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Zhou P, Yu X, Song T, Hou X. Safety and efficacy of antioxidant therapy in children and adolescents with attention deficit hyperactivity disorder: A systematic review and network meta-analysis. PLoS One 2024; 19:e0296926. [PMID: 38547138 PMCID: PMC10977718 DOI: 10.1371/journal.pone.0296926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 12/22/2023] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE To systematically evaluate the safety and efficacy of antioxidant therapy in children and adolescents with attention deficit hyperactivity disorder (ADHD). METHODS Randomized controlled trials and prospective studies on antioxidant therapy in children and adolescents with ADHD were searched in PubMed, Embase, and Cochrane Library from the inception of databases to November 12, 2022. Two investigators independently screened the literature, extracted data, and evaluated the quality of the included studies. Network meta-analysis (PROSPERO registration number CRD 42023382824) was carried out by using R Studio 4.2.1. RESULTS 48 studies involving 12 antioxidant drugs (resveratrol, pycnogenol, omega-3, omega-6, quercetin, phosphatidylserine, almond, vitamin D, zinc, folic acid, ginkgo biloba, Acetyl-L-carnitine) were finally included, with 3,650 patients. Network meta-analysis showed that omega-6 (0.18), vitamin D (0.19), and quercetin (0.24) were the top three safest drugs according to SUCRA. The omega-3 (SUCRA 0.35), pycnogenol (SUCRA 0.36), and vitamin D (SUCRA 0.27) were the most effective in improving attention, hyperactivity, and total score of Conners' parent rating scale (CPRS), respectively. In terms of improving attention, hyperactivity, and total score of Conners' teacher rating scale (CTRS), pycnogenol (SUCRA 0.32), phosphatidylserine+omega-3 (SUCRA 0.26), and zinc (SUCRA 0.34) were the most effective, respectively. In terms of improving attention, hyperactivity and total score of ADHD Rating Scale-Parent, the optimal agents were phosphatidylserine (SUCRA 0.39), resveratrol+MPH (SUCRA 0.24), and phosphatidylserine (SUCRA 0.34), respectively. In terms of improving attention, hyperactivity and total score of ADHD Rating Scale-Teacher, pycnogenol (SUCRA 0.32), vitamin D (SUCRA 0.31) and vitamin D (SUCRA 0.18) were the optimal agents, respectively. The response rate of omega-3+6 was the highest in CGI (SUCRA 0.95) and CPT (SUCRA 0.42). CONCLUSION The rankings of safety and efficacy of the 12 antioxidants vary. Due to the low methodological quality of the included studies, the probability ranking cannot fully explain the clinical efficacy, and the results need to be interpreted with caution. More high-quality studies are still needed to verify our findings.
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Affiliation(s)
- Peike Zhou
- Department of Pediatrics, Affiliated ZhongShan Hospital of Dalian University, Dalian, Liaoning, China
| | - Xiaohui Yu
- Department of Pediatrics, Affiliated ZhongShan Hospital of Dalian University, Dalian, Liaoning, China
| | - Tao Song
- Department of Pediatrics, Affiliated ZhongShan Hospital of Dalian University, Dalian, Liaoning, China
| | - Xiaoli Hou
- Department of Pediatrics, Affiliated ZhongShan Hospital of Dalian University, Dalian, Liaoning, China
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Golsorkhi H, Qorbani M, Sabbaghzadegan S, Dadmehr M. Herbal medicines in the treatment of children and adolescents with attention-deficit/hyperactivity disorder (ADHD): An updated systematic review of clinical trials. AVICENNA JOURNAL OF PHYTOMEDICINE 2023; 13:338-353. [PMID: 37663386 PMCID: PMC10474921 DOI: 10.22038/ajp.2022.21115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/04/2022] [Indexed: 09/05/2023]
Abstract
Objective This study was performed to provide an updated systematic review of herbal medicines and phytochemicals used for treatment of the pediatric patients with attention- deficit/hyperactivity disorder (ADHD). Materials and Methods International electronic databases, including Scopus, PubMed, ScienceDirect, and Google Scholar were investigated from 1st January 2000 to late October 2021. Interventional studies published in English language, including randomized controlled trials (RCTs) or open-label clinical studies, which evaluated the effect of herbal medicines and phytochemicals on pediatric ADHD were included in this review. Results Fifteen studies met the inclusion criteria. Several pieces of evidence support the efficacy of Ginkgo biloba L. and Pycnogenol; mainly inconclusive evidence could be found for Valeriana officinalis L., Melissa officinalis L., and ginseng. The results showed that while Hypericum perforatum L. was ineffective for ADHD, Passiflora incarnata L., Crocus sativus L, and Prunus dulcis (Mill.) D.A.Webb had similar efficacy compared to methylphenidate (MPH). Conclusion A number of herbal medicines appear to be relatively safe and provide potential efficacy in amelioration of ADHD. However, due to lack of adequate reports of RCTs, no definitely specific recommendations could been made so far.
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Affiliation(s)
- Haide Golsorkhi
- Department of Traditional Medicine, School of Persian Medicine, Iran University of Medical Sciences, Tehran, Iran
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeideh Sabbaghzadegan
- Department of Traditional Medicine, School of Persian Medicine, Iran University of Medical Sciences, Tehran, Iran
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Dadmehr
- Department of Traditional Medicine, School of Persian Medicine, Iran University of Medical Sciences, Tehran, Iran
- Institute for Studies in Medical History, Persian and Complementary Medicine, Iran University of Medical Sciences, Tehran, Iran
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Custódio L, Vizetto‐Duarte C, Cebeci F, Özçelik B, Sharopov F, Gürer ES, Kumar M, Iriti M, Sharifi‐Rad J, Calina D. Natural products of relevance in the management of attention deficit hyperactivity disorder. EFOOD 2023. [DOI: 10.1002/efd2.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Luísa Custódio
- Centre of Marine Sciences, Faculty of Sciences and Technology University of Algarve Faro Portugal
| | - Catarina Vizetto‐Duarte
- School of Material Sciences and Engineering Nanyang Technological University Singapore Singapore
| | - Fatma Cebeci
- Department of Nutrition and Dietetics Bayburt University Bayburt Turkey
| | - Beraat Özçelik
- Department Food Engineering, Faculty of Chemical and Metallurgical Engineering Istanbul Technical University, Maslak Istanbul Turkey
- BIOACTIVE Research & Innovation Food Manufacturing Industry Trade LTD Co., Maslak Istanbul Turkey
| | - Farukh Sharopov
- Department of Pharmaceutical Technology Avicenna Tajik State Medical University Dushanbe Tajikistan
| | - Eda Sönmez Gürer
- Department of Pharmacognosy, Faculty of Pharmacy Sivas Cumhuriyet University Sivas Turkey
| | - Manoj Kumar
- Chemical and Biochemical Processing Division ICAR—Central Institute for Research on Cotton Technology Mumbai India
| | - Marcello Iriti
- Department of Agricultural and Environmental Sciences Università degli Studi di Milano Milan Italy
| | | | - Daniela Calina
- Department of Clinical Pharmacy University of Medicine and Pharmacy of Craiova Craiova Romania
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Nobakht SZ, Akaberi M, Mohammadpour AH, Tafazoli Moghadam A, Emami SA. Hypericum perforatum: Traditional uses, clinical trials, and drug interactions. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2022; 25:1045-1058. [PMID: 36246064 PMCID: PMC9526892 DOI: 10.22038/ijbms.2022.65112.14338] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/04/2022] [Indexed: 11/07/2022]
Abstract
Hypericum perforatum (Hypericaceae), known as Saint John’s wort (SJW), has been used in different systems of traditional medicine such as Chinese traditional medicine, Greek traditional medicine, and Islamic traditional medicine. The plant and its active constituents such as hyperforin and hypericin have a wide range of medicinal uses, particularly as anti-depressant, wound-healing, and antibacterial agents. In recent decades, many clinical trials have been performed to investigate the safety and efficacy of this medicinal plant. However, to the best on our knowledge, there is no comprehensive review article in this regard. In the current study, we aim to have a comprehensive review of the clinical trials of SJW to evaluate its efficacy and safety as well as its application in traditional medicine. Clinical studies investigating the safety, interactions, and efficacy of SJW were identified and summarized, including contributions from 2000 until December 2021. According to the results, these clinical studies were divided into three main categories based on the type of disease: psychiatric, endocrine, and skin problems. Important details of the studies, including the type and duration of the study, the type and percentage of the effective compounds or the extract used, the number of patients, and the obtained results were also discussed. In addition, co-administration and drug interaction of SJW with other drugs were summarized. SJW is a valuable medicinal plant, especially for psychiatric disorders. However, precautions should be taken while administrating the plant.
