hypertension prophylaxis with omega-3 fatty acids in heart transplant recipients. J Am Coll Cardiol. 1997;29:1324-1331.

Angerer P, von Schacky C. n-3 polyunsaturated fatty acids and the cardiovascular system. Curr Opin Lipidol. 2000;11(1):57-63.

Anti M, Armelau F, Marra G, et al. Effects of different doses of fish oil on rectal cell proliferation in patients with sporadic colonic adenomas. Gastroenterology. 1994;107(6):1892-1894.

Appel LJ. Nonpharmacologic therapies that reduce blood pressure: a fresh perspective. Clin Cardiol. 1999;22(Suppl. III):III1-III5.

Arnold LE, Kleykamp D, Votolato N, Gibson RA, Horrocks L. Potential link between dietary intake of fatty acid and behavior: pilot exploration of serum lipids in attention-deficit hyperactivity disorder. J Child Adolesc Psychopharmacol. 1994;4(3):171-182.

Aronson WJ, Glaspy JA, Reddy ST, Reese D, Heber D, Bagga D. Modulation of omega-3/omega-6 polyunsaturated ratios with dietary fish oils in men with prostate cancer. Urology. 2001;58(2):283-288.

Badalamenti S, Salerno F, Lorenzano E, et al. Renal Effects of Dietary Supplementation With Fish Oil in Cyclosporine-Treated Liver Transplant Patients. Hepatol. 1995;2(6):1695-1701.

Baumgaertel A. Alternative and controversial treatments for attention-deficit/hyperactivity disorder. Pediatr Clin of North Am. 1999;46(5):977-992.

Belluzzi A, Boschi S, Brignola C, Munarini A, Cariani C, Miglio F. Polyunsaturated fatty acids and inflammatory bowel disease. Am J Clin Nutr. 2000;71(suppl):339S-342S.


 


Belluzzi A, Brignolia C, Campieri M, Pera A, Boschi S, Miglioli M. Effect of an enteric-coated fish-oil preparation on relapses in Crohn's disease. New Engl J Med. 1996;334(24):1558-1560.

Boelsma E, Hendriks HF. Roza L. Nutritional skin care: health effects of micronutrients and fatty acids. Am J Clin Nutr. 2001;73(5):853-864.

Bonaa KH, Bjerve KS, Nordoy A. Docosahexaenoic and eicosapentaenoic acids in plasma phospholipids are divergently associated with high density lipoprotein in humans. Arterioscler Thromb. 1992;12(6):675-681.

Broadhurst CL, Cunnane SC, Crawford MA. Rift Valley lake fish and shellfish provided brain-specific nutrition for early Homo. Br J Nutr. 1998;79(1):3-21.

Brown DJ, Dattner AM. Phytotherapeutic approaches to common dermatologic conditions. Arch Dermtol. 1998;134:1401-1404.

Bruinsma KA, Taren DL. Dieting, essential fatty acid intake, and depression. Nutrition Rev. 2000;58(4):98-108.

Burgess J, Stevens L, Zhang W, Peck L. Long-chain polyunsaturated fatty acids in children with attention-deficit hyperactivity disorder. Am J Clin Nutr. 2000; 71(suppl):327S-330S.

Calder PC. n-3 polyunsaturated fatty acids, inflammation and immunity: pouring oil on troubled waters or another fishy tale? Nut Res. 2001;21:309-341.

Caron MF, White CM. Evaluation of the antihyperlipidemic properties of dietary supplements. Pharmacotherapy. 2001;21(4):481-487.

Cellini M, Caramazzu N, Mangiafico P, Possati GL, Caramazza R. Fatty acid use in glaucomatous optic neuropathy treatment. Acta Ophthalmol Scand Suppl. 1998;227:41-42.

Cho E, Hung S, Willet WC, Spiegelman D, Rimm EB, Seddon JM, et al. Prospective study of dietary fat and the risk of age-related macular degeneration. Am J Clin Nutr. 2001;73(2):209-218.

Christensen JH, Skou HA, Fog L, Hansen V, Vesterlund T, Dyerberg J, Toft E, Schmidt EB. Marine n-3 fatty acids, wine intake, and heart rate variability in patients referred for coronary angiography. Circulation. 2001;103:623-625.

Clark WF, Kortas C, Heidenheim AP, Garland J, Spanner E, Parbtani A. Flaxseed in lupus nephritis: a two - Å“year nonplacebo-controlled crossover study. J Am Coll Nutr. 2001;20(2 Suppl):143-148.

Connolly JM, Gilhooly EM, Rose DP. Effects of reduced dietary linoleic acid intake, alone or combined with an algal source of docosahexaenoic acid, on MDA-MD-231 breast cancer cell growth and apoptosis in nude mice. Nutrition Can. 1999;35(1):44-49.

Connor SL, Connor WE. Are fish oils beneficial in the prevention and treatment of coronary artery disease? Am J Clin Nutr. 1997;66(suppl):1020S-1031S.

Curtis CL, Hughes CE, Flannery CR, Little CB, Harwood JL, Caterson B. N-3 fatty acids specifically modulate catabolic factors involved in articular cartilage degradation. J Biol Chem. 2000;275(2):721-724.

Danao-Camara TC, Shintani TT. The dietary treatment of inflammatory arthritis: case reports and review of the literature. Hawaii Med J. 1999;58(5):126-131.

Danno K, Sugie N. Combination therapy with low-dose etretinate and eicosapentaenoic acid for psoriasis vulgaris. J Dermatol. 1998;25:703-705.

Davidson MH, Maki KC, Kalkowski J, Schaefer EJ, Torri SA, Drennan KB. Effects of docosahexeaenoic acid on serum lipoproteins in patients with combined hyperlipidemia. A randomized, double-blind, placebo-controlled trial. J Am Coll Nutr. 1997;16:3:236-243.

de Deckere EAM. Possible beneficial effect of fish and fish n-3 polyunsaturated fatty acids in breast and colorectal cancer. Eur J Cancer Prev. 1999;8:213-221.

deDeckere EAM, Korver O, Verschuren PM, Katan MB. Health aspects of fish and n-3 polyunsaturated fatty acids from plant and marine origin. Eur J Clin Nutr. 1998;52(10):749-753.

de Logeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation. 1999;99(6):779-785.

De-Souza DA, Greene LJ. Pharmacological nutrition after burn injury. J Nutr. 1998;128:797-803.

Deutch B. Menstrual pain in Danish women correlated with low n-3 polyunsaturated fatty acid intake. Eur J Clin Nutr. 1995;49(7):508-516.

Dewailly E, Blanchet C, Lemieux S, et al. n-3 fatty acids and cardiovascular disease risk factors among the Inuit of Nunavik. Am J Clin Nutr. 2001;74(4):464-473.

Dichi I, Frenhane P, Dichi JB, Correa CR, Angeleli AY, Bicudo MH, et al. Comparison of omega-3 fatty acids and sulfasalazine in ulcerative colitis. Nutrition. 2000;16:87-90.

Edwards R, Peet M, Shay J, Horrobin D. Omega-3 polyunsaturated fatty acid levels in the diet and in red blood cell membranes of depressed patients. J Affect Disord. 1998;48(2-3):149-155.

Fatty fish consumption and ischemic heart disease mortality in older adults: The cardiovascular heart study. Presented at the American Heart Association's 41st annual conference on cardiovascular disease epidemiology and prevention. AHA. 2001.

Fenton WS, Dicerson F, Boronow J, et al. A placebo controlled trial of omega-3 fatty acid (ethyl eicosapentaenoic acid) supplementation for residual symptoms and cognitive impairment in schizophrenia. Am J Psychiatry. 2001;158(12):2071-2074.

Foulon T, Richard MJ, Payen N, et al. Effects of fish oil fatty acids on plasma lipids and lipoproteins and oxidant-antioxidant imbalance in healthy subjects. Scan J Clin Lab Invest. 1999;59(4):239-248.

Freeman VL, Meydani M, Yong S, Pyle J, Flanigan RC, Waters WB, Wojcik EM. Prostatic levels of fatty acids and the histopathology of localized prostate cancer. J Urol. 2000;164(6):2168-2172.

Friedberg CE, Janssen MJ, Heine RJ, Grobbee DE. Fish oil and glycemic control in diabetes: a meta-analysis. Diabetes Care. 1998;21:494-500.

Frieri G, Pimpo MT, Palombieri A, Melideo D, Marcheggiano A, Caprilli R, et al. Polyunsaturated fatty acid dietary supplementation: an adjuvant approach to treatment of Helicobacter pylori infection. Nut Res. 2000;20(7):907-916.

Gamez-Mez N, Higuera-Ciapara I, Calderon de la Barca AM, Vazquez-Moreno L, Noriega-Rodriquez J, Angulo-Guerrero O. Seasonal variation in the fatty acid composition and quality of sardine oil from Sardinops sagax caeruleus of the Gulf of California. Lipids. 1999;34)6_:639-642.

Geerling BJ, Badart-Smook A, van Deursen C, et al. Nutritional supplementation with N-3 fatty acids and antioxidants in patients iwth Crohn's disease in remission: effects on antioxidant status and fatty acid profile. Inflamm Bowel Dis. 2000;6(2):77-84.

Geerling BJ, Houwelingen AC, Badart-Smook A, StockbrÃÂ ¼gger RW, Brummer R-JM. Fat intake and fatty acid profile in plasma phospholipids and adipose tissue in patients with Crohn's disease, compared with controls. Am J Gastroenterol. 1999;94(2):410-417.

Gibson SL, Gibson RG. The treatment of arthritis with a lipid extract of Perna canaliculus: a randomized trial. Complement Ther Med. 1998;6:122-126.

Griffini P, Fehres O, Klieverik L, et al. Dietary omega-3 polyunsaturated fatty acids promote colon carcinoma metastasis in rat liver. Can Res. 1998;58(15):3312-3319.

