Do Herbs Work Against ADHD?

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I believe this is a topic that many care about. I've tried to find scientific view and here's what I found. The contents below is from the study of James Ahn, Hyung Seok Ahn, Jae Hoon Cheong, and Ike dela Peña on natural product-derived treatment on ADHD, published in Feb, 2016.

Pycnogenol® (French Maritime Pine Bark Extract)

Pycnogenol is a standardized extract derived from the bark of the French maritime pine (Pinus pinaster). This extract is rich in catechin, phenolic acids, procyanidins, and taxifolin, each with multiple biologic effects. Several studies on Pycnogenol showed its potentiality in improving ADHD symptoms in patients. Most notably, a double-blind, placebo-controlled trial with 61 participants (ages 6–14 years) reported that Pycnogenol treatment (1 mg/kg/day) for 1 month alleviated ADHD symptoms, particularly episodic hyperactivity and inattentiveness, and improved visual-motor coordination. One month after termination of Pycnogenol, there was a relapse of symptoms in ADHD participants. The latter study also assumed that Pycnogenol's therapeutic benefits were mediated via an increase in nitric oxide production, which modulates dopamine and norepinephrine release and intake. Pycnogenol reportedly produced mild side effects such as gastric discomfort. Nevertheless, the relatively small number of participants treated with Pycnogenol and the short duration of the study limit the generalization of the study's findings. It is noteworthy, however, that significant effects of Pycnogenol were observed, coupled with minimal side effects, supporting the suggestion that it could be used as an alternative ADHD treatment.

Another randomized, placebo-controlled study investigating efficacy of Pycnogenol reported improvement in attention along with reduction in oxidative DNA damage and normalization of homeostatic antioxidant status in ADHD patients treated for 1 month with the compound. A month after Pycnogenol treatment, the total antioxidant status (TAS) was increased in ADHD children (ADHD children showed lower TAS levels at the beginning of the study compared with healthy controls) and was significantly elevated after 1 month of termination of Pycnogenol treatment. Oxidative stress is believed to be a contributing factor to the etiology of ADHD. The improvement of ADHD symptoms in ADHD patients given Pycnogenol has been attributed to the drug's potent antioxidant effects. Some ancillary benefits of Pycnogenol were normalization of the concentration of urinary catecholamines in children with ADHD and improvement in cerebral blood flow to regions of the brain implicated in this disorder. Of note, neither Pycnogenol nor the positive control, methylphenidate, outperformed placebo on any ADHD rating scale. In summary, Pycnogenol is a promising botanical alternative in the management of ADHD symptoms, although more studies are required before it can be used as an ADHD treatment.

St. John's Wort


This herb “Hypericum perforatum,” while best known for its antidepressant qualities, was found to have beneficial effects on other psychiatric disorders, including obsessive compulsive disorder, major and bipolar depression, somatization disorder, and social phobia. It has been suggested that the mechanism by which St. John's wort produces its therapeutic effects involves inhibition of the reuptake of dopamine, serotonin, and norepinephrine. A preliminary study reported improvement in ADHD symptoms of 3 ADHD patients (ages 14–16) given St. John's wort. However, a more stringent randomized, double-blind, placebo-controlled trial found that 8 weeks of St. John's wort treatment (300 mg/day) did not alleviate ADHD symptoms in 54 ADHD patients (aged 6–17). In light of these findings, more studies are required to determine efficacy of St. John's wort in the treatment of ADHD. While the above studies did not report adverse effects of St. John's wort, investigations on the safety of this treatment are still necessary.

Ginseng

Ginseng contains ginsenosides, a class of phytochemicals with neuroprotective and antioxidant effects. Ginseng has also been reported to improve ADHD symptoms. In addition, ginsenosides are reported to elevate levels of dopamine and norepinephrine; hence, they could potentially be used to treat ADHD. Ginseng's therapeutic benefits in ADHD were confirmed in an observational study involving ADHD participants (18 kids, ages 6–14) given Korean red ginseng (KRG, Panax ginseng) twice per day for 8 weeks (1,000 mg twice daily). In this study, KRG improved attention as measured by significant differences in omission errors measured by the computerized ADHD-diagnostic system (ADS) (78.56 ± 43.33 at baseline, 55.17 ± 21.44 at 8 weeks, p < 0.023). Omission errors in ADS measure inattentiveness. The significant decrease in omission errors has been associated with the restoration of impaired cognitive function in children with ADHD. Nevertheless, the small population size limits generalizability of the study's findings. A large-scale study with larger number of participants is necessary, as well as studies which assess long-term efficacy of KRG supplementation.