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Affiliation(s)
- Seyedeh Zahra Nobakht
- Department of Traditional Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Akaberi
- Department of Pharmacognosy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Hooshang Mohammadpour
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Tafazoli Moghadam
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Ahmad Emami
- Department of Traditional Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran,Corresponding author: Seyed Ahmad Emami. Department of Traditional Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran. Tel: +98-51-3180 1267; Fax: +98-05118823251;
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Zhuo L, Zhao X, Zhai Y, Zhao B, Tian L, Zhang Y, Wang X, Zhang T, Gan X, Yang C, Wang W, Gao W, Wang Q, Rohde LA, Zhang J, Li Y. Transcutaneous electrical acupoint stimulation for children with attention-deficit/hyperactivity disorder: a randomized clinical trial. Transl Psychiatry 2022; 12:165. [PMID: 35449191 PMCID: PMC9022403 DOI: 10.1038/s41398-022-01914-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 11/23/2022] Open
Abstract
Little is known about the effects of transcutaneous electrical acupoint stimulation (TEAS) for children with attention-deficit/hyperactivity disorder (ADHD). Here, we carried out a 4 week randomized clinical trial in which patients aged 6-12 years old with an ADHD diagnosis received TEAS or sham TEAS. The primary outcome measure was the investigator-rated Clinical Global Impression-Improvement (CGI-I) score at week 4. Secondary outcomes included changes from baseline to week 4 in the investigator-rated Clinical Global Impression-Severity of Illness (CGI-S) score, the Conners' Parent/Teacher Rating Scales-Revised: Short Form (CPRS-R: S/CTRS-R: S) score, go/no-go task performance, and functional near-infrared spectroscopy (fNIRS)-based oxygenated hemoglobin level within the prefrontal cortex. At week 4, the CGI-I score indicated improvement in 33.3% of the TEAS group compared with 7.7% of the sham group (P = 0.005). The TEAS group had a greater decrease in the mean CGI-S score (-0.87) than the sham TEAS group (-0.28) (P = 0.003). A greater enhancement in the mean cerebral oxygenated hemoglobin within the prefrontal cortex was found in the TEAS group (0.099 mM mm) compared with the sham TEAS group (0.005 mM mm) (P < 0.001). CPRS-R: S score, CTRS-R: S score, and go/no-go performance exhibited no significant improvement after TEAS treatment. The manipulation-associated adverse events were uncommon in both groups, and events were very mild. Our results show that noninvasive TEAS significantly improved general symptoms and increased prefrontal cortex blood flow within 4 weeks for children with ADHD. Further clinical trials are required to understand the long-term efficacy in a larger clinical sample. This trial was registered on ClinicalTrials.gov (NCT03917953).
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Affiliation(s)
- Lixia Zhuo
- grid.452438.c0000 0004 1760 8119Department of Anesthesiology & Center for Brain Science, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi China
| | - Xiaoyan Zhao
- grid.452902.8Children’s Health Care Center, Xi’an Children’s Hospital, Xi’an, Shaanxi China
| | - Yifang Zhai
- grid.452438.c0000 0004 1760 8119Department of Anesthesiology & Center for Brain Science, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi China
| | - Boqiang Zhao
- grid.452438.c0000 0004 1760 8119Department of Anesthesiology & Center for Brain Science, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi China
| | - Lin Tian
- grid.452902.8Children’s Health Care Center, Xi’an Children’s Hospital, Xi’an, Shaanxi China
| | - Yannan Zhang
- grid.452902.8Children’s Health Care Center, Xi’an Children’s Hospital, Xi’an, Shaanxi China
| | - Xiaodan Wang
- grid.452438.c0000 0004 1760 8119Department of Anesthesiology & Center for Brain Science, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi China
| | - Tingyu Zhang
- grid.511083.e0000 0004 7671 2506Department of Rehabilitation Medicine, The Seventh Affiliated Hospital Sun Yat-sen University, Shenzhen, Guangdong China
| | - Xinyi Gan
- grid.452438.c0000 0004 1760 8119Department of Anesthesiology & Center for Brain Science, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi China
| | - Cheng Yang
- grid.452438.c0000 0004 1760 8119Department of Anesthesiology & Center for Brain Science, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi China
| | - Weigang Wang
- grid.508012.eDepartment of Acupuncture, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi China
| | - Wei Gao
- grid.452438.c0000 0004 1760 8119Department of Anesthesiology & Center for Brain Science, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi China
| | - Qiang Wang
- grid.452438.c0000 0004 1760 8119Department of Anesthesiology & Center for Brain Science, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi China
| | - Luis Augusto Rohde
- grid.8532.c0000 0001 2200 7498ADHD and Developmental Psychiatry Programs, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Jie Zhang
- Children's Health Care Center, Xi'an Children's Hospital, Xi'an, Shaanxi, China.
| | - Yan Li
- Department of Anesthesiology & Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
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Potential Novel Therapies for Neurodevelopmental Diseases Targeting Oxidative Stress. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:6640206. [PMID: 34336109 PMCID: PMC8321748 DOI: 10.1155/2021/6640206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 06/13/2021] [Accepted: 07/12/2021] [Indexed: 12/28/2022]
Abstract
Neurodevelopmental disorders are a category of diseases that is not yet fully understood. Due to their common traits and pathways, often it is difficult to differentiate between them based on their symptoms only. A series of hypotheses are trying to define their etiology, such as neuroinflammation, neurodegeneration, and immunology, but none have managed to explain their multifactorial manifestation. One feature that may link all theories is that of oxidative stress, with a redox imbalance as well as several other markers of oxidative damage (on lipids, proteins, and nucleic acids) being observed in both postmortem samples of the brain of patients with schizophrenia and autism spectrum disorders. However, the implication of oxidative stress in pathology is still distrustfully looked upon. For this purpose, in the current paper, we were interested in reviewing the implications of oxidative stress in these disorders as well as the impact of N-acetylcysteine on the oxidative status with a focus on the glutathione level and N-methyl-D-aspartate receptor. We were also interested in finding papers targeting the use of antioxidant properties of different plant extracts.