GISSI-Prevenzione Investigators. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Lancet. 1999;354:447-455

Halpern G-M. Anti-inflammatory effects of a stabilized lipid extract of Perna canaliculus (Lyprinol). Allerg Immunol (Paris). 2000;32(7):272-278.

Harper CR, Jacobson TA. The fats of life: the role of omega-3 fatty acids in the prevention of coronary heart disease. Arch Intern Med. 2001;161(18):2185-2192.

Harris WS. N-3 fatty acids and serum lipoproteins: human studies. Am J Clin Nutr. 1997;65(5):1645S (10).

Hayashi N, Tsuguhiko T, Yamamori H, et al. Effect of intravenous w-6 and w-3 fat emulsions on nitrogen retention and protein kinetics in burned rats. Nutrition. 1999;15(2):135-139.

Hibbeln JR. Fish consumption and major depression. Lancet. 1998;351(9110):1213.

Hibbeln JR, Salem N, Jr. Dietary polyunsaturated fatty acids and depression: when cholesterol does not satisfy. Am J Clin Nut. 1995;62(1):1-9.

Holman RT, Adams CE, Nelson RA, et al. Patients with anorexia nervosa demonstrate deficiencies of selected essential fatty acids, compensatory changes in nonessential fatty acids and decreased fluidity of plasma lipids. J Nutr. 1995;125:901-907.

Homan van der Heide JJ, Bilo HJ, Tegzess AM, Donker AJ. The effects of dietary supplementation with fish oil on renal function in cyclosporine-treated renal transplant recipients. Transplantation. 1990;49:523-527.

Horrobin DF. The membrane phospholipid hypothesis as a biochemical basis for the neurodevelopmental concept of schizophrenia. Schizophr Res. 1998;30(3):193-208.

Horrobin DF, Bennett CN. depression and bipolar disorder: relationships to impaired fatty acid and phospholipid metabolism and to diabetes, cardiovascular disease, immunological abnormalities, cancer, ageing and osteoporosis. Prostaglandins Leukot Essent Fatty Acids. 1999;60(4):217-234.

Horrocks LA, Yeo YK. Health benefits of docosahexaenoic acid. Pharmacol Res. 1999;40(3):211-225.

Howe PR. Can we recommend fish oil for hypertension? Clin Exp Pharmacol Physiol. 1995;22(3):199-203.

Hrboticky N, Zimmer B, Weber PC. Alpha-Linolenic acid reduces the lovastatin-induced rise in arachidonic acid and elevates cellular and lipoprotein eicosapentaenoic and docosahexaenoic acid levels in Hep G2 cells. J Nutr Biochem. 1996;7:465-471.

Hu FB, Stampfer MJ, Manson JE et al. Dietary intake of alpha-linolenic acid and risk of fatal ischemic heart disease among women. Am J Clin Nutr. 1999;69:890-897.

Iso H, Rexrode KM, Stampfer MJ, Manson JE, Colditz GA, Speizer FE et al. Intake of fish and omega-3 fatty acids and risk of stroke in women. JAMA. 2001;285(3):304-312.

Jeschke MG, Herndon DN, Ebener C, Barrow RE, Jauch KW. Nutritional intervention high in vitamins, protein, amino acids, and omega-3 fatty acids improves protein metabolism during the hypermetabolic state after thermal injury. Arch Surg. 2001;136:1301-1306.

Juhl A, Marniemi J, Huupponen R, Virtanen A, Rastas M, Ronnemaa T. Effects of diet and simvistatin on serum lipids, insulin, and antioxidants in hypercholesterolemic men; a randomized controlled trial. JAMA. 2002;2887(5):598-605.

Klurfeld DM, Bull AW. Fatty acids and colon cancer in experimental models. Am J Clin Nut. 1997;66(6 Suppl):1530S-1538S.

Kooijmans-Coutinho MF, Rischen-Vos J, Hermans J, Arndt JW, van der Woude FJ. Dietary fish oil in renal transplant recipients treated with cyclosporin-A: no beneficial effects shown. J Am Soc Nephrol. 1996;7(3):513-518.

Krauss RM, Eckel RH, Howard B, et al. AHA Scientific Statement: AHA Dietary guidelines Revision 2000: A statement for healthcare professionals from the nutrition committee of the American Heart Association. Circulation. 2000;102(18):2284-2299.

Kremer JM. N-3 fatty acid supplements in rheumatoid arthritis. Am J Clin Nutr. 2000;(suppl 1):349S-351S.

Kris-Etherton P, Eckel RH, Howard BV, St. Jeor S, Bazzare TL. AHA Science Advisory: Lyon Diet Heart Study. Benefits of a Mediterranean-style, National Cholesterol Education Program/American Heart Association Step I Dietary Pattern on Cardiovascular Disease. Circulation. 2001;103:1823.

Kris-Etherton PM, Taylor DS, Yu-Poth S, et al. Polyunsaturated fatty acids in the food chain in the United States. Am J Clin Nutr. 2000;71(1 Suppl):179S-188S.

Kruger MC, Coetzer H, de Winter R, Gericke G, van Papendorp DH. Calcium, gamma-linolenic acid and eicosapentaenoic acid supplementation in senile osteoporosis. Aging Clin Exp Res. 1998;10:385-394.

Kruger MC, Horrobin DF. Calcium metabolism, osteoporosis and essential fatty acids: a review. Prog Lipid Res. 1997;36:131-151.

Kulkarni PS, Srinivasan BD. Cyclooxygenase and lipoxygenase pathways in anterior uvea and conjunctiva. Prog Clin Biol Res. 1989;312:39-52.

Kuroki F, Iida M, Matsumoto T, Aoyagi K, Kanamoto K, Fujishima M. Serum n3 polyunsaturated fatty acids are depleted in Crohn's disease. Dig Dis Sci. 1997;42(6):1137-1141.

Laugharne JD, Mellor JE, Peet M. Fatty acids and schizophrenia. Lipids. 1996;31(Suppl):S-163-165.

Levy E, Rizwan Y, Thibault L, et al. Altered lipid profile, lipoprotein composition, and oxidant and antioxidant status in pediatric Crohn disease. Am J Clin Nutr. 2000;71:807-815.

Lockwood K, Moesgaard S, Hanioka T, Folkers K. Apparent partial remission of breast cancer in 'high risk' patients supplemented with nutritional antioxidants, essential fatty acids, and coenzyme Q10. Mol Aspects Med. 1994;15Suppl:s231-s240.

Lopez-Miranda J, Gomez P, Castro P, et al. Mediterranean diet improves low density lipoproteins' susceptibility to oxidative modifications. Med Clin (Barc) [in Spanish]. 2000;115(10):361-365.

Lorenz-Meyer H, Bauer P, Nicolay C, Schulz B, Purrmann J, Fleig WE, et al. Omega-3 fatty acids and low carbohydrate diet for maintenance of remission in Crohn's disease. A randomized controlled multicenter trial. Study Group Members (German Crohn's Disease Study Group). Scan J Gastroenterol. 1996;31(8):778-785.

Mabile L, Piolot A, Boulet L, Fortin LJ, Doyle N, Rodriquez C, et al. Moderate intake of omega-3 fatty acids is associated with stable erythrocyte resistance to oxidative stress in hypertriglyceridemic subjects. Am J Clin Nutr. 2001;7494):449-456.

Mayser P, Mrowietz U, Arenberger P, Bartak P, Buchvald J, Christophers E, et al. Omega-3 fatty acid-based lipid infusion in patients with chronic plaque psoriasis: results of a double-blind, randomized, placebo controlled, multicenter trial. J Am Acad Dermatol. 1998;38(4):539-547.

Meydani M. Omega-3 fatty acids alter soluble markers of endothelial function in coronary heart disease patients. Nutr Rev. 2000;58(2 pt 1):56-59.

Mitchell EA, Aman MG, Turbott SH, Manku M. Clinical characteristics and serum essential fatty acid levels in hyperactive children. Clin Pediatr (Phila). 1987;26:406-411.

Montori V, Farmer A, Wollan PC, Dinneen SF. Fish oil supplementation in type 2 diabetes: a quantitative systematic review. Diabetes Care. 2000;23:1407-1415.

Mori TA, Bao, DQ, Burke V, et al. Dietary fish as a major component of a weight-loss diet: effect on serum lipids, glucose, and insulin metabolism in overweight hypertensive subjects. Am J Clin Nutr. 1999;70:817-825.

Morris MC, Sacks F, Rosner B. Does fish oil lower blood pressure? A meta-analysis of controlled trials. Circulation. 1993;88:523-533.

Nagakura T, Matsuda S, Shichijyo K, Sugimoto H, Hata K. Dietary supplementation with fish oil rich in omega-3 polyunsaturated fatty acids in children with bronchial asthma. Eur Resp J. 2000;16(5):861-865.

Nestel PJ, Pomeroy SE, Sasahara T, et al. Arterial compliance in obese subjects is improved with dietary plant n-3 fatty acid from flaxseed oil despite increased LDL oxidizability. Arterioscler Thromb Vasc Biol. July 1997;17(6):1163-1170.

Newcomer LM, King IB, Wicklund KG, Stanford JL. The association of fatty acids with prostate cancer risk. Prostate. 2001;47(4):262-268.

Okamoto M, Misunobu F, Ashida K, et al. Effects of dietary supplementation with n-3 fatty acids compared with n-6 fatty acids on bronchial asthma. Int Med. 2000;39(2):107-111.

Okamoto M, Misunobu F, Ashida K, et al. Effects of perilla seed oil supplementation on leukotriene generation by leucocytes in patients with asthma associated with lipometabolism. Int Arch Allergy Immunol. 2000;122(2):137-142.

