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Caterfino A, Krishna S, Chen V. Novel and complementary treatment approaches in attention-deficit/hyperactivity disorder. Curr Opin Pediatr 2024; 36:562-569. [PMID: 38957089 DOI: 10.1097/mop.0000000000001378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
PURPOSE OF REVIEW To provide an updated review of novel and complementary treatment approaches for children and adolescents with attention-deficit/hyperactivity disorder. RECENT FINDINGS The evidence for complementary attention-deficit/hyperactivity disorder treatments is often promising, but limited to small, unblinded studies. Recent evidence from larger, more rigorous studies reveals that most of these treatments have modest efficacy. Omega-3 polyunsaturated fatty acids, saffron, broad spectrum micronutrients, and physical exercise have potential benefits that seem to outweigh known risks. However, neurofeedback, cognitive training, and trigeminal nerve stimulation need further research to determine whether specific sub-groups of children/adolescents with attention-deficit/hyperactivity disorder would benefit long-term with their associated tolerable risks. SUMMARY There is not sufficient evidence for complementary treatments to be recommended as substitutes for first-line pharmacological and psychosocial treatment options. Nonetheless, some adjuvant therapies to currently recommended attention-deficit/hyperactivity disorder treatments can be safe. Physicians should be familiar with existing and emerging complementary treatments to help guide families.
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Affiliation(s)
- Andrew Caterfino
- Northwell, New Hyde Park
- Cohen Children's Medical Center, Queens, New York, USA
| | - Shruthi Krishna
- Northwell, New Hyde Park
- Cohen Children's Medical Center, Queens, New York, USA
| | - Victoria Chen
- Northwell, New Hyde Park
- Cohen Children's Medical Center, Queens, New York, USA
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Han S, Cao Y, Wu X, Xu J, Nie Z, Qiu Y. New horizons for the study of saffron (Crocus sativus L.) and its active ingredients in the management of neurological and psychiatric disorders: A systematic review of clinical evidence and mechanisms. Phytother Res 2024; 38:2276-2302. [PMID: 38424688 DOI: 10.1002/ptr.8110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/27/2023] [Accepted: 12/16/2023] [Indexed: 03/02/2024]
Abstract
Saffron (Crocus sativus), as an herbal medicine, has been extensively investigated for treating neurological and psychiatric disorders. This systematic review aimed to assess the overall effects of saffron on cognition, depression, anxiety, sleep disorders, attention-deficit/hyperactivity disorder (ADHD), and obsessive-compulsive disorder (OCD). Relevant randomized controlled trials (RCTs) were identified by searching PubMed/Medline, Web of Science, and Clinical Trials databases up to June 2023 according to search terms and inclusion criteria. The participants were either healthy or suffering from some diseases, including neurological and psychiatric disorders, and consumed saffron or its extracts as an intervention. The risk of bias was assessed according to the Cochrane guidelines, and the PRISMA statement was followed. The meta-analysis was performed using RevMan and STATA software. A random-effects or fixed-effects model was used to calculate the pooled effect sizes. Forty-six RCTs were enrolled, and the duration of these trials ranged from 4 to 48 weeks with saffron or its extracts, both alone or in combination with conventional drugs. Saffron was more effective than placebo in improving cognition, depression with an overall effect size of -4.26 (95% CI: -5.76, -2.77), anxiety of -3.75 (95% CI: -5.83, -1.67), and sleep disorders of -1.91 (95% CI: -2.88, -0.93). Saffron was non-inferior to conventional drugs for treating cognitive disorders, depression, anxiety, ADHD, and OCD, and it exhibited good tolerance with few side effects. Saffron may exert protective roles for neurological and psychiatric disorders and represents a relatively favorable and safe treatment.