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Farrokhian S, Alamdarloo GH, Asadmanesh E. The effectiveness of functional training on impulsiveness of females with intellectual disability. Health Psychol Res 2020; 8:9116. [PMID: 33553788 PMCID: PMC7859959 DOI: 10.4081/hpr.2020.9116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/17/2020] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was to determine the effectiveness of Functional Training (FT) on impulsiveness of female students with Intellectual Disability (ID). The research method was pretestposttest- with a control group. The statistical population consisted of all female students with ID in elementary school of Shiraz studying under the auspices of the Special Education Organization in 2018-2019. The participants included 30 female students with ID selected through convenience sampling and randomly assigned to the experimental (n=14) and control (n=14) groups. The experimental group received the functional training for 15 sessions, while the control group did not receive any intervention. The Barratt Impulsiveness Scale Version 11 (BIS-11) was used for measuring the impulsiveness. The Impulsiveness pre-test was performed for both experimental and control groups. The experimental group received the FT for 15 sessions, while the control group did not receive any intervention. At the end of the intervention, post-test was performed for both groups. Mann-Whitney U test was used to analyze the data. The results showed that the mean scores of impulsivities and its subscales (motor impulsiveness, attentional impulsiveness and nonplanning impulsiveness) in the experimental group were significantly reduced. The results showed that FT had a significant effect on impulsiveness of female students with ID (p<0.001). Therefore, it is recommended to design and implement a FT program to improve impulsiveness in people with ID.
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Affiliation(s)
| | | | - Enayatollah Asadmanesh
- Physical Education Department, School of Education and Psychology, Shiraz University, Shiraz, Iran
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Alvarez-Arellano L, Salazar-García M, Corona JC. Neuroprotective Effects of Quercetin in Pediatric Neurological Diseases. Molecules 2020; 25:E5597. [PMID: 33260783 PMCID: PMC7731313 DOI: 10.3390/molecules25235597] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/20/2020] [Accepted: 11/26/2020] [Indexed: 02/07/2023] Open
Abstract
Oxidative stress is a crucial event underlying several pediatric neurological diseases, such as the central nervous system (CNS) tumors, autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). Neuroprotective therapy with natural compounds used as antioxidants has the potential to delay, ameliorate or prevent several pediatric neurological diseases. The present review provides an overview of the most recent research outcomes following quercetin treatment for CNS tumors, ASD and ADHD as well as describes the potential in vitro and in vivo ameliorative effect on oxidative stress of bioactive natural compounds, which seems like a promising future therapy for these diseases. The neuroprotective effects of quercetin against oxidative stress can also be applied in the management of several neurodegenerative disorders with effects such as anti-cancer, anti-inflammatory, anti-viral, anti-obesity and anti-microbial. Therefore, quercetin appears to be a suitable adjuvant for therapy against pediatric neurological diseases.
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Affiliation(s)
| | - Marcela Salazar-García
- Laboratorio de Investigación en Biología del Desarrollo y Teratogénesis Experimental, Hospital Infantil de México Federico Gómez, Mexico City 06720, Mexico;
| | - Juan Carlos Corona
- Laboratory of Neurosciences, Hospital Infantil de México Federico Gómez, Mexico City 06720, Mexico
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Shrestha M, Lautenschleger J, Soares N. Non-pharmacologic management of attention-deficit/hyperactivity disorder in children and adolescents: a review. Transl Pediatr 2020; 9:S114-S124. [PMID: 32206589 PMCID: PMC7082245 DOI: 10.21037/tp.2019.10.01] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a very common neurobehavioral disorder that affects children and adolescents with impact that persists beyond adolescence into adulthood. Medication and non-pharmacological treatments are evidence-based interventions for ADHD in various age groups, and this article will elaborate on the psychosocial, physical and integrative medicine interventions that have been studied in ADHD.
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Affiliation(s)
- Mahesh Shrestha
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | | | - Neelkamal Soares
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
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Bawari S, Tewari D, Argüelles S, Sah AN, Nabavi SF, Xu S, Vacca RA, Nabavi SM, Shirooie S. Targeting BDNF signaling by natural products: Novel synaptic repair therapeutics for neurodegeneration and behavior disorders. Pharmacol Res 2019; 148:104458. [DOI: 10.1016/j.phrs.2019.104458] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/13/2019] [Accepted: 09/15/2019] [Indexed: 12/12/2022]
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The acute effect of Hypericum perforatum on short-term memory in healthy adults. Psychopharmacology (Berl) 2019; 236:613-623. [PMID: 30382352 DOI: 10.1007/s00213-018-5088-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 10/19/2018] [Indexed: 12/19/2022]
Abstract
RATIONALE Over-the-counter drugs containing Hypericum perforatum (H. perforatum) have been argued to improve memory and sustained attention. So far, these claims have not been supported in human studies. However, previous studies used rather high dosages, and little is known about the acute effect of small dosages. OBJECTIVE We evaluated whether an acute treatment with Remotiv 500 and Remotiv 250 (500 or 250 mg of H. perforatum quantified to either 1 or 0.5 mg of hypericin) improved memory and sustained attention, as well as mood and state anxiety in healthy adults. METHOD A single dosage, randomized, double-blind, placebo-controlled trial was conducted with 82 student participants (33 women). Each participant received placebo in one session and one of two dosages in the other session. Order of the sessions and dosage conditions were randomized between subjects. Participants completed a battery of tasks assessing short-term memory capacity and sustained attention. RESULTS A significant positive effect of Remotiv 250 on digit span (mean Cohen's d = 0.58; p = .01) was observed. By contrast, Remotiv 500 had a negative effect on digit span (mean d = - 0.48, p = 0.04). A similar effect emerged when factoring across tests of short-term memory. Both dosages improved mood (d = 0.60, p = .03). CONCLUSIONS The results indicate that acute treatment with small (250 mg) dosages of H. perforatum has a positive effect on the capacity of short-term verbal memory, and stress the importance of maintaining small dosages in nootropic applications. TRIAL REGISTRATION www.clinicaltrials.gov NCT02862236.
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Natural Compounds for the Management of Parkinson's Disease and Attention-Deficit/Hyperactivity Disorder. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4067597. [PMID: 30596091 PMCID: PMC6282143 DOI: 10.1155/2018/4067597] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/31/2018] [Accepted: 11/11/2018] [Indexed: 11/18/2022]
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disorder with an unknown aetiology. The pathogenic mechanisms include oxidative stress, mitochondrial dysfunction, protein dysfunction, inflammation, autophagy, apoptosis, and abnormal deposition of α-synuclein. Currently, the existing pharmacological treatments for PD cannot improve fundamentally the degenerative process of dopaminergic neurons and have numerous side effects. On the other hand, attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder of childhood and is characterised by hyperactivity, impulsivity, and inattention. The aetiology of ADHD remains unknown, although it has been suggested that its pathophysiology involves abnormalities in several brain regions, disturbances of the catecholaminergic pathway, and oxidative stress. Psychostimulants and nonpsychostimulants are the drugs prescribed for the treatment of ADHD; however, they have been associated with increased risk of substance use and have several side effects. Today, there are very few tools available to prevent or to counteract the progression of such neurological disorders. Thus, therapeutic approaches with high efficiency and fewer side effects are needed. This review presents a brief overview of the two neurological disorders and their current treatments, followed by a discussion of the natural compounds which have been studied as therapeutic agents and the mechanisms underlying the beneficial effects, in particular, the decrease in oxidative stress.