Another study (randomized, double-blind, and placebo-controlled) reported similar results in that participants (ADHD patients aged 6–15, n = 33), given one pouch of KRG (1 g KRG extract/pouch) twice per day, showed improvement in their inattention and hyperactivity scores after an 8-week treatment course compared with the control group (n = 37). Accordingly, the KRG group displayed significantly decreased inattention/hyperactivity scores compared with the control group at week 8 (least squared means of the differences in inattention adjusted for baseline scores are as follows: −2.25 versus −1.24, p = 0.048; hyperactivity: −1.53 versus −0.61, p = 0.047). They also showed decreased quantitative electroencephalography theta/beta ratio in comparison with the control group (least squared means of the differences are as follows: −0.94 versus −0.14, p = 0.001). The side effect profiles of ginseng included headache, fatigue, perspiration, and subjective issues with the taste of the ginseng product. Ginseng's potential use as both alternative and adjunct ADHD treatment appears promising given the minimal safety concerns and remarkable efficacy.

Ginkgo biloba


A unique species of tree native to East Asia, Ginkgo biloba, has been extensively studied for its memory-enhancing effects. Currently, G. biloba is used as an alternate treatment in patients with dementia or memory impairment. Studies also indicate that G. biloba may have therapeutic benefits in ADHD. For instance, Uebel-von Sandersleben et al. reported improvement in overall quality of life, ADHD core symptoms, and Continuous Performance Test (CPT) performance in children given G. biloba (240 mg/daily) for 3–5 weeks. A reduced dose of G. biloba (50 mg), when combined with ginseng (200 mg) for 4 weeks of treatment, significantly improved ADHD symptoms in a test group of 36 children (ages 3–17) as quantified by Conners' Parent Rating Scale-Revised (long version) (CPRS-R [L]). Accordingly, there was significant improvement in each of the 3 areas which are most troublesome in ADHD (i.e., hyperactivity, cognitive problems, and oppositional behavior) in at least 50% of the subjects given G. biloba (50 mg) and ginseng (200 mg) up to 4 weeks after treatment. Reported side effects of G. biloba were observed; for example, subjects became more impulsive, hyperactive, aggressive, emotional, and tired and manifested increased sweating. G. biloba's beneficial effects have been linked to various activities such as improvement in cerebrovascular blood flow (alleviating hyperactivity), reversal of serotonergic (5-HT) 1A and noradrenergic receptor reductions, and inhibition of both monoamine oxidase- (MAO-) A and MAO-B in the brain. While G. biloba did produce improvement in ADHD symptoms, a trial by Salehi et al. conducted over a 6-week period (double-blind, randomized, and placebo-controlled, n = 50 children) found that G. biloba (80–120 mg/day) was inferior to methylphenidate in efficacy endpoint. More formal clinical trials are required with longer duration and rigorous clinical endpoints in order to prove the worth of G. biloba in ADHD treatment.

Valerian


Valerian (Valeriana officinalis) is a perineal plant with sedative and antispasmodic effect. It has also been traditionally used in the treatment of insomnia, anxiety, and restlessness. The efficacy of Valerian as an ADHD treatment has been evaluated in a double-blind, placebo-controlled pilot study. Participants (30 kids, aged 5–11), given Valerian tincture three times a day for two weeks, showed improvement in ADHD symptoms, in particular, sustained inattention and impulsivity and/or hyperactivity. Nevertheless, the positive effects produced in the first two weeks of the study were not maintained overall following one week of no administration. The therapeutic effects of Valerian have been ascribed to valerenic acid (a significant component of Valerian) acting on the receptor gamma-aminobutyric acid (GABA)A receptor. GABA is the brain's main inhibitory neurotransmitter and has calming effects. Deficiency in GABA causes anxiety, restlessness, and obsessive behavior, symptoms often seen in ADHD. Valerian is considered generally safe and its use in children with ages 3–12 years was approved by the European Scientific Cooperative on Phytotherapy. However, Valerian must only be used under medical supervision. More studies are required to augment limited clinical evidence supporting efficacy of Valerian in treating ADHD.