Olsen SF, Secher NJ. Low consumption of seafood in early pregnancy as a risk factor for preterm delivery: prospective cohort study. BMJ. 2002;324(7335): 447-451.

Prisco D, Paniccia R, Bandinelli B, et al. Effect of medium term supplementation with a moderate dose of n-3 polyunsaturated fatty acid on blood pressure in mild hypertensive patients. Thromb Res. 1998;91:105-112.

Paul KP, Leichsenring M, Pfisterer M, Mayatepek E, Wagner D, Domann M, et al. Influence of n-6 and n-3 polyunsaturated fatty acids on the resistance to experimental tuberculosis. Metabolism. 1997;46(6):619-624.

Peet M, Laugharne JD, Mellor J, et al. Essential fatty acid deficiency in erythrocyte membranes from chronic schizophrenic patients, and the clinical effects of dietary supplementation. Prostaglandins Leukot Essent Fatty Acids. 1996;55(1-2):71-75.

Puri B, Richardson AJ, Horrobin DF, et al. Eicosapentaenoic acid treatment in schizophrenia associated with symptom remission, normalisation of blood fatty acids, reduced neuronal membrane phospholipid turnover and structural brain changes. Int J Clin Pract. 2000;54(1):57-63.

Rhodes LE, Durham BH, Fraser WD, Friedmann PS. Dietary fish oil reduces basal and ultraviolet B-generated PGE2 levels in skin and increases the threshold to provocation of polymorphic light eruption. J Invest Dermatol. 1995;105(4):532-535.

Rhodes LE, White SI. Dietary fish oil as a photoprotective agent in hydroa vacciniforme. Br J Dermatol. 1998;138(1):173-178.

Richardson AJ, Puri BK. The potential role of fatty acids in attention-deficit/hyperactivity disorder. Prostaglandins Leukot Essent Fatty Acids. 2000;63(1/2):79-87.

Rose DP, Connolly JM, Coleman M. Effect of omega-3 fatty acids on the progression of metastases after the surgical excision of human breast cancer cell solid tumors growing in nude mice. Clin Cancer Res. 1996;2:1751-1756.

Sakaguchi K, Morita I, Murota S. Eicosapentaenoic acid inhibits bone loss due to ovariectomy in rats. Prostaglandins Leukot Essent Fatty Acids. 1994;50:81-84.

Sanders TA, Hinds A. The influence of a fish oil high in docosahexaenoic acid on plasma lipoprotein and vitamin E concentrations and haemostatic function in healthy male volunteers. Br J Nutr. 1992;68(1):163-173.

Seddon JM, Rosner B, Sperduto RD, Yannuzzi L, Haller JA, Blair NP, Willett W. Dietary fat and risk for advanced age-related macular degeneration. Arch Opthalmol. 2001;119(8):1191-1199.

Shils ME, Olson JA, Shike M, Ross AC. Modern Nutrition in Health and Disease. 9th ed. Baltimore, Md: Williams & Wilkins; 1999:90-92, 1377-1378.

Shoda R, Matsueda K, Yamato S, Umeda N. Therapeutic efficacy of N-3 polyunsaturated fatty acid in experimental Crohn's disease. J Gastroenterol. 1995;30(Suppl 8):98-101.

Simopoulos AP. Essential fatty acids in health and chronic disease. Am J Clin Nutr. 1999;70(30 Suppl):560S-569S.

Simopoulos AP. Human requirement for N-3 polyunsaturated fatty acids. Poult Sci. 2000;79(7):961-970.

Smith W, Mitchell P, Leeder SR. Dietary fat and fish intake and age-related maculopathy. Arch Opthamol. 2000;118(3):401-404.

Soyland E, Funk J, Rajka G, Sandberg M, Thune P, Ruistad L, et al. Effect of dietary supplementation with very-long chain n-3 fatty acids in patients with psoriasis. N Engl J Med. 1993;328(25):1812-1816.

Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. 2000;343(1):16-22

Stark KD, Park EJ, Maines VA, et al. Effect of fish-oil concentrate on serum lipids in postmenopausal women receiving and not receiving hormone replacement therapy in a placebo-controlled, double blind trial. Am J Clin Nutr. 2000;72:389-394.

Stevens LJ, Zentall SS, Abate ML, Kuczek T, Burgess JR. Omega-3 fatty acids in boys with behavior, learning and health problems. Physiol Behav. 1996;59(4/5):915-920.

Stevens LJ, Zentall SS, Deck JL, et al. Essential fatty acid metabolism in boys with attention-deficit hyperactivity disorder. Am J Clin Nutr. 1995;62:761-768.

Stoll AL, Severus WE, Freeman MP, et al. Omega 3 fatty acids in bipolar disorder: a preliminary double-blind placebo-controlled trial. Arch Gen Psychiatry. 1999:56(5):407-412.

Stoll BA. Breast cancer and the Western diet: role of fatty acids and antioxidant vitamins. Eur J Cancer. 1998;34(12):1852-1856.

Terry P, Lichtenstein P, Feychting M, Ahlbom A, Wolk A. Fatty fish consumption and risk of prostate cancer. Lancet. 2001;357(9270):1764-1766.

Tsai W-S, Nagawa H, Kaizaki S, Tsuruo T, Muto T. Inhibitory effects of n-3 polyunsaturated fatty acids on sigmoid colon cancer transformants. J Gastroenterol. 1998;33:206-212.

Tsujikawa T, Satoh J, Uda K, Ihara T, Okamoto T, Araki Y, et al. Clinical importance of n-3 fatty acid-rich diet and nutritional education for the maintenance of remission in Crohn's disease. J Gastroenterol. 2000;35(2):99-104.

Ventura HO, Milani RV, Lavie CJ, Smart FW, Stapleton DD, Toups TS, Price HL. Cyclosporine induced hypertension. Efficacy of omega-3 fatty acids in patients after cardiac transplantation. Circulation. 1993;88(5 Pt 2):II281-II285.

von Schacky C, Angere P, Kothny W, Theisen K, Mudra H. The effect of dietary omega-3 fatty acids on coronary atherosclerosis: a randomized, double-blind, placebo-controlled trial. Ann Intern Med. 1999;130:554-562.

Voskuil DW, Feskens EJM, Katan MB, Kromhout D. Intake and sources of alpha-linolenic acid in Dutch elderly men. Euro J Clin Nutr. 1996;50(12):784-787.

Wagner W, Nootbaar-Wagner U. Prophylactic treatment of migraine with gamma-linolenic and alpha-linolenic acids. Cephalalgia. 1997;17(2):127-130.

Werbach MR. Nutritional Influences on Illness. 2nd ed. Tarzana, Calif: Third Line Press; 1993:13-22, 655-671.

Yehuda S, Rabinovitz S, Carasso RL, Mostofsky DI. Fatty acids and brain peptides. Peptides. 1998;19(2):407-419.

Yosefy C, Viskoper JR, Laszt A, Priluk R, Guita E, Varon D, et al. The effect of fish oil on hypertension, plasma lipids and hemostasis in hypertensive, obese, dyslipidemic patients with and without diabetes mellitus. Prostaglandins Leukot Essent Fatty Acids. 1999;61(2):83-87.

ZambÃÂ ³n D, Sabate J, Munoz S, et al. Substituting walnuts for monounsaturated fat improves the serum lipid profile of hypercholesterolemic men and women. Ann Intern Med. 2000;132:538-546.

Zimmerman R, Radhakrishnan J, Valeri A, Appel G. Advances in the treatment of lupus nephritis. Ann Rev Med. 2001;52:63-78.

 


The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application, use, or misuse of any of the information contained herein, including any injury and/or damage to any person or property as a matter of product liability, negligence, or otherwise. No warranty, expressed or implied, is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor, pharmacist, nurse, or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage, precautions, warnings, interactions, and contraindications before administering any drug, herb, or supplement discussed herein.

back to: Supplement-Vitamins Homepage

APA Reference
Staff, H. (2008, December 21). Omega-3 Fatty Acids, HealthyPlace. Retrieved on 2024, March 29 from https://www.healthyplace.com/alternative-mental-health/supplements-vitamins/omega-3-fatty-acids

Last Updated: July 10, 2016

Melatonin

Comprehensive information on melatonin for depression, seasonal effective disorder -SAD, insomnia and eating disorders. Learn about the usage, dosage, side-effects of melatonin.

Comprehensive information on melatonin supplements for depression, seasonal effective disorder (SAD), insomnia and eating disorders. Learn about the usage, dosage, side-effects of melatonin.

Overview

Melatonin is secreted by the pineal gland in the brain and is important in the regulation of many hormones in the body. Among its key roles, melatonin controls the body's circadian rhythm, an internal 24-hour time-keeping system that plays an important role in when we fall asleep and when we wake up. Darkness stimulates the release of melatonin and light suppresses its activity. Normal melatonin cycles are disrupted when we are exposed to excessive light in the evening or too little light during the daytime. For example, jet lag, shift work, and poor vision can disrupt melatonin cycles. In addition, some experts claim that exposure to low-frequency electromagnetic fields (as is common in household appliances) may disrupt normal cycles and production of melatonin.

Melatonin is also one of the hormones that controls the timing and release of female reproductive hormones. As a result, melatonin helps determine when menstruation begins, the frequency and duration of menstrual cycles, and when menstruation ends (menopause). Many researchers also believe that levels of melatonin in the body are related to the aging process. For example, young children have the highest levels of nighttime melatonin and these levels are thought to diminish progressively with age. This decline likely contributes to why many older adults suffer from disrupted sleep patterns and tend to go to bed earlier and wake up earlier in the morning than when they were younger. However, emerging research is bringing the idea of diminished melatonin levels in the elderly into some question. Therefore, those considering use of this supplement should first talk to their healthcare provider about having blood levels of melatonin checked.