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Zirak N, Shafiee M, Soltani G, Mirzaei M, Sahebkar A. Hypericum perforatum in the treatment of psychiatric and neurodegenerative disorders: Current evidence and potential mechanisms of action. J Cell Physiol 2018; 234:8496-8508. [PMID: 30461013 DOI: 10.1002/jcp.27781] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 10/30/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Psychiatric disorders are substantially associated with reduced quality of life and increased mortality. Depression and anxiety are two of the most common psychiatric disorders that often co-occur with each other as well as with other mental health conditions. Because of the limitations of currently available antidepressant therapies, there is a need for agents with improved efficacy and less adverse effects. Hypericum perforatum, widely known as St. John's wort, is a perennial herbaceous plant most well known for its antidepressant properties. METHODS We reviewed the available in vitro, in vivo, and clinical evidence on the efficacy, safety, and mechanisms of action of St. John's wort and its active constituents in the treatment of psychiatric and neurodegenerative disorders. RESULTS Several interesting data have been reported about the antidepressant properties of H. perforatum in clinical trials with different designs. In particular, a number of antidepressant-controlled trials demonstrated that H. perforatum and its active ingredients, hypericin and hyperforin, possess antidepressant properties similar to those of tricyclic antidepressants and selective serotonin reuptake inhibitors but with fewer and milder side effects. CONCLUSION St. John's wort may exert potent antidepressant effects and represents an efficacious and safe treatment. However, the current clinical evidence regarding the efficacy of H. perforatum in other psychiatric and neurodegenerative disorders is not sufficient to draw a robust conclusion.
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Affiliation(s)
- Nahid Zirak
- Lung Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mojtaba Shafiee
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ghasem Soltani
- Lung Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Mirzaei
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhossein Sahebkar
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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Sarris J. Herbal medicines in the treatment of psychiatric disorders: 10-year updated review. Phytother Res 2018; 32:1147-1162. [DOI: 10.1002/ptr.6055] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Jerome Sarris
- NICM Health Research Institute, School of Science and Health; Western Sydney University; Westmead NSW Australia
- Department of Psychiatry, The Melbourne Clinic, Professorial Unit, ARCADIA Research Group; The University of Melbourne; Melbourne VIC Australia
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Verlaet AAJ, Maasakkers CM, Hermans N, Savelkoul HFJ. Rationale for Dietary Antioxidant Treatment of ADHD. Nutrients 2018; 10:nu10040405. [PMID: 29587355 PMCID: PMC5946190 DOI: 10.3390/nu10040405] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 03/12/2018] [Accepted: 03/21/2018] [Indexed: 12/27/2022] Open
Abstract
Increasing understanding arises regarding disadvantages of stimulant medication in children with ADHD (Attention-Deficit Hyperactivity Disorder). This review presents scientific findings supporting dietary antioxidant treatment of ADHD and describes substantial alterations in the immune system, epigenetic regulation of gene expression, and oxidative stress regulation in ADHD. As a result, chronic inflammation and oxidative stress could develop, which can lead to ADHD symptoms, for example by chronic T-cell-mediated neuroinflammation, as well as by neuronal oxidative damage and loss of normal cerebral functions. Therefore, modulation of immune system activity and oxidant-antioxidant balance using nutritional approaches might have potential in ADHD treatment. The use of natural antioxidants against oxidative conditions is an emerging field in the management of neurodegenerative diseases. Dietary polyphenols, for example, have antioxidant capacities as well as immunoregulatory effects and, therefore, appear appropriate in ADHD therapy. This review can stimulate the development and investigation of dietary antioxidant treatment in ADHD, which is highly desired.
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Affiliation(s)
- Annelies A J Verlaet
- Department of Pharmaceutical Sciences, Laboratory of Nutrition and Functional Food Science, University of Antwerp, Universiteitsplein 1 (A104), 2610 Wilrijk, Belgium.
| | - Carlijn M Maasakkers
- Department of Pharmaceutical Sciences, Laboratory of Nutrition and Functional Food Science, University of Antwerp, Universiteitsplein 1 (A104), 2610 Wilrijk, Belgium.
- Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
- Cell Biology and Immunology Group, Wageningen University, De Elst 1 Building 122, 6709 PG Wageningen, The Netherlands.
| | - Nina Hermans
- Department of Pharmaceutical Sciences, Laboratory of Nutrition and Functional Food Science, University of Antwerp, Universiteitsplein 1 (A104), 2610 Wilrijk, Belgium.
| | - Huub F J Savelkoul
- Cell Biology and Immunology Group, Wageningen University, De Elst 1 Building 122, 6709 PG Wageningen, The Netherlands.
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Biggs JM, Morgan JA, Lardieri AB, Kishk OA, Klein-Schwartz W. Abuse and Misuse of Selected Dietary Supplements Among Adolescents: a Look at Poison Center Data. J Pediatr Pharmacol Ther 2017; 22:385-393. [PMID: 29290737 DOI: 10.5863/1551-6776-22.6.385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The use of dietary supplements has increased and is associated with adverse effects. Indications for use include recreation, body image concerns, mood enhancement, or control of medical conditions. The risk of adverse effects may be enhanced if agents are used improperly. The objective of this study was to determine the frequency of abuse and misuse of 4 dietary substances among adolescents reported nationally to poison centers. Secondary outcomes included an assessment of medical outcomes, clinical effects, location of treatments provided, and treatments administered. METHODS This descriptive retrospective review assessed data concerning the use of garcinia (Garcinia cambogia), guarana (Paullinia cupana), salvia (Salvia divinorum), and St John's wort (Hypericum perforatum) among adolescents reported nationally to poison centers from 2003 to 2014. Adolescents with a singlesubstance exposure to one of the substances of interest coded as intentional abuse or misuse were included. Poison center calls for drug information or those with unrelated clinical effects were excluded. Data were collected from the National Poison Data System. RESULTS There were 84 cases: 7 cases of Garcinia cambogia, 28 Paullinia cupana, 23 Salvia divinorum, and 26 Hypericum perforatum. Garcinia cambogia was used more frequently by females (100% versus 0%), and Paullinia cupana and Salvia divinorum were used more frequently by males (61% versus 36% and 91% versus 9%, respectively). Abuse, driven by Salvia divinorum, was more common overall than misuse. Abuse was also more common among males than females (p <0.001). Use of these agents fluctuated over time. Overall, use trended down since 2010, except for Garcinia cambogia use. In 62 cases (73.8%), the medical outcome was minor or had no effect or was judged as nontoxic or minimally toxic. Clinical effects were most common with Paullinia cupana and Salvia divinorum. Treatment sites included emergency department (n = 33; 39.3%), non-healthcare facility (n = 24; 28.6%), admission to a health care facility (n = 8; 9.5%), and other/unknown (n = 19; 22.6%). CONCLUSIONS Abuse and misuse of these dietary supplements was uncommon, and outcomes were mild. Further research should be performed to determine use and outcomes of abuse/misuse of other dietary supplements in this population.