Ningdong

Ningdong granule (NDG) is a widely used Chinese medicinal preparation for various medicinal purposes. NDG showed promise in treating Tourette's syndrome, which invited studies to determine its efficacy in ADHD. A randomized, double-blind, methylphenidate-controlled trial, where 72 children with ADHD were given 5 mg/kg/day of NDG (n = 36) or 1 mg/kg/day methylphenidate (n = 36) for a period of 8 weeks, reported that NDG was equally effective as methylphenidate in improving ADHD symptoms. Accordingly, no significant difference was observed between the NDG and methylphenidate groups with regard to the data of teacher and parent ADHD rating scales at 8 weeks after medication. Furthermore, NDG produced less side effect profiles and was more tolerated by children as confirmed by urine, blood, and stool analysis along with renal and hepatic function tests. Interestingly, levels of homovanillic acid (HVA), which is involved in dopamine regulation, were increased in the sera of NDG-treated group with no resulting change in the concentration of dopamine. Hence the investigators proposed that NDG could be a safe, efficacious alternative treatment for ADHD. One of the limitations of the study, however, involves the lack of placebo control in the study and the short-term outcomes. More meaningful pharmacological evidences to support the utility of NDG as an ADHD treatment are also required.

Passion Flower

Passion flower is comprised of the fragmented or cut, dried aerial parts of Passiflora incarnata L., which is a traditional remedy for anxiety and ADHD. Effect of passion flower in alleviating ADHD symptoms was tested in 34 children with ADHD randomized to receive tablets of Passiflora (0.04 mg/kg/day, twice daily) or methylphenidate (1 mg/kg/day, twice daily), dosed on a weight-adjusted basis, for 8 weeks. Both parent and teacher rating scores revealed no significant difference in the clinical benefits of Passiflora and methylphenidate treatment in ADHD children over the course of the trial (F = 0.007, df = 1, and p = 0.93; and F = 0.006, df = 1, and p = 0.94, resp.). Moreover, side effect profile of Passiflora was less compared with methylphenidate. As the study was conducted in a small population of patients, the results of this study need to be validated in larger trials.

Oroxylin A

Oroxylin A (5,7-dihydroxy-6-methoxyflavone) is a flavonoid isolated from the root of Scutellaria baicalensis Georgi, a herb commonly found in East Asia. Oroxylin A is an antagonist of the GABAA receptor. Furthermore, its biological activities, including antioxidant, anti-inflammatory, and antiallergy as well as memory-enhancing and neuroprotective effects, provide basis for its potential therapeutic use in ADHD. Preclinical studies showed that Oroxylin A or its derivative (5,7-dihydroxy-6-methoxy-4′-phenoxyflavone) produced improvement of ADHD-like behaviors in spontaneously hypertensive rats, animal models of ADHD. The therapeutic activities of Oroxylin A have been ascribed to enhanced dopamine neurotransmission. Ongoing studies are investigating efficacy of Oroxylin A in ADHD patients.
YY162

YY162 is a combination pharmaceutical product consisting of terpenoid-strengthened G. biloba and ginsenoside Rg3 from ginseng. A recent study showed improvement of ADHD-like symptoms, induced by Aroclor1254, in mice given YY1612. The degree of alleviation of ADHD-like symptoms induced by YY1612 was found to be comparable to that exerted by methylphenidate. YY1612 also produced neuroprotective effects with minimal behavioral side effects. The mediation of the ADHD-like symptoms in mice by YY1612 is believed to be due to its antioxidant properties and its ability to regulate and control dopamine and norepinephrine transporters. Further studies are required to show the potentiality of YY1612 as an ADHD medication.
Sideritis scardica


The genus Sideritis plant, species “Sideritis scardica,” has been used traditionally in the Mediterranean region as teas and flavoring agents and also for treatment purposes. Studies have shown that S. scardica extracts may have an inhibitory effect on the reuptake of three key monoamines: dopamine, serotonin, and noradrenaline. Moreover, an electroencephalogram (EEG) study showed that Sideritis treatment in rats induced frequency patterns comparable to those produced by methylphenidate. Overall, these studies suggest the benefit of Sideritis in the treatment of mental disorders, including ADHD. Further in vivo studies measuring its efficacy in ADHD are warranted.
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