 


In addition to its hormone actions, melatonin also has strong antioxidant properties and preliminary evidence suggests that it may help strengthen the immune system. Because melatonin is a potent hormone, it's advisable to check with a healthcare provider before using it as an antioxidant supplement.

 


Uses

Melatonin for Insomnia
Although results are still controversial, studies suggest that melatonin supplements help induce sleep in people with disrupted circadian rhythms (such as those suffering from jet lag or poor vision or those who work the night shift) and those with low melatonin levels (such as some elderly and individuals with schizophrenia). In fact, a recent review of scientific studies found that melatonin supplements help prevent jet lag, particularly in people who cross five or more time zones.

A few studies suggest that when taken for short periods of time (days to weeks) melatonin is significantly more effective than placebo in decreasing the amount of time required to fall asleep, increasing the number of sleeping hours, and boosting daytime alertness. In addition, at least one study suggests that melatonin may improve the quality of life in people who suffer from insomnia and some experts suggest that melatonin may be of value for children with learning disabilities who suffer from insomnia.

Although research suggests that melatonin may be modestly effective for treating certain types of insomnia as described, few studies have investigated whether melatonin supplements are safe and effective over the long term.

Osteoporosis
Melatonin has been shown in laboratory studies to stimulate cells called osteoblasts that promote bone growth. Given that melatonin levels may also be lower in some older individuals such as postmenopausal women, current studies are investigating whether or not decreased melatonin levels contribute to the development of osteoporosis, and whether treatment with melatonin can help prevent this condition.

Menopause
Melatonin supplements may benefit menopausal women by promoting and sustaining sleep. Peri- or postmenopausal women who use melatonin supplements to regulate sleep patterns should do so only for a short period of time since long term effects, as indicated earlier, are not known.

Melatonin for depression (Melotonin for SAD)
In one small study of 10 people with a particular type of depression known as seasonal affective disorder (depressive symptoms that develop during the winter months when exposure to light is lessened), those who received melatonin supplements had significant improvement in their symptoms compared to those who received placebo. Given the small size of this study, however, more research is needed before conclusions can be drawn regarding use of melatonin for either seasonal affective disorder or any other type of depression. This is particularly true since one study from the 1970s suggested that symptoms of depression may worsen when taking melatonin.


Melatonin for Eating Disorders
Melatonin levels may play a role in the symptoms of anorexia. For example, abnormally low melatonin levels may cause depressed mood in people with this condition. However, it is not known whether supplementation will change the course of the disease. Some researchers speculate that low melatonin levels in people with anorexia may indicate who is likely to benefit from antidepressant medications (a treatment often used for eating disorders).

Breast Cancer
Several studies indicate that melatonin levels may be linked with breast cancer risk. For example, women with breast cancer tend to have lower levels of melatonin than those without the disease. In addition, laboratory experiments have found that low levels of melatonin stimulate the growth of certain types of breast cancer cells and adding melatonin to these cells inhibits their growth. Preliminary laboratory and clinical evidence also suggests that melatonin may enhance the effects of some chemotherapy drugs used to treat breast cancer. In a study that included a small number of women with breast cancer, melatonin (administered 7 days before beginning chemotherapy) prevented the lowering of platelets in the blood. This is a common complication of chemotherapy, known as thrombocytopenia, that can lead to bleeding.

In another study of a small group of women whose breast cancer was not improving with tamoxifen (a commonly used chemotherapy medication), the addition of melatonin caused tumors to modestly shrink in over 28% of the women. People with breast cancer who are considering taking melatonin supplements should first consult a healthcare provider who can help construct a comprehensive treatment approach to be administered together with conventional care.


 


Prostate Cancer
Similar to breast cancer, studies of people with prostate cancer suggest that melatonin levels are lower compared to men without cancer, and test tube studies have found that melatonin inhibits the growth of prostate cancer cells. In one small-scale study, melatonin (when used in conjunction with conventional medical treatment) improved survival rates in 9 out of 14 patients with metastatic prostate cancer. Interestingly, meditation appears to be a valuable addition to the treatment of prostate cancer. The positive effects of meditation may be due to a rise in levels of melatonin in the body. Although these early results are intriguing, more research is needed.

Cancer-related Weight Loss
Weight loss and malnutrition are of great concern for people with cancer. In one study of 100 people with advanced cancer that had spread throughout the body, those who received melatonin supplements were less likely to lose weight than those who did not receive the supplement.

Sarcoidosis
Some physicians use melatonin to help treat sarcoidosis (a condition where fibrous tissue develops in the lungs and other tissues). Two case reports suggest that melatonin may be helpful for those who do not improve from conventional steroid treatment.

Rheumatoid Arthritis
In a group of patients with rheumatoid arthritis, melatonin levels were low compared to healthy individuals without arthritis. When treated with the anti-inflammatory medication indomethacin, melatonin levels returned to normal. The chemical structure of melatonin resembles indomethacin, so researchers speculate that melatonin supplements may work similarly to this medication for people with rheumatoid arthritis. This theory has not been tested, however.

Melatonin for Attention Deficit/Hyperactivity Disorder (ADHD)
Although melatonin supplementation does not appear to improve the key behavioral symptoms of attention deficit/hyperactivity disorder (ADHD), it may be effective in managing sleep disturbances in children with this condition.

Melatonin for Epilepsy
Preliminary research suggests that melatonin reduces the number of seizures in certain animal species and may reduce seizures in people with epilepsy. However, not all experts agree with these findings. In fact, concern has been raised that melatonin (1 to 5 mg per day) may actually induce seizures, particularly in children with neurologic disorders. Given that the research is in a very premature stage, some experts suggest that melatonin should be administered by healthcare providers to only a select group of people who suffer from seizures that cannot be controlled by any other type of therapy.

Sunburn
A few small-scale studies suggest that gels, lotions, or ointments containing melatonin may protect against redness (erythema) and other skin damage when used either alone or in combination with topical vitamin E prior to exposure to UV radiation from the sun.

Viral Encephalitis
Although melatonin has not been scientifically evaluated for use in treating human encephalitis (inflammation of the brain), some studies suggest that this supplement may protect animals from serious complications associated with the condition and even increase their survival rates. In one study of mice infected with Venezuelan equine virus (a type of organism that causes viral encephalitis), melatonin supplements significantly lowered the presence of virus in the blood and reduced death rates by more than 80%. More studies are needed, however, to determine whether similar treatment may offer the same protection to people with viral encephalitis.

Heart Disease

Low levels of melatonin in the blood have been associated with heart disease, but it is not clear whether melatonin levels are low in response to having heart disease or if low levels of melatonin predispose people to developing this condition. In addition, several studies in rats suggest that melatonin may protect the hearts of these animals from the damaging effects of ischemia (decreased blood flow and oxygen that often leads to a heart attack). It is not known from this information, however, whether melatonin supplements may help prevent or treat heart disease in people. More research and scientific information is needed before conclusions can be drawn.


Available Forms

Melatonin is available as tablets, capsules, cream, and lozenges that dissolve under the tongue.

 


How to Take Melatonin

There is currently no recommended dose range for melatonin supplements. Different people will be more sensitive or less sensitive to its effects. For those especially sensitive, lower doses may work effectively while a higher dose could cause anxiety and irritability. The best approach for any condition is to begin with very low doses of melatonin that match the amounts our bodies normally make on a daily basis (< 0.3 mg) and keep the dose to a minimum. Your healthcare provider can help guide what is best and most appropriate, including how to increase the amount as needed.

Pediatric

  • Less than 0.3 mg/day

Although studies including small numbers of children suggest that doses of 1-10 mg melatonin have little to no side effects, there is not enough information at this point to clearly say that doses greater than 0.3 mg per day are safe in children under age 15. In fact, doses between 1 to 5 mg may cause seizures in this age group. Until more information is available, it is safest to keep the dose close to the amount that our bodies normally produce (< 0.3 mg per day).

Adult

    • Insomnia: 3 mg one hour before bedtime is usually effective, although doses as low as 0.1 to 0.3 mg may improve sleep for some people. If 3 mg per night is not effective after three days, try 5-6 mg one hour before bedtime. An effective dose should produce restful sleep with no daytime irritability or fatigue.

 


  • Jet lag: 0.5 to 5 mg of melatonin one hour prior to bedtime at final destination has been successful in several studies. Another approach that has been used clinically is 1 to 5 mg one hour before bedtime for two days prior to departure and for 2 to 3 days upon arrival at final destination.
  • Sarcoidosis: 20 mg per day for 4 to 12 months. Use of melatonin to treat this specific health condition should only be done under medical supervision. Do not take melatonin supplements long-term without consulting your healthcare provider.
  • depression: 0.125 mg twice in the late afternoon, each dose four hours apart (for example, 4 PM and 8 PM). People with depression tend to be particularly sensitive to the effects of melatonin -- meaning that a very low dose is generally enough to get the desired outcomes.

 


Precautions

Because of the potential for side effects and interactions with medications, dietary supplements should be taken only under the supervision of a knowledgeable healthcare provider.

Some people may experience vivid dreams or nightmares when they take melatonin. Overuse or incorrect use of melatonin could disrupt circadian rhythms. Melatonin can cause drowsiness if taken during the day. Individuals experiencing morning drowsiness after taking melatonin at night should take less of the supplement. Additional side effects that have been reported from melatonin include stomach cramps, dizziness, headache, irritability, decreased libido, breast enlargement in men (called gynecomastia), and decreased sperm count.

Melatonin could interfere with fertility and also should not be taken by pregnant or nursing women.

A 1973 study including only 4 people with depression found that melatonin supplements actually worsened symptoms of the condition. For this reason, individuals with depression should consult a healthcare practitioner before using melatonin supplements.

Although many researchers believe that levels of melatonin diminish with age, emerging evidence has brought this theory into question. Given these inconsistent findings, people older than 65 years of age should consult a healthcare practitioner before taking melatonin supplements so that blood levels of this hormone can be monitored appropriately.