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Affiliation(s)
- Jessica M Biggs
- Department of Pharmacy (JMB, OAK), University of Maryland Medical Center, Baltimore, Maryland; Department of Pharmacy Practice and Science (JAM, ABL, WKS), University of Maryland School of Pharmacy, Baltimore, Maryland; and (WKS) Maryland Poison Center, Baltimore, Maryland
| | - Jill A Morgan
- Department of Pharmacy (JMB, OAK), University of Maryland Medical Center, Baltimore, Maryland; Department of Pharmacy Practice and Science (JAM, ABL, WKS), University of Maryland School of Pharmacy, Baltimore, Maryland; and (WKS) Maryland Poison Center, Baltimore, Maryland
| | - Allison B Lardieri
- Department of Pharmacy (JMB, OAK), University of Maryland Medical Center, Baltimore, Maryland; Department of Pharmacy Practice and Science (JAM, ABL, WKS), University of Maryland School of Pharmacy, Baltimore, Maryland; and (WKS) Maryland Poison Center, Baltimore, Maryland
| | - Omayma A Kishk
- Department of Pharmacy (JMB, OAK), University of Maryland Medical Center, Baltimore, Maryland; Department of Pharmacy Practice and Science (JAM, ABL, WKS), University of Maryland School of Pharmacy, Baltimore, Maryland; and (WKS) Maryland Poison Center, Baltimore, Maryland
| | - Wendy Klein-Schwartz
- Department of Pharmacy (JMB, OAK), University of Maryland Medical Center, Baltimore, Maryland; Department of Pharmacy Practice and Science (JAM, ABL, WKS), University of Maryland School of Pharmacy, Baltimore, Maryland; and (WKS) Maryland Poison Center, Baltimore, Maryland
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Anheyer D, Lauche R, Schumann D, Dobos G, Cramer H. Herbal medicines in children with attention deficit hyperactivity disorder (ADHD): A systematic review. Complement Ther Med 2017; 30:14-23. [DOI: 10.1016/j.ctim.2016.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 10/10/2016] [Accepted: 11/17/2016] [Indexed: 01/30/2023] Open
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Sorkin BC, Kuszak AJ, Williamson JS, Hopp DC, Betz JM. The Challenge of Reproducibility and Accuracy in Nutrition Research: Resources and Pitfalls. Adv Nutr 2016; 7:383-9. [PMID: 26980822 PMCID: PMC4785474 DOI: 10.3945/an.115.010595] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Inconsistent and contradictory results from nutrition studies conducted by different investigators continue to emerge, in part because of the inherent variability of natural products, as well as the unknown and therefore uncontrolled variables in study populations and experimental designs. Given these challenges inherent in nutrition research, it is critical for the progress of the field that researchers strive to minimize variability within studies and enhance comparability between studies by optimizing the characterization, control, and reporting of products, reagents, and model systems used, as well as the rigor and reporting of experimental designs, protocols, and data analysis. Here we describe some recent developments relevant to research on plant-derived products used in nutrition research, highlight some resources for optimizing the characterization and reporting of research using these products, and describe some of the pitfalls that may be avoided by adherence to these recommendations.
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Affiliation(s)
| | | | - John S Williamson
- National Center for Complementary and Integrative Health, NIH, Bethesda, MD
| | - D Craig Hopp
- National Center for Complementary and Integrative Health, NIH, Bethesda, MD
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Complementary and Alternative Medicine use in Pediatric Attention-Deficit Hyperactivity Disorder (ADHD): Reviewing the Safety and Efficacy of Herbal Medicines. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2016. [DOI: 10.1007/s40474-016-0074-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Natural Product-Derived Treatments for Attention-Deficit/Hyperactivity Disorder: Safety, Efficacy, and Therapeutic Potential of Combination Therapy. Neural Plast 2016; 2016:1320423. [PMID: 26966583 PMCID: PMC4757677 DOI: 10.1155/2016/1320423] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/30/2015] [Accepted: 01/10/2016] [Indexed: 01/27/2023] Open
Abstract
Typical treatment plans for attention-deficit/hyperactivity disorder (ADHD) utilize nonpharmacological (behavioral/psychosocial) and/or pharmacological interventions. Limited accessibility to behavioral therapies and concerns over adverse effects of pharmacological treatments prompted research for alternative ADHD therapies such as natural product-derived treatments and nutritional supplements. In this study, we reviewed the herbal preparations and nutritional supplements evaluated in clinical studies as potential ADHD treatments and discussed their performance with regard to safety and efficacy in clinical trials. We also discussed some evidence suggesting that adjunct treatment of these agents (with another botanical agent or pharmacological ADHD treatments) may be a promising approach to treat ADHD. The analysis indicated mixed findings with regard to efficacy of natural product-derived ADHD interventions. Nevertheless, these treatments were considered as a “safer” approach than conventional ADHD medications. More comprehensive and appropriately controlled clinical studies are required to fully ascertain efficacy and safety of natural product-derived ADHD treatments. Studies that replicate encouraging findings on the efficacy of combining botanical agents and nutritional supplements with other natural product-derived therapies and widely used ADHD medications are also warranted. In conclusion, the risk-benefit balance of natural product-derived ADHD treatments should be carefully monitored when used as standalone treatment or when combined with other conventional ADHD treatments.
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Lao L, Hochberg M, Lee DY, Gilpin AM, Fong HH, Langenberg P, Chen K, Li EK, Tam LS, Berman B. Huo-Luo-Xiao-Ling (HLXL)-Dan, a Traditional Chinese Medicine, for patients with osteoarthritis of the knee: a multi-site, randomized, double-blind, placebo-controlled phase II clinical trial. Osteoarthritis Cartilage 2015; 23:2102-2108. [PMID: 26099553 PMCID: PMC4663117 DOI: 10.1016/j.joca.2015.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 05/29/2015] [Accepted: 06/09/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the efficacy and safety of Huo-Luo-Xiao-Ling (HLXL)-Dan, a Traditional Chinese Medicine (TCM), in patients with knee osteoarthritis (OA). DESIGN A multi-site, randomized, double-blind, placebo-controlled phase II dose-escalation clinical trial was conducted. Eligible patients who fulfilled American College of Rheumatology criteria were randomized to receive either HLXL or placebo. Clinical assessments included measurement of knee pain and function with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), patient global assessment (PGA), and knee pain scores every 2 weeks. A Data and Safety Monitoring Board (DSMB) was established to review the data for ensuring the quality of the trial. RESULTS In the first stage, 28 participants were randomized to receive either low-dose HLXL-Dan (2400 mg/day) or placebo for 6 weeks. The results showed no statistical difference between the two groups. The study was then re-designed following the recommendation of DSMB. Ninety-two patients were enrolled in the second stage and were randomized to receive either high-dose HLXL-Dan (4000 mg/day for week 1-2, and 5600 mg/day for week 3-8) or placebo for 8 weeks. All outcome assessments showed significant improvements for both groups after 8 weeks but no significant between-group differences. The change (mean ± SD) of WOMAC pain and WOMAC function scores of HLXL and placebo group after 8 weeks were -1.2 ± 1.7 vs -1.4 ± 1.5, and -1.1 ± 1.6 vs -1.3 ± 1.5 respectively. No serious adverse events were reported. CONCLUSION Although safe to use, an 8-week treatment of HLXL-Dan was not superior to placebo for reduction in pain or functional improvement in patients with knee OA. CLINICAL TRIAL REGISTRATION NUMBER Clinicaltrials.gov (NCT00755326).
