Wednesday, April 18, 2012

A Controlled Trial of Herbal Treatment for ADHD

There is a lot of interest in using alternative medicine to treat ADHD.  A lot of people have problems with the commonly prescribed stimulants such as Ritalin or Alderall so they are looking for other treatments.  

One alter­na­tive approach to treat­ing ADHD has relied on the use of Com­pound Herbal Prepa­ra­tions (CHP) derived from tra­di­tional Chi­nese med­i­cine. Prac­ti­tion­ers of this approach believe that such prepa­ra­tions have impor­tant cog­ni­tive enhanc­ing prop­er­ties because they sup­ply essen­tial nutri­ents, fatty acids, phos­pho­lipids, amino acids, B vit­a­mins, min­er­als, and other micronu­tri­ents that are impor­tant for opti­mal brain growth and devel­op­ment. As a treat­ment for ADHD, the idea is that many indi­vid­u­als with ADHD have defi­cien­cies in essen­tial nutri­ents that com­pro­mise healthy brain devel­op­ment and result in ADHD symp­toms. Pro­vid­ing these nutri­ents via an appro­pri­ately pre­pared herbal com­pound thus has the poten­tial to be ther­a­peu­tic and reduce these symptoms.

Active ingre­di­ents in the CHP — brand name Nur­ture & Clar­ity — included Paeo­niae Alba, With­a­nia Som­nifera, Cen­tella Asi­at­ica, Spir­ulina Platen­sis, Bacopa Monieri, and Mel­lissa Offic­i­nalis. All raw herbs used in the prepar­ing the com­pound were approved by the Israeli Min­istry of Health as safe, food-grade herbs.

At the follow-up assess­ment, data was obtained on 73 of 80 chil­dren who received the CHP com­pared to only 19 of 40 who received placebo. The sig­nif­i­cantly greater drop-out rate among placebo-treated chil­dren reflected the greater num­ber of par­ents who were not sat­is­fied with their child’s response and who with­drew to pur­sue other options.

Results from the TOVA were ana­lyzed in 2 pri­mary ways. First, within each group, researchers tested whether there was sig­nif­i­cant improve­ment from pre-test to post-test. Then, they directly com­pared CHP vs. placebo dif­fer­ences con­trol­ling for age and sex. Because pre­lim­i­nary analy­ses indi­cated that results were con­sis­tent across dif­fer­ent ADHD sub­types, i.e., inat­ten­tive, hyperactive-impulsive, and com­bined, chil­dren with each sub­type were com­bined in all analyses.

The active ADHD herbs in Nurture and Clarity include an herb called Brahmi. Bacopa or Brahmi is a very old, often used, trusted and respected herb in ayurveda, the traditional medicine of India.  It is used in India by families to help their children excel in school and is often taken as a tea before important exams.  It is available on Ebay in a product called Mentat that has been studied extensively in clinical trials in India and found to help with attention.  Studies documenting the effectiveness of Mentat for cognitive function can be found on the Himalayan Herbal Site.

Lemon balm was also part of the ADHD herbal medicine. Lemon balm acts as a relaxing or calming agent. It is available in stores as lemon balm
 tea. Lemon balm works because it is thought to be a potent inhibitor of GABA transaminase. This GABA transaminase has been found to be elevated in people with hyperactive ADHD.

The herbal ADHD supplement in the study also included Paeoniae Alba, or white peony. This is also available as
White Peony tea. According to the study Paeoniae Alba works by improving the information transfer function of the cholinergic neuron synapses, and enhancing cerebral oxygenation.

Nurture and Clarity contains Spirulina, also known as blue-green algae. This substance is rich in essential fatty acids, B vitamins, many other vitamins, zinc, and all the essential amino acids. The researchers of the Nurture and Clarity study reported that, " Preliminary evidence supports the idea that supplementation with these nutrients may help to ameliorate ADHD".   It is available in stores and can be taken in
tablet and powder form.

The other herbs for ADHD in Nurture and Clarity included Centella Asiatica or Gotu Kola. This herb in other studies has demonstrated increased neurite elongation, dendritic growth, and improved learning and memory.

The last main ADHD herb in the product is called Wathania somnifera. It is also known as ashwagandha or Indian Ginseng. This herb has been shown to normalize the HPA axis and the neuroendocrine system and to increase acetylcholine receptor capacity and acetyl cholinesterase (AChE) inhibitory activity according to the Nurture and Clarity study. Remember from the earlier post on cortisol that folks with ADHD may have a faulty neuroendocrine response that may be a cause of ADHD symptoms.  It is generally taken in capsules.