 


Possible Interactions

If you are currently being treated with any of the following medications, you should not use melatonin without first talking to your healthcare provider.

antidepressant medications
In an animal study, melatonin supplements reduced the antidepressant effects of desipramine and fluoxetine. More research is needed to determine whether these effects would occur in people. In addition, fluoxetine (a member of a class of drugs called selective serotonin reuptake inhibitors or SSRIs) has led to measurable depletion of melatonin in people.

Antipsychotic Medications
A common side effect of antipsychotic medications used to treat schizophrenia is a condition called tardive dyskinesia, a movement disorder of the mouth characterized by a constant chewing motion and darting action of the tongue. In a study of 22 people with schizophrenia and tardive dyskinesia caused by antipsychotic medications, those who took melatonin supplements had significantly reduced mouth movements compared to those who did not take the supplements.

Benzodiazepines
The combination of melatonin and triazolam (a benzodiazepine medication used for the treatment of anxiety and sleep disorders) improved sleep quality in one study. In addition, there have been a few reports suggesting that melatonin supplements may help individuals stop using long-term benzodiazepine therapy. (Benzodiazepines are highly addictive.)

Blood Pressure Medications
Melatonin may reduce the effectiveness of blood pressure medications like methoxamine and clonidine. In addition, medications in a class called calcium channel blockers (such as nifedipine, verapamil, diltiazem, amlodipine, nimodipine, felodipine, nisoldipine, and bepridil) may decrease melatonin levels.


 


Use of beta-blockers (another class of high blood pressure medications including propranolol, acebutolol, atenolol, labetolol, metoprolol, pindolol, nadolol, sotalol, and timolol) may reduce melatonin production in the body.

Blood-thinning Medications, Anticoagulants
Melatonin may increase the risk of bleeding from anticoagulant medications such as warfarin.

Interleukin-2
In one study of 80 cancer patients, use of melatonin in conjunction with interleukin-2 led to more tumor regression and better survival rates than treatment with interleukin-2 alone.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
NSAIDs such as ibuprofen may reduce the levels of melatonin in the blood.

Steroids and Immunosuppressant Medications
Melatonin should not be taken with corticosteroids or other medications used to suppress the immune system because the supplement may cause them to be ineffective.

Tamoxifen
Preliminary research suggests that the combination of tamoxifen (a chemotherapy drug) and melatonin may benefit certain patients with breast and other cancers. More research is needed to confirm these results.

Other Substances
Caffeine, tobacco, and alcohol can all diminish levels of melatonin in the body while cocaine and amphetamines may increase melatonin production.

back to: Supplement-Vitamins Homepage


Supporting Research

Attele AS, Xie JT, Yuan CS. Treatment of insomnia: an alternative approach.Altern Med Rev. 2000;5(3):249-259.

Avery D, Lenz M, Landis C. Guidelines for prescribing melatonin. Ann Med. 1998;30(1):122-130.

Baumgaertel A. Alternative and controversial treatments for attention-deficit/hyperactivity disorder. Pediatr Clin N Am. 1999;46(5):977-992.

Bazil CW, Short D, Crispin D, Zheng W. Patients with intractable epilepsy have low melatonin, which increases following seizures. Neurology. 2000;55(11):1746-1748.

Bekaroglu M, Aslan Y, Gedik Y. Relationships between serum free fatty acids and zinc, and attention deficit hyperactivity disorder: a research note. J Child Psychol Psychiatry. 1996;37(2):225-227.

Ben-Nathan D, Maestroni GJ, Lustig S, Conti A. Protective effects of melatonin in mice infected with encephalitis viruses. Arch Virol. 1995;140(2):223-230.

Bonilla E, Valero-Fuenmayor N, Pons H, Chacin-Bonilla L. Melatonin protects mice infected with Venezuelan equine encephalomyelitis virus. Cell Mol Life Sci. 1997;53(5):430-434.

Brzezinski A. "Melatonin replacement therapy" for postmenopausal women: is it justified? Menopause. 1998;5:60-64.

Bylesjo I, Forsgren L, Wetterberg L. Melatonin and epileptic seizures in patients with acute intermittent porphyria. Epileptic Disord. 2000;2(4):203-208.

Cagnoni ML, Lombardi A, Cerinic MC, Dedola GL, Pignone A. Melatonin for treatment of chronic refractory sarcoidosis [letter]. Lancet. 1995;346(4):1299-1230.

Carman JS, Post RM, Buswell R, Goodwin FK. Negative effects of melatonin on depression. Am J Psychiatry. 1976;133:1181-1186.

Cauffield JS, Forbes HJ. Dietary supplements used in the treatment of depression, anxiety, and sleep disorders. Lippincotts Prim Care Pract. 1999; 3(3):290-304.

Chase JE, Gidal BE. Melatonin: Therapeutic use in sleep disorders. Ann Pharmacother. 1997;31:1218-1225.


 


Coker KH. Meditation and prostate cancer: integrating a mind/body intervention with traditional therapies. Sem Urol Onc. 1999;17(2):111-118.

Cornelissen G, Halberg F, Burioka N, Perfetto F, Tarquini R, Bakken EE. Do plasma melatonin concentrations decline with age? Am J Med. 2000;109(4):343-345.

Cos S, Sanchez-Barcelo EJ. Melatonin and mamary pathological growth. Frontiers Neuroendo. 2000;21:133-170.

Cos S, Sanchez-Barcelo EJ. Melatonin, experimental basis for a possible application in breast cancer prevention and treatment. Histo Histopath. 2000;15:637-647.

Dagan Y, Zisapel N, Nof D, et al. Rapid reversal of tolerance to benzodiazepine hypnotics by treatment with oral melatonin: a case report. Eur Neuropsychopharmacol. 1997;7(2):157-160.

Dreher F, Denig N, Gabard B, Schwindt DA, Maibach HI. Effect of topical antioxidants on UV-induced erythema formation when administered after exposure. Dermatology. 1999;198(1):52-55.

Dreher F, Gabard B, Schwindt DA, Maibach HI. Topical melatonin in combination with vitamins E and C protects skin from ultraviolet-induced erythema: a human study in vivo. Br J Dermatol. 1998;139(2):332-339.

Eck-Enriquez K, Kiefer TL, Spriggs LL, Hill SM. Pathways through which a regimen of melatonin and retinoic acid induces apoptosis in MCF-7 human breast cancer cells. Breast Cancer Res Treat. 2000;61(3):229-239.

Fauteck J, Schmidt H, Lerchl A, Kurlemann G, Wittkowski W. Melatonin in epilepsy: first results of replacement therapy and first clinical results. Biol Signals Recept. 1999;8(1-2):105-110.

Ferini-Strambi L, Zucconi M, Biella G, et al. Effect of melatonin on sleep microstructure: preliminary results in healthy subjects. Sleep. 1993;16(8):744-747.

Forsling ML, Wheeler MJ, Williams AJ. The effect of melatonin administration on pituitary hormone secretion in man. Clin Endocrinol (Oxf). 1999;51(5):637-642.

Fraschini F, Demartini G, Esposti D, Scaglione F. Melatonin involvement in immunity and cancer. Biol Signals Recept. 1998;7(1):61-72.

Garfinkel D, Laundon M, Nof D, Zisapel N. Improvement in sleep quality in elderly people by controlled-release melatonin (see comments). Lancet. 1995;346(8974):541-544.

Garfinkel D, Zisapel N, Wainstein J, Laudon M. Facilitation of benzodiazepine discontinuation by melatonin: a new clinical approach. Arch Intern Med. 1999;159(8):2456-2460.

Gibb JW, Bush L, Hanson GR. Exacerbation of methamphetamine-induced neurochemical deficits by melatonin. J Pharmacol and Exp Ther. 1997;283:630-635.

Gordon N. The therapeutics of melatonin: a paediatric perspective. Brain Dev. 2000;22(4):213-217.

Haimov I, Laudon I, Zisapel N, Souroujon M, Nof D, Shiltner A, et al. Sleep disorders and melatonin rhythms in elderly people. BMJ. 1994(9120);309:167.

Herxheimer A, Petrie KJ. Melatonin for preventing and treating jet lag. Cocharane Database Syst Rev. 2001;(1):CD001520.

Jacobson JS, Workman SB, Kronenberg F. Research on complementary/alternative medicine for patients with breast cancer: a review of the biomedical literature. J Clin Onc. 2000;18(3):668-683.

Jan JE, Espezel H, Appleton RE. The treatment of sleep disorders with melatonin. Dev Med Child Neurol. 1994;36(2):97-107.

Jan JE, Espezel H, Freeman RD, Fast DK. Melatonin treatment of chronic sleep disorders. J Child Neurol. 1998; 13(2):98.

Kaneko S, Okumura K, Numaguchi Y, Matsui H, Murase K, Mokuno S, et al. Melatonin scavenges hydroxyl radical and protects isolated rat hearts from ischemic reperfusion injury. Life Sciences. 2000;67(2):101-112.

Kennedy SH. Melatonin disturbances in anorexia nervosa and bulimia nervosa. Int J Eating Disord. 1994;16:257-265.

Kirkwood CK. Management of insomnia. J Am Pharm Assoc. 1999;39(1):688-696.

Lagneux C, Joyeux M, Demenge P, Ribuot C, Godin-Ribuot D. Protective effects of melatonin against ischemia-reperfusion injury in the isolated rat heart. Life Sciences. 2000;66(6):503-509.

Lewy AJ, Bauer VK, Cutler NL, Sack RL. Melatonin treatment of winter depression: a pilot study. Psych Res. 1998;77(1):57-61.

Lissoni P, Barni S, Meregalli S, Fossati V, Cazzaniga M, Esposti D, Tancini G. Modulation of cancer endocrine therapy to melatonin: a phase II study of tamoxifen plus melatonin in metastatic breast cancer patients progressing under tamoxifen alone. Br J Cancer. 1995;71(4):854-856.