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Affiliation(s)
- Lixing Lao
- Center for Integrative Medicine, School of Medicine, University of Maryland, Baltimore, USA,School of Chinese Medicine, The University of Hong Kong, HKSAR,Corresponding author: Prof. Lixing Lao, Professor and Director, School of Chinese Medicine, The University of Hong Kong, HKSAR. Professor, Center for Integrative Medicine, School of Medicine, University of Maryland, Baltimore, USA, Telephone: +852-25890476, Fax: +852-28725476,
| | - Marc Hochberg
- Division of Rheumatology & Clinical Immunology, Department of Medicine, School of Medicine, University of Maryland, Baltimore, USA
| | - David Y.W. Lee
- Mailman Research Center, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
| | - Adele M.K. Gilpin
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, USA
| | - Harry H.S. Fong
- Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Patrica Langenberg
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, USA
| | - Kevin Chen
- Department of Family and Community Medicine, School of Medicine, University of Maryland, Baltimore, USA
| | - Edmund K. Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, HKSAR
| | - Lai Shan Tam
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, HKSAR
| | - Brian Berman
- Center for Integrative Medicine, School of Medicine, University of Maryland, Baltimore, USA
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Psychiatric Disorders and Polyphenols: Can They Be Helpful in Therapy? OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2015; 2015:248529. [PMID: 26180581 PMCID: PMC4477218 DOI: 10.1155/2015/248529] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 02/06/2015] [Accepted: 02/10/2015] [Indexed: 12/24/2022]
Abstract
The prevalence of psychiatric disorders permanently increases. Polyphenolic compounds can be involved in modulation of mental health including brain plasticity, behaviour, mood, depression, and cognition. In addition to their antioxidant ability other biomodulating properties have been observed. In the pathogenesis of depression disturbance in neurotransmitters, increased inflammatory processes, defects in neurogenesis and synaptic plasticity, mitochondrial dysfunction, and redox imbalance are observed. Ginkgo biloba, green tea, and Quercus robur extracts and curcumin can affect neuronal system in depressive patients. ADHD patients treated with antipsychotic drugs, especially stimulants, report significant adverse effects; therefore, an alternative treatment is searched for. An extract from Ginkgo biloba and from Pinus pinaster bark, Pycnogenol, could become promising complementary supplements in ADHD treatment. Schizophrenia is a devastating mental disorder, with oxidative stress involved in its pathophysiology. The direct interference of polyphenols with schizophrenia pathophysiology has not been reported yet. However, increased oxidative stress caused by haloperidol was inhibited ex vivo by different polyphenols. Curcumin, extract from green tea and from Ginkgo biloba, may have benefits on serious side effects associated with administration of neuroleptics to patients suffering from schizophrenia. Polyphenols in the diet have the potential to become medicaments in the field of mental health after a thorough study of their mechanism of action.
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Abstract
Dietary and herbal interventions for attention-deficit/hyperactivity disorder (ADHD) have been proposed by practitioners of Western medicine and traditional Chinese medicine. Children who are suspected to have nutritional deficiencies, insufficiencies, and/or food allergies should be evaluated and, if the suspicion is confirmed, treated with supplementation or specific food elimination as part of standard care. Limited research exists on the efficacy and safety of dietary intervention as an adjunct to conventional medication; thus, improvement and side effects should be closely monitored.
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Affiliation(s)
- Elizabeth A Hurt
- Wright State University, School of Professional Psychology, Ellis Human Development Institute, 9 North Edwin C. Moses Boulevard, Dayton, OH 45402, USA.
| | - L Eugene Arnold
- Nisonger Center, The Ohio State University, 1581 Dodd Drive, Columbus OH 43210, USA
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Bloch MH, Mulqueen J. Nutritional Supplements for the Treatment of Attention-Deficit Hyperactivity Disorder. Child Adolesc Psychiatr Clin N Am 2014; 23:883-97. [PMID: 25220092 PMCID: PMC4170184 DOI: 10.1016/j.chc.2014.05.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Polyunsaturated fatty acid supplementation appears to have modest benefit for improving ADHD symptoms. Melatonin appears to be effective in treating chronic insomnia in children with ADHD but appears to have minimal effects in reducing core ADHD symptoms. Many other natural supplements are widely used in the United States despite minimal evidence of efficacy and possible side effects. This review synthesizes and evaluates the scientific evidence regarding the potential efficacy and side effects of natural supplements and herbal remedies for ADHD. We provide clinicians with recommendations regarding their potential use and role in overall ADHD treatment.
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Affiliation(s)
- Michael H Bloch
- Yale Child Study Center, PO BOX 207900, 230 South Frontage Road, New Haven, CT 06520, USA.
| | - Jilian Mulqueen
- Yale Child Study Center, PO BOX 207900, 230 South Frontage Road, New Haven, CT 06520, USA
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Stevenson J, Buitelaar J, Cortese S, Ferrin M, Konofal E, Lecendreux M, Simonoff E, Wong ICK, Sonuga-Barke E. Research review: the role of diet in the treatment of attention-deficit/hyperactivity disorder--an appraisal of the evidence on efficacy and recommendations on the design of future studies. J Child Psychol Psychiatry 2014; 55:416-27. [PMID: 24552603 DOI: 10.1111/jcpp.12215] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND The efficacy of three dietary treatments for ADHD has been repeatedly tested in randomized controlled trials (RCTs). These interventions are restricted elimination diets (RED), artificial food colour elimination (AFCE) and supplementation with free fatty acids (SFFA). There have been three systematic reviews and associated meta-analyses of the RCTs for each of these treatments. SCOPE The aim of this review is to critically appraise the studies on the dietary treatments of ADHD, to compare the various meta-analyses of their efficacy that have been published and to identify where the design of such RCTs could be improved and where further investigations are needed. FINDINGS The meta-analyses differ in the inclusion and exclusion criteria applied to potentially eligible studies. The range of average effect sizes in standard deviation units is RED (0.29-1.2), AFCE (0.18-0.42) and SFFA (0.17-0.31). The methodology of many of the trials on which the meta-analyses are based is weak. CONCLUSIONS Nevertheless, there is evidence from well-conducted studies for a small effect of SFFA. Restricted elimination diets may be beneficial, but large-scale studies are needed on unselected children, using blind assessment and including assessment of long-term outcome. Artificial food colour elimination is a potentially valuable treatment but its effect size remains uncertain, as does the type of child for whom it is likely to be efficacious. There are additional dietary supplements that have been used with children with ADHD. A systematic search identified 11 RCTs that investigated the effects of these food supplements. Despite positive results for some individual trials, more studies are required before conclusions can be reached on the value in reducing ADHD symptoms of any of these additional supplements.