Lissoni P, Barni S, Tancini G, Ardizzoia A, Ricci G, Aldeghi R, et al. A randomised study with subcutaneous low-dose interleukin 2 alone vs interleukin 2 plus the pineal neurohormone melatonin in advanced solid neoplasms other than renal cancer and melanoma. Br J Cancer. 1994;69(1):196-199.

Lissoni P, Cazzaniga M, Tancini G, Scardino E, Musci R, Barni S, Maffezzini M, Meroni T, Rocco F, Conti A, Maestroni G. Reversal of clinical resistance to LHRH analogue in metastatic prostate cancer by the pineal hormone melatonin: efficacy of LHRH analogue plus melatonin in patients progressing on LHRH analogue alone. Eur Urol. 1997;31(2):178-181.

Lissoni P, Paolorossi F, Tancini G, et al. A phase II study of tamoxifen plus melatonin in metastic solid tumour patients. Br J Cancer. 1996;74(9):1466-1468.

Lissoni P, Paolorossi F, Tancini G, Barni S, Ardizzoia A, Brivio F, Zubelewicz B, Chatikhine V. Is there a rold for melatonin in the treatment of neoplastic cachexia? Eur J Cancer. 1996;32A(8):1340-1343.

Lissoni P, Tancini G, Barni S, Paolorossi F, Ardizzoia A, Conti A, Maestroni G. Treatment of cancer chemotherapy-induced toxicity with the pineal hormone melatonin. Support Care Cancer. 1997;5(2):126-129.

Lissoni P, Tancini G, Paolorossi F, Mandala M, Ardizzoia A, Malugani F, et al. Chemoneuroendocrine therapy of metastatic breast cancer with persistent thrombocytopenia with weekly low-dose epirubicin plus melatonin: a phase II study. J Pineal Res. 1999;26(3):169-173.

Lissoni, P, Vigore L, Rescaldani R, et al. Neuroimmunotherapy with low-dose subcutaneous interleukin-2 plus melatonin in AIDS patients with CD4 cell number below 200/mm3: a biological phase-II study. J Biol Regul Homeost Agents. 1995;9:155 - 158.

Low Dog T, Riley D, Carter T. Traditional and alternative therapies for breast cancer. Alt Ther. 2001;7(3):36-47.

Lusardi P, Piazza E, Fogari R. Cardiovascular effects of melatonin in hypertensive patients well controlled by nifedipine: a 24-hour study. Br J Clin Pharmacol. 2000;49(5):423-7.

MacIntosh A. Melatonin: clinical monograph. Q Rev Nat Med. 1996; 47 - Å“60.

Manev H, Uz T. Oral melatonin in neurologicaly disabled children [letter]. Lancet. 1998;351:1963.

Massion AO, Teas J, Hebert JR, Wertheimer MD, Kabat-Zinn J. Meditation, melatonin and breast/prostate cancer: hypothesis and preliminary data. Med Hypo. 1995;44:39-46.

Moretti RM, Marelli MM, Maggi R, Dondi D, Motta M, Limonta P. Antiproliferative action of melatonin on human prostate cancer LNCaP cells. Oncol Rep. 2000;7(2):347-351.

Munoz-Hoyos A, Sanchez-Forte M, Molina-Carballo A, Escames G, Martin-Medina E, Reiter RJ, et al. Melatonin's role as an anticonvulsant and neuronal protector: experimental and clinical evidence. J Child Neurol. 1998;13(10):501-509.

Murphy P, Myers B, Badia P. NSAIDs suppress human melatonin levels. Am J Nat Med. 1997; iv: 25.

Nagtagaal JE, Laurant MW, Kerkhof GA, Smits MG, van der Meer YG, Coenen AM. Effects of melatonin on the quality of life in patients with delayed sleep phase syndrome. J Psychosom Res. 2000;48(1):45-50.

Neri B, de Leonardis V, Gemelli MT, di Loro F, Mottola A, Ponchietti R, Raugei A, Cini G. Melatonin as biological response modifier in cancer patients. Anticancer Res. 1998;18(2B):1329-1332.

Oosthuizen JM, Bornman MS, Barnard HC, Schulenburg GW, Boomker D, Reif S. Melatonin and steroid-dependent carcinomas. Andrologia. 1989;21(5):429-431.

Partonen T. Short note: melatonin-dependent infertility. Med Hypotheses. 1999;52(5):487-488.

Peled N, Shorer Z, Peled E. Pillar G. Melatonin effect on seizures in children with severe neurologic deficit disorders. Epilepsia. 2001;42(9):1208-1210.

Petrie K, Conaglen JV, Thompson L, Chamberlain K. Effect of melatonin on jet lag after long haul flights. BMJ. 1989;298:705 - 707.

Pillar G, Shahar E, Peled N, Ravid S, Lavie P, Etzioni A. Melatonin improves sleep-wake patterns in psychomotor retarded children. Pediatr Neurol. 2000;23(3):225-228.

Ram PT, Yuan L, Dai J, Kiefer T, Klotz DM, Spriggs LL, et al. Differential responsiveness of MCF-7 human breast cancer cell line stocks to the pineal hormone, melatonin. J Pineal Res. 2000;28(4):210-218.

Rommel T, Demisch L. Influence of chronic beta-adrenoreceptor blocker treatment on melatonin secretion and sleep quality in patients with essential hypertension. J Neural Transm Gen Sect. 1994;95:39-48.

Roth JA, Kim B-G, Lin W-L, Cho M-I. Melatonin promotes osteoblast differentiation and bone formation. J Biol Chem. 1999;274:22041-22047.

Sack RL, Brandes RW, Kendall AR, Lewy AJ. Entrainment of free-running circadian rhythms by melatonin in blind people. N Engl J Med. 2000;343(15):1070-1077.

Sack RL, Hughes RJ, Edgar DM, Lewy AJ. Sleep-promoting effects of melatonin: at what dose, in whom, under what conditions, and by what mechanisms? Sleep. 1997;20(10):908-915.

Sakotnik A, Liebmann PM, Stoschitzky K, Lercher P, Schauenstein K, Klein W, et al. Decreased melatonin synthesis in patients with coronary artery disease. Eur Heart J. 199;20(18):1314-1317.

Shamir E, Barak Y, Shalman I, Laudon M, Zisapel N, Tarrasch R, et al. Melatonin treatment for tardive dyskinesia: a double-blind, placebo-controlled, crossover study. Arch Gen Psych. 2001;58(11):1049-1052.

Shamir E, Laudon M, Barak Y, Anis Y, Rotenberg V, Elizur A, Zisapel N. Melatonin improves sleep quality of patients with chronic schizophrenia. J Clin Psychiatry. 2000;61(5):373-377.

Shannon M. Alternative medicines toxicology: a review of selected agents. Clin Tox. 1999;37(6):709-713.

Sheldon SH. Oral melatonin in neurologicaly disabled children [letter]. Lancet. 1998;351(9120):1964.

Sheldon SH. Pro-convulsant effects of oral melatonin in neurologically disabled children[letter]. Lancet. 1998;351(9111):1254.

Skene DJ, Lockley SW, Arendt J. Use of melatonin in the treatment of phase shift and sleep disorders. Adv Exp Med Biol. 1999;467:79-84.

Smits MG, Nagtegaal EE, van der Heijden J, Coenen AM, Kerkhof GA. Melatonin for chronic sleep onset insomnia in children: a randomized placebo-controlled trial. J Child Neurol. 2001;16(2):86-92.

Spitzer RL, Terman M, Williams JB, Terman JS, Malt UF, Singer F, et al. Jet lag: clinical features, validation of a new syndrome-specific scale, and lack of response to melatonin in a randomized, double-blind trial. Am J Psych. 1999;156(9):1392-1396.

Stewart LS. Endogenous melatonin and epileptogenesis: facts and hypothesis. Int J Neurosci. 2001;107(1-2):77-85.

Stoschitzky K, Sakotnik A, Lercher P, Zweiker R, Maier R, Liebmann P, Lindner W. Influence of beta-blockers on melatonin release. Eur J Clin Pharmacol. 1999;55(2):111-115.

Tzischinsky O, Lavie P. Melatonin possesses time-dependent hypnotic effects. Sleep. 1994;17:638 - 645.

van Wijingaarden E, Savitz DA, Kleckner RC, Cai J, Loomis D. Exposure to electromagnetic fields and suicide among electric utility workers: a nested case-control study. West J Med. 2000;173;94-100.

Wagner DR. Circadian rhythm sleep disorders. Curr Treat Opt Neurol. 1999;1(4):299-308.

Wagner J, Wagner ML, Hening WA. Beyond benzodiazepines: alternative pharmacologic agents for the treatment of insomnia. Ann Pharmacother. 1998; 32:680-691.

Walsh HA, Daya S. Influence of the antidepressants desipramine and fluoxetine on tryptophan-2,3-dioxygenase in the presence of exogenous melatonin. Life Sci. 1998;62(26):2417-2423.

Weekley LB. Melatonin-induced relaxation of rat aorta: Interaction with adrenergic agonists. J Pineal Res. 1991;11:28-34.

West Sk, Oosthuizen JM. Melatonin levels are decreased in rheumatoid arthritis. J Basic Clin Physiol Pharmacol. 1992;3(1):33-40.

Wurtman RJ, Zhdanova II. Oral melatonin in neurologicaly disabled children [letter]. Lancet. 1998;351(9120):1963-1964.

Zawilska JB, Nowak JZ. Melatonin: from biochemistry to therapeutic applications. Pol J Pharm. 1999;51:3-23.

Zeitzer JM, Daniels JE, Duffy JF, Klerman EB, Shanahan TL, Dijk DJ et al. Do plasma melatonin concentrations decline with age? Am J Med. 1999;107(5):432-436.

Zhdanova IV, Wurtman RJ, Morabito C, Piotrovska VR, Lynch HJ. Effects of low oral doses of melatonin, given 2-4 hours before habitual bedtime, on sleep in normal young humans. Sleep. 1996;19:423 - 431.

Zhdanova IV, Wurtman RJ, Lynch HJ, et al. Sleep-inducing effects of low doses of melatonin ingested in the evening. Clin Pharmacol Ther. 1995; 57:552 - Å“558.

back to: Supplement-Vitamins Homepage

APA Reference
Staff, H. (2008, December 21). Melatonin, HealthyPlace. Retrieved on 2024, March 29 from https://www.healthyplace.com/alternative-mental-health/supplements-vitamins/melatonin

Last Updated: July 10, 2016

Eating Disorders: Muscle Dysmorphia in Men

Pumped-Up Physically/Deflated Emotionally: The Heartbreak of Muscle Dysmorphia

For some men, their focus on muscularity goes much too far, leaving these men chronically dissatisfied with their size and appearance and affecting their lives.Muscularity is "in" today; pick up a magazine or turn on your television, and images of densely-muscled demi-gods with astoundingly broad shoulders and massive biceps are presented as the ultimate in masculinity.

Of course, many men (and women) are focused on eating "right" and getting sufficient exercise to enhance their physical and emotional well-being. Understandably, they also appreciate the byproduct of these efforts in the form of a toned if not robustly-healthy appearance.

For some men, however, their focus on muscularity goes much too far, taking time and attention away from other pursuits and leaving these men chronically dissatisfied with their size and appearance.

In the August 2000 issue of the American Journal of Psychiatry, Roberto Olivardia, Harrison G. Pope, Jr., and James I. Hudson from McLean Hospital present the first case-control study of this phenomenon, which they have labeled "muscle dysmorphia."

Two Varieties of Muscle-Mindedness

Olivardia and colleagues characterize muscle dysmorphia as a chronic preoccupation with the belief that one is not sufficiently muscular. This preoccupation results in marked subjective distress, serious impairment in social and occupational functioning and, for some, use of anabolic-androgenic steroids to facilitate muscle growth, risking adverse medical and psychiatric consequences.

In this study, 24 men with muscle dysmorphia were compared on a variety of psychiatric, physical, and demographic measures with 30 weightlifters who did not meet criteria for this condition (i.e., spending more than 30 minutes daily preoccupied with thoughts that they were too small or insufficiently muscular; avoiding social situations for fear of appearing too small or refusing to appear shirtless in public; and giving up enjoyable activities as a result of this preoccupation). In addition to comparisons between these two groups, the authors conducted a post-study comparison involving these two groups and 25 college men with and 25 college men without eating disorders who were evaluated with virtually identical instruments in an earlier study.

Is Muscle Dysmorphia a Distinct Disorder?

Interestingly, the authors found important differences between the dysmorphic and non-dysmorphic groups on measures of body dissatisfaction, eating attitudes, the use of anabolic steroids, and lifetime prevalence of DSM-IV diagnosable disorders involving anxiety (29% of the dysmorphic group vs. 3% of the non-dysmorphic group), mood (58% vs. 20%), and eating (29% vs. 0%). The onset of these DSM-IV disorders occurred both before and after the development of muscle dysmorphia, suggesting that the latter disorder is distinct from these others but likely rooted in the same underlying genetic or environmental factors that predispose individuals to their development.

And yet, while there may be important experiences from childhood and family life that contribute to this phenomenon, there were few differences between the dysmorphic and non-dysmorphic groups on measures of family history, physical and/or sexual abuse in childhood, and sexual orientation and behavior.

From a phenomenological standpoint, these researchers found that muscle dysmorphia appears quite similar to the eating disorders. In their post-study comparison, they found that men with muscle dysmorphia resembled men with eating disorders in many respects, while the normal weightlifters resembled men without eating disorders. Olivardia, Pope, and Hudson conclude that there are striking parallels between the pursuit of "bigness" and the pursuit of thinness, both with regard to psychological make-up as well as their emergence as a response to sociocultural pressures concerning appearance.

The authors further conclude that muscle dysmorphia is a distinct and valid diagnostic entity. It is not yet clear, however, whether muscle dysmorphia is part of the obsessive-compulsive disorder spectrum (as are the other forms of body dysmorphia) or more closely related to affective disorders. This classification question is important in so far as treatment recommendations are concerned, since this disorder would likely respond to those treatments effective for the disorders to which this one is related (e.g., cognitive-behavioral therapy for anxiety disorders; antidepressant medications and therapy for depressive disorders).

Source: Olivardia, R., Pope, H.G. Jr., & Hudson, J.I. (2000). Muscle dysmorphia in male weightlifters: A case-control study. American Journal of Psychiatry, 157(8), 1291-1296.

next: American Academy of Pediatrics: Identifying and Treating Eating Disorders
~ eating disorders library
~ all articles on eating disorders

APA Reference
Staff, H. (2008, December 21). Eating Disorders: Muscle Dysmorphia in Men, HealthyPlace. Retrieved on 2024, March 29 from https://www.healthyplace.com/eating-disorders/articles/eating-disorders-muscle-dysmorphia-in-men

Last Updated: January 14, 2014

Assessment for ADD-ADHD Adults in the UK

In the UK, it's not easy getting an assessment for adult ADHD. And if you do, there are some doctors who don't believe in adult ADHD.

Assessment for ADD/ADHD in adults is still very difficult in the UK. There are only 2 NHS Clinics, one at the Maudsley Hospital in London and one at Addenbrooks Hospital in Cambridge. They will only take referrals from a local health service provider- GP or consultant Psychiatrist. This means that they will not take self-referrals or contacts before a referral.

Preparing for an ADHD Assessment in the UK

The first step is to speak to your GP and ask for a referral to your local Psychiatrist- there are waiting lists, which can vary in length in each area.

Once you have a referral and an appointment has been made, you do need to be prepared.

Gather together up-to-date information including the diagnostic criteria for ADHD in adults and some up-to-date research and if possible some old school reports and some evidence of why you feel you do fit the diagnostic criteria for ADHD. Try to keep some sort of diary of how the ADD-ADHD symptoms affect you and how they disrupt your daily life.

Some Psychiatrists Don't Believe in Adult ADHD

There are still many adult psychiatrists who believe that children outgrow ADD/ADHD and are therefore very sceptical of the condition in adults. It is therefore quite possible that they will disregard any mention of a referral for assessment of ADD/ADHD.

Below are some quotes from professionals who were asked about the prevalance of ADD/ADHD in adults. They're very interesting and may help when trying to get the professionals to take notice of what you are saying.

"The estimated rates of persistence of ADHD into adulthood range between 50 - 60% (Faraone, Biederman,et: Attention Deficit Hyperactivity Disorder in Adults; An Overview. iBiological Psychiatry, 2000;489-20). In practice however, the rates seem to be much higher." Ricardo Castaneda, MD, NYU/Bellevue

"The problem comes out of semantics. I think of ADHD as a genetic disorder which some circumstantial issues can mimic (alcohol and drugs in utero, concussions, lead poisoning, drug abuse) thus creating 'pseudo-ADHD.' In this view, you are correct: it is 100% persistent. No one who truly has ADHD 'gets rid' of it till there is a way to exchange chromosomes. Some adults cope with it better than others (so do some children!) and don't 'need' medication or coaching or education or structure or or or... You can see where this goes--who could not use a little better structure or organization? Who defines how good of coping is 'good enough?' What those people are saying when they say X% of ADHD patients have the disorder is that, by the standards of the one judging it, (100-X)% of ADHD patients are doing well enough that they don't need help (again, what is 'help'?--would they suddenly develop ADHD again if you took their secretary and Microsoft Outlook away from them?)"

"On the other hand, if you define ADHD by function, you have a moving target that is about as easy to pin down as to nail the proverbial Jell-O blob to a tree. I go with the 100%." John I. Bailey, Jr., M.D., Center for Attention & Learning, Mobile, AL.

This is when they will look into many other conditions and this is then when you need to politely suggest that they read the literature you have with you and ask if they would at least consider the up-to-date evidence. You may also ask if they can get in touch with one of the NHS Clinics to discuss things further before dismissing the referral request completely. Hopefully, after this (it may mean a 2nd appointment to give them time to look through things), they will try to be helpful and look into a referral. Bear in mind even if they do believe in the condition, they still have to get the authority of the local health authority to refer you to one of the clinics. So there may still be problems with obtaining the referral. Don't blame them directly if this is the case, but talk to them and see how you could maybe help to get the authority to understand the condition in your area.

What To Do When the Doctor Doesn't Believe in Adult ADHD

If, however, the local Psychiatrist still does not believe in the condition after reading the evidence, then you may have to get in touch with the local Health Authority directly.

If you do have to contact the local Health Authority either because the Psychiatrist will not consider a referral or if the Authority has told the Psychiatrist that they cannot refer you then you can start by writing direct to the Director for Mental Health Services at your local Authority or Trust. The best thing would be to get in touch with your local PALS and ask for the contact name for the Director of Mental Health Services and also where they are based so that you can write to them direct.

You need to start by explaining the problem, that you have asked for a referral for an assessment of ADD/ADHD and the local service providers have not agreed to refer you to one of the NHS Adult ADD/ADHD Clinics and that you feel that you do fit the Diagnostic Criteria and that you do not fit the criteria for other Mental Health conditions. Say you are requesting them to look into the problem and for them to arrange the referral for you, explain that you accept that if after an assessment by a doctor at the clinic they say that you do not fit the criteria you would at least appreciate the referral to at least know for sure that this is not the cause of your problems.