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Affiliation(s)
- Jim Stevenson
- Department of Psychology, Developmental Brain-Behaviour Laboratory, University of Southampton, Southampton, UK
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27
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Rucklidge JJ, Johnstone J, Kaplan BJ. Nutrient supplementation approaches in the treatment of ADHD. Expert Rev Neurother 2014; 9:461-76. [DOI: 10.1586/ern.09.7] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Warikoo N, Faraone SV. Background, clinical features and treatment of attention deficit hyperactivity disorder in children. Expert Opin Pharmacother 2013; 14:1885-906. [PMID: 23865438 DOI: 10.1517/14656566.2013.818977] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Attention deficit hyperactivity disorder (ADHD) is an early onset, clinically heterogeneous, complex neurobiological disorder, defined by symptoms of inattention and hyperactivity/impulsivity and has been associated with a broad range of impairments for those affected. Additionally, ADHD in children and adolescents is frequently associated with psychiatric comorbidities. This review provides an overview of the epidemiology, neurobiology, genetics, diagnosis and most recent pharmacological approaches for treatment with a focus on safety and efficacy and describes the use of medications used to treat ADHD in special populations. AREAS COVERED PubMed, Cochrane database, Essential Evidence and Uptodate were searched for relevant articles about stimulant and non-stimulant pharmacological approaches in ADHD. EXPERT OPINION Data supporting the safety and efficacy of both stimulant and non-stimulant formulations have significantly grown over the past decade and more efforts are being made to tailor medications to the needs of the patients and their families. Pharmacogenomics research is evolving, but predictors of treatment response and side effects remain largely unknown. Other unmet clinical needs include long-term follow-up studies of the safety and efficacy of medications for those with ADHD alone, or with comorbidities and in special populations including preschoolers.
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Affiliation(s)
- Nisha Warikoo
- SUNY Upstate Medical University, Department of Psychiatry , 750 East Adams Street, Syracuse, NY 13210-2375 , USA
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Arnold LE, Hurt E, Lofthouse N. Attention-deficit/hyperactivity disorder: dietary and nutritional treatments. Child Adolesc Psychiatr Clin N Am 2013; 22:381-402, v. [PMID: 23806311 DOI: 10.1016/j.chc.2013.03.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Dozens of complementary and alternative treatments have been advocated for attention-deficit/hyperactivity disorder. Some verge into standard treatment of specific cases. Most do not have conclusive evidence of effectiveness or safety for attention-deficit/hyperactivity disorder, but some have enough evidence and are safe, easy, cheap, and sensible enough that individual patient trials can be justified. There is a need to flesh out the evidence base, which could be done cost effectively for supplements or off-label agents that are amenable to placebo control.
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Affiliation(s)
- L Eugene Arnold
- Nisonger Center, Ohio State University, McCampbell 395E, 1581 Dodd Drive, Columbus, OH 43210, USA.
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Abstract
St. John's wort (Hypericum perforatum) has been extensively studied and reviewed for its use in depression; however, there is less salient discussion on its clinical application for a range of other psychiatric disorders. This article outlines the current evidence of the efficacy of St John's wort in common psychiatric disorders, including major depression, bipolar depression, attention-deficit hyperactivity disorder, obsessive-compulsive disorder, social phobia, and somatization disorder. Mechanisms of action, including emerging pharmacogenetic data, safety, and clinical considerations are also detailed.
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Affiliation(s)
- Jerome Sarris
- Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, 2 Salisbury Street, Richmond, Victoria 3121, Australia.
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Searight HR, Robertson K, Smith T, Perkins S, Searight BK. Complementary and alternative therapies for pediatric attention deficit hyperactivity disorder: a descriptive review. ISRN PSYCHIATRY 2012; 2012:804127. [PMID: 23762770 PMCID: PMC3671686 DOI: 10.5402/2012/804127] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 11/28/2012] [Indexed: 05/03/2023]
Abstract
Attention deficit hyperactivity disorder (AD/HD), characterized by impulsivity, distractibility, and inattention, has an estimated pediatric population prevalence of 6-8%. Family physicians and pediatricians evaluate and treat the majority of children with this condition. The evidence-based treatment of choice for ADHD, stimulant medication, continues to be a source of public controversy. Surveys suggest that among parents of children with ADHD, there is considerable interest in complementary and alternative medicine (CAM). These therapies include herbal preparations, mineral supplements, sugar restriction, and polyunsaturated fatty acids. Other AD/HD therapies include neuro-feedback, cognitive training, mindfulness meditation, and exposure to "green space." In order to assist physicians and mental health professionals in responding to patient and parent queries, this paper briefly describes these CAM therapies and current research regarding their effectiveness. While investigations in this area are hampered by research design issues such as sample size and the absence of double-blind placebo-controlled trials, there is some evidence that omega three fatty acids, zinc supplements, and neuro-feedback may have some efficacy.
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Affiliation(s)
- H. Russell Searight
- Department of Psychology, Lake Superior State University, 650 West Easterday Avenue, Sault Sainte Marie, MI 49783, USA
| | - Kayla Robertson
- School of Social Work, University of Illinois, Urbana, IL 61801, USA
| | - Todd Smith
- Department of Psychology, St. Catharine College, St. Catharine, Catharine, KY 40061, USA
| | - Scott Perkins
- Department of Psychology, Western Kentucky University, Bowling Green, KY 42101-3576, USA
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Abstract
PURPOSE OF REVIEW To provide a comprehensive review of complementary and alternative medicine (CAM) treatments for children and adolescents with attention deficit hyperactivity disorder (ADHD). RECENT FINDINGS Many parents of children with ADHD are reluctant to pursue medication options and unable to access behavioral counseling. CAM therapies are often appealing to families and studies show that a large percentage of children with ADHD are treated with one or more CAM therapy. Most research studies evaluating CAM therapies are methodologically flawed, and often times there are inconsistencies across either study design or results. Although the American Academy of Pediatrics does not recommend any CAM therapies for ADHD, essential fatty acid supplementation is likely well tolerated and modestly effective. SUMMARY Most complementary and alternative treatments do not have adequate research to recommend their use in children with ADHD. Physicians should be aware of the many CAM treatment options and the research surrounding them in order to provide their patients with the most current and accurate information available.
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Weder N. In this issue/abstract thinking: is there a place for complementary and alternative medicine in child psychiatry? J Am Acad Child Adolesc Psychiatry 2011; 50:961-2. [PMID: 21961767 DOI: 10.1016/j.jaac.2011.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 07/25/2011] [Indexed: 10/17/2022]
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Hurt EA, Arnold LE, Lofthouse N. Dietary and nutritional treatments for attention-deficit/hyperactivity disorder: current research support and recommendations for practitioners. Curr Psychiatry Rep 2011; 13:323-32. [PMID: 21779824 DOI: 10.1007/s11920-011-0217-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Evidence for dietary/nutritional treatments of attention-deficit/hyperactivity disorder (ADHD) varies widely, from double-blind, placebo-controlled trials to anecdotal. In guiding patients, clinicians can apply the SECS versus RUDE rule: treatments that are Safe, Easy, Cheap, and Sensible (SECS) require less evidence than those that are Risky, Unrealistic, Difficult, or Expensive (RUDE). Two nutritional treatments appear worth general consideration: Recommended Daily Allowance/Reference Daily Intake multivitamin/mineral supplements as a pediatric health intervention not specific to ADHD and essential fatty acids, especially a mix of eicosapentaenoic acid, docosahexaenoic acid, and γ-linolenic acid as an ADHD-specific intervention. Controlled studies support the elimination of artificial food dyes to reduce ADHD symptoms, but this treatment may be more applicable to the general pediatric population than to children with diagnosed ADHD. Mineral supplementation is indicated for those with documented deficiencies but is not supported for others with ADHD. Carnitine may have a role for inattention, but the evidence is limited. Dimethylaminoethanol probably has a small effect. Herbs, although "natural," are actually crude drugs, which along with homeopathic treatments have little evidence of efficacy. Consequences of delayed proven treatments need consideration in the risk-benefit assessment of dietary/nutritional treatments.