It is worth remembering at this point that you try to ensure that you point out the problem and what you want the person you are writing to do in the first paragraph and then maybe go on to give the evidence as to why in the following paragraphs - these are busy people so need to have a good idea in the first paragraph of any correspondence as it is more difficult if they have to read through reams to get to the point of the letter.

It is also worth enclosing evidence such as that prepared for the local Psychiatrist - Diagnostic Criteria, up-to-date information, up-to-date research and any personal evidence including old school reports if you have them. However, in the main body of the correspondence, keep things simple and to the point. It is therefore worth writing something like the following where you mention things and enclose them separately i.e.




"I am requesting a referral for an assessment of ADD/ADHD at one of the two ADD/ADHD NHS Clinics1 as I feel I fit the Diagnostic Criteria2 and have enclosed evidence to this effect3 and some up to date information4 and research5. Then at the bottom of the letter list the items enclosed:

1 Name of Clinics
2 Diagnostic Criteria
3 Personal diary type of evidence and/or school reports
4 Information
5 Research

Make sure you also number the pages you enclose so that they match the list you have in the letter.

If you do not get any response in a couple of weeks, either an acknowledgement that your letter has been received, or that the person you wrote to is looking into your problem and they will get back to you when they have completed their investigations, write back to them asking if they received your initial correspondence and if they have been able to read the enclosed documents and ask how they will be able to progress with your request for a referral for assessment. You are entitled to at least ask for an initial reply within a certain time frame - maybe 2 weeks. This at least gives them time to acknowledge they have received the request.

It is also worth at this time considering sending copies of all correspondence to various other members of the Health Authority, i.e. Director for Psychiatrist Services, the Trust Director, Director of Mental Health Nursing, Director of Psychology Services, Director of Patient Services (you can get the contact names and addresses from your local PALS so that you can address all correspondence direct to the person rather than just an office where it may not get to the right person) and maybe also your local MP. Remember to send a covering letter to each and also to enclose all the attachments you enclosed in the first main correspondence all listed correctly. You also need to remember to list at the bottom of each letter all those you have sent carbon copies to i.e. c.c. Name local MP.

If you continue to get no response to any of your correspondence keep going, don't give up. Give it another couple of weeks and then write again to all those you wrote to asking if they have received your letter and how they are going to look into the situation for you. It may be then also worth making an appointment to see your local MP or Patient Liaison people.

Even if it seems you are not getting anywhere DON'T GIVE UP in the end you will be able to get the help and services you are looking for. Try not to get too frustrated with the services - at least try not to let it showJ and try to make those you write to know that even if after an assessment it is found that you do not receive a diagnosis that you will accept this but what you are asking for is the opportunity to at least have the correct assessment by a specialist who is experienced in the condition rather than one who is not, to confirm or rule out the diagnosis of ADD/ADHD.

The Private Option

There is also the private option, there are a number of private consultants who are experienced in ADD/ADHD and some will take NHS referrals ad work with your local Authority. The best thing to do is to get in touch with a local support group, as they will know if there is anyone in your area or at least the contacts for some specialists in adult ADD/ADHD who will be able to help.

It is also worth considering that if you do receive a diagnosis from an experienced private consultant you may be able to recover costs from your local NHS Trust if it can be proven that they have not been willing to consider an assessment by a qualified experienced consultant on the NHS.


 


 

APA Reference
Staff, H. (2008, December 21). Assessment for ADD-ADHD Adults in the UK, HealthyPlace. Retrieved on 2024, March 29 from https://www.healthyplace.com/adhd/articles/assessment-for-add-adhd-adults-in-the-uk

Last Updated: May 7, 2019

Painful Legacy of Divorce Breakup's Effect On Children Often Reaches Far into Adulthood

Says book based on 25-year study

You may feel as if you grew up on a desert island, far from the mysterious world of lasting romantic love.

You may believe that even if you do fall in love, you are destined to jinx the relationship, or be abandoned, or be terribly hurt.

You may fear conflict and change and have a tough time separating from your parents, even though you left home years ago.

A new book, based on a lengthy study, argues that emotional complications like these are common among adult children of divorced parents -- and that they may not be fully evident until decades after the breakup.

"The Unexpected Legacy of Divorce,'' by Marin County psychologist Judith Wallerstein, San Francisco State University psychology professor Julia M. Lewis and New York Times science correspondent Sandra Blakeslee, is based on a 25-year examination of the lives of 93 Marin County adults.

Wallerstein, founder of the Center for the Family in Transition in Corte Madera, began examining this group in 1971, when they were children and adolescents. Now they are between the ages of 28 and 43.

Initially, researchers expected that the study findings would be different -- that the most stressful time for the children would come right after the divorce.

Instead, they found that post-divorce difficulties become most severe when the children of divorced parents reach adulthood, as their search for lasting commitment moves to center stage.

"They are terrified because they are convinced they are going to fail,'' said Wallerstein in a telephone interview from Massachusetts, where she was on tour promoting the book. "They don't know how to choose. They make bad choices. They divorce a lot.''

hp-relationships-01"It breaks their hearts,'' she said. ``They don't take marriage lightly, but they don't know how to do it.'' Many of the study participants said that seriously searching for a life partner felt like going through their parents' divorce all over again.

The findings are not without critics. Some experts question how many of the problems Wallerstein identifies can be truly attributed to divorce and not to other causes such as poor parenting skills.

"There are a lot of other family processes associated with divorce, like the extent to which parents support or undermine each other,'' said Gayla Margolin, a professor of psychology at the University of Southern California, who studies the effects of marital conflict on children.


 


Others question the reliability of a study based on such a narrow sample, or say the effect of divorce is not as wrenching as the study concludes.

Mavis Hetherington, a sociology professor emeritus at the University of Virginia who also studies divorce, said her studies have shown that although children of divorced parents do have more problems, the majority of them function well.

"Judy really views divorce as a terminal disease. That's just not true. When kids move into a happier family situation with a competent, caring, firm parent they do better than they do in a nasty family situation,'' Hetherington told the Associated Press.

The book's researchers say they are not opposed to divorce. Indeed, they argue that children raised in highly dysfunctional marriages were no better off -- and sometimes worse off -- than children of divorced parents.

Rather, what the study shows is that parents, society and the courts need to pay closer attention to the consequences of divorce on children, said Lewis, who began working with Wallerstein about 10 years into the study.

For example, none of the child- support arrangements made by the divorcing parents included provisions to pay for the children's college educations, and few of the young people in the study received money for college from their fathers, many of whom were wealthy professionals.

"One of the main findings of the book is that what makes adults happier isn't necessarily what makes kids happier. That, I think, is hard for a lot of adults to swallow,'' Lewis said.

Although some of the divorced parents in the study did go on to lead happier lives, that did not translate into happier lives for the children, Lewis said.

"If you're in a middling marriage where it could go either way, you have to look at the quality of the parenting,'' she said. "If you're both pretty good parents and you're putting the kids first, then you work harder to save that marriage. That's really what we're trying to get across.''

Today, a quarter of Americans ages 18 to 44 are children of divorced parents, and Wallerstein said her latest book is meant primarily for these people, who may be struggling with problems they do not even know are related to divorce.

Wallerstein found that these otherwise well-functioning adults must fight to overcome such feelings as a fear of loss because of childhood anxiety about abandonment or fear of conflict because it leads to emotional explosions.

The study, based on extensive individual interviews, also found that adult children of divorced parents are more likely to become addicted to drugs and alcohol in adolescence, and they seldom match their parents' educational and economic achievements by the time they reach their 20s.

Their adolescence lasted longer, the study found, because the children were so preoccupied with their parents. For example, Wallerstein said, many girls end up fearing success, thinking: "How can I have a happy life when my mother or father has been unhappy?''


On the positive side, the researchers found that the adult children of divorced parents are survivors.

The same experiences that hindered relationships helped in the workplace. The study participants were very good at getting along with difficult people, Wallerstein said. And with mothers who often said one thing and fathers who said another, the grown children also became adept at making up their own minds.

The study also compared the adults from divorced families to 44 adults from intact families.

Children of intact marriages took strength from their parents' decision to stay together, the researchers found, even though the marriage may have had conflict and unhappiness similar to those of families that broke up.

"In intact marriages, the young people had a much different childhood -- this is what startled me,'' Wallerstein said. "I couldn't get them to stop talking about their play. . . . I realized that children divorced families never mentioned play. They all said that `the day my parents divorced was the day my childhood ended.' '' FACTS ABOUT DIVORCE

-- More than 25 percent of Americans between 18 and 44 were children of divorce.

-- One-half of people marrying in the 1990s were getting married for the second time.

-- Eighty percent of divorces occur by the ninth year of marriage.

FINDINGS FROM THE WALLERSTEIN STUDY:

A landmark study on the long-term effects of divorce by Marin County psychologist Judith Wallerstein followed 93 children of divorce over 25 years. Among the study's findings:


 


-- Children of divorce were far more likely than children of intact families to marry before age 25 -- 50 percent versus 11 percent.

-- The failure rate of these early marriages was 57 percent for children of divorce, 11 percent for children of intact families.

-- Among the adult children of divorce, 38 percent had children. Among adult children from intact families, 61 percent had children.

-- The use of drugs and alcohol before age 14 among the children of divorce was 25 percent, while among children of intact families it was 9 percent.

Source: "The Unexpected Legacy of Divorce: A 25-year Landmark Study" (Hyperio, 2000)

This story appeared in the San Francisco Chronicle - Sept. 2000.

next: Analyzing Feelings When A Relationship Ends

APA Reference
Staff, H. (2008, December 21). Painful Legacy of Divorce Breakup's Effect On Children Often Reaches Far into Adulthood, HealthyPlace. Retrieved on 2024, March 29 from https://www.healthyplace.com/relationships/main/painful-legacy-of-divorce-breakups-effect-on-children-often-reaches-far-into-adulthood

Last Updated: March 25, 2016