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Affiliation(s)
- Elizabeth A Hurt
- Nisonger Center, The Ohio State University, Columbus, OH 43210, USA.
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Sarris J, Kean J, Schweitzer I, Lake J. Complementary medicines (herbal and nutritional products) in the treatment of Attention Deficit Hyperactivity Disorder (ADHD): A systematic review of the evidence. Complement Ther Med 2011; 19:216-27. [DOI: 10.1016/j.ctim.2011.06.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 06/02/2011] [Accepted: 06/29/2011] [Indexed: 12/17/2022] Open
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Complementary medicine for children and young people who have attention deficit hyperactivity disorder. Curr Opin Psychiatry 2011; 24:291-300. [PMID: 21602686 DOI: 10.1097/yco.0b013e32834776bd] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Despite effectiveness of medication in treating children and young people who have attention deficit hyperactivity disorder (ADHD), concerns about the effects of medication on children's developing brains, adverse side-effects, possibility of long-term use, and compliance issues have all contributed to the continuing search for alternative therapies. This article reviews the latest scientific evidence of the effectiveness and safety of these treatments in ADHD. RECENT FINDINGS Although there is evidence from a large randomized controlled study that neurofeedback has positive effects on reducing children's symptoms of ADHD, most recent randomized controlled trials have generally yielded negative results. Some positive results exist from a pilot study of repetitive transcranial magnetic stimulation. However, the sample size was far too small to enable any conclusions to be drawn about the evidence. Findings from the recent randomized controlled trials of supplements of essential fatty acids in children who have ADHD clearly demonstrated lack of superiority compared with placebo. SUMMARY Notwithstanding efforts made to increase the scientific rigor of previous studies, more recent studies have generally been unsuccessful in demonstrating adequate treatment effects of complementary medicine on children who have ADHD. Currently, there is no proof that complementary medicine provides a better alternative for children who have ADHD than treatments that are currently available within multimodal therapy.
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Schmidt AJ, Krieg JC, Hemmeter UM, Kircher T, Schulz E, Clement HW, Heiser P. Impact of plant extracts tested in attention-deficit/hyperactivity disorder treatment on cell survival and energy metabolism in human neuroblastoma SH-SY5Y cells. Phytother Res 2011; 24:1549-53. [PMID: 20878709 DOI: 10.1002/ptr.3198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Plant extracts such as Hypericum perforatum and Pycnogenol have been tested as alternatives to the classical ADHD drugs. It has been possible to describe neuroprotective effects of such plant extracts. A reduction of ADHD symptoms could be shown in clinical studies after the application of Pycnogenol, which is a pine bark extract. The impacts of the standardized herbal extracts Hypericum perforatum, Pycnogenol and Enzogenol up to a concentration of 5000 ng/mL on cell survival and energy metabolism in human SH-SY5Y neuroblastoma cells has been investigated in the present examination. Hypericum perforatum significantly decreased the survival of cells after treatment with a concentration of 5000 ng/mL, whereas lower concentrations exerted no significant effects. Pycnogenol( induced a significant increase of cell survival after incubation with a concentration of 32.25 ng/mL and a concentration of 250 ng/mL. Other applied concentrations of Pycnogenol failed to exert significant effects. Treatment with Enzogenol did not lead to significant changes in cell survival.Concerning energy metabolism, the treatment of cells with a concentration of 5000 ng/mL Hypericum perforatum led to a significant increase of ATP levels, whereas treatment with a concentration of 500 ng/mL had no significant effect. Incubation of cells with Pycnogenol and Enzogenol exerted no significant effects.None of the tested substances caused any cytotoxic effect when used in therapeutically relevant concentrations.
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Affiliation(s)
- Ian M Paul
- Department of Pediatrics and Public Health Sciences, The Milton S. Hershey Medical Center, Penn State College of Medicine, 500 University Drive, HS83, Hershey, PA 17033, USA.
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Abstract
Attention-deficit-hyperactivity disorder (ADHD) is a common neuropsychiatric disorder that impairs social, academic, and occupational functioning in children, adolescents, and adults. In patients with ADHD, neurobiologic research has shown a lack of connectivity in key brain regions, inhibitory control deficits, delayed brain maturation, and noradrenergic and dopaminergic dysfunction in multiple brain regions. The prevalence of this disorder in the United States is 6-9% in youth (i.e., children and adolescents) and 3-5% in adults. Prevalence rates for youth are similar worldwide. Children with ADHD are at greater risk than children without ADHD for substance abuse and delinquency whether or not they receive drug therapy; however, early treatment with psychoeducation as well as drug therapy and/or behavioral intervention may decrease negative outcomes of ADHD, including the rate of conduct disorder and adult antisocial personality disorder. Drug therapy is effective for all age groups, even preschoolers, and for late-onset ADHD in adults. Stimulants, such as methylphenidate and amphetamine, are the most effective therapy and have a good safety profile; although recent concerns of sudden unexplained death, psychiatric adverse effects, and growth effects have prompted the introduction of other therapies. Atomoxetine, a nonstimulant, has no abuse potential, causes less insomnia than stimulants, and poses minimal risk of growth effects. Other drug options include clonidine and guanfacine, but both can cause bradycardia and sedation. Polyunsaturated fatty acids (fish oil), acetyl-L-carnitine, and iron supplements (for youth with low ferritin levels) show promise in improving ADHD symptoms. As long-term studies show that at least 50% of youth are nonadherent with their drug therapy as prescribed over a 1-year period, long-acting formulations (administered once/day) may improve adherence. Comorbid conditions are common in patients with ADHD, but this patient population can be treated effectively with individualized treatment regimens of stimulants, atomoxetine, or bupropion, along with close monitoring.
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Affiliation(s)
- Julie A Dopheide
- Titus Family Department of Clinical Pharmacy and Pharmaceutical Economics and Policy, School of Pharmacy, University of Southern California, Los Angeles, California 90033, USA
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St. John's Wort Not Effective for Treatment of ADHD. J Natl Med Assoc 2008. [DOI: 10.1016/s0027-9684(15)31495-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Silva RR. Psychopharmacology news. J Child Adolesc Psychopharmacol 2008; 18:527. [PMID: 18928417 DOI: 10.1089/cap.2008.18501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Millichap JG. St John’s Wort Complementary Therapy for ADHD. Pediatr Neurol Briefs 2008. [DOI: 10.15844/pedneurbriefs-22-6-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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