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Affiliation(s)
- Shufen Han
- Department of Nutrition and Toxicology, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, People's Republic of China
| | - Yifei Cao
- Department of Nutrition and Toxicology, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, People's Republic of China
| | - Xingrong Wu
- Male Department of General Psychiatry, Shanxi Provincial Mental Health Center and Taiyuan Psychiatric Hospital, Taiyuan, Shanxi, People's Republic of China
| | - Jiaoyang Xu
- Department of Nutrition and Toxicology, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, People's Republic of China
| | - Zizheng Nie
- Department of Nutrition and Toxicology, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, People's Republic of China
| | - Yue Qiu
- Department of Nutrition and Toxicology, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, People's Republic of China
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Abd Rahim IN, Mohd Kasim NA, Omar E, Abdul Muid S, Nawawi H. Safety evaluation of saffron extracts in early and established atherosclerotic New Zealand white rabbits. PLoS One 2024; 19:e0295212. [PMID: 38207245 PMCID: PMC10783933 DOI: 10.1371/journal.pone.0295212] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/17/2023] [Indexed: 01/13/2024] Open
Abstract
Previous research has shown that natural medications pose health risks, especially in subjects with comorbidities. This study aimed to evaluate the safety of saffron ethanolic extract (SEE) administration in early and established atherosclerotic rabbits. Rabbits were given a high-cholesterol diet (HCD) for 4 and 8 weeks to induce early and established atherosclerosis respectively, and then they were treated with 50 and 100 mg/kg/day SEE. The body weight of the animals was recorded. Blood samples were collected at baseline, pre-treatment, and post-treatment for hematological studies, lipid profiles, and biochemical profiles. Tissue specimens of the vital organs were subjected to histological examination. The above parameters were significantly altered post-intervention with 4 and 8 weeks of HCD. No significant differences in body weight were observed in all the groups post-treatment with 50 and 100mg/kg of SEE compared to pre-treatment. However, low-density lipoprotein cholesterol, total cholesterol, serum urea, and glucose significantly decreased post-treatment with 50 and 100mg/kg/day SEE compared to pre-treatment in early and established atherosclerosis groups. Hematological parameters that were affected post-intervention with HCD returned to their baseline values post-treatment with 50 and 100mg/kg/day SEE. There was a significant improvement in the vital organs post-treatment with 50 and 100mg/kg SEE. SEE can safely be administered without causing harmful effects on the hematological, biochemical profiles, and vital organs. Notably, SEE exerts hypolipidemic and hypoglycemic effects on atherosclerotic conditions. Further clinical trials are warranted to ensure the safety of saffron administration in patients with atherosclerosis-related diseases.
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Affiliation(s)
- Iman Nabilah Abd Rahim
- Department of Pathology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Noor Alicezah Mohd Kasim
- Department of Pathology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Effat Omar
- Department of Pathology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Suhaila Abdul Muid
- Department of Pathology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
- Department of Biochemistry & Molecular Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Hapizah Nawawi
- Department of Pathology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
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Seyedi-Sahebari S, Farhang S, Araj-Khodaei M, Akhondzadeh S, Naseri A, Sanaie S, Frounchi N. The Effects of Crocus sativus (Saffron) on ADHD: A Systematic Review. J Atten Disord 2024; 28:14-24. [PMID: 37864351 DOI: 10.1177/10870547231203176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
BACKGROUND AND AIM Crocus sativus also known as saffron, is one of the most popular traditional plants. This study aims to evaluate the efficacy and safety of saffron extracts in ADHD. METHOD This study includes clinical trial studies that assessed the efficacy and/or safety of saffron in ADHD patients. Non-English papers, review articles, commentaries, letters, observational studies, thesis, animal studies, in-vitro studies, and conference abstracts were not included. The risk of bias in randomized studies was evaluated based on the Cochrane RoB.2, and risk of bias in pre-post intervention studies was assessed using the ROBINS-I tool. RESULTS Four studies met our inclusion criteria with a total of 118 patients. The results manifested an efficient role of saffron as either an adjuvant therapy to MPH or a single therapy against ADHD, without significant safety issues. DISCUSSION Saffron demonstrates promise in improving ADHD symptoms, with an acceptable safety profile. Future well-designed multicentral studies are suggested.
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Affiliation(s)
| | - Sara Farhang
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirreza Naseri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sarvin Sanaie
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Negin Frounchi
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
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Blasco-Fontecilla H, Moyano-Ramírez E, Méndez-González O, Rodrigo-Yanguas M, Martin-Moratinos M, Bella-Fernández M. Effectivity of Saffron Extract (Saffr’Activ) on Treatment for Children and Adolescents with Attention Deficit/Hyperactivity Disorder (ADHD): A Clinical Effectivity Study. Nutrients 2022; 14:nu14194046. [PMID: 36235697 PMCID: PMC9573091 DOI: 10.3390/nu14194046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/19/2022] [Accepted: 09/24/2022] [Indexed: 12/14/2022] Open
Abstract
Attention Deficit/Hyperactivity Disorder is the most prevalent neurodevelopmental disorder worldwide. Choice treatment includes psychostimulants, but parents tend to be reluctant to administer them due to side effects, and alternatives are needed. Saffron extract is a natural stimulant that has been proven safe and effective for treating a variety of mental disorders. This study compares the efficacy of saffron and the usual treatment with methylphenidate, using objective and pen-and-paper tests. We performed a non-randomized clinical trial with two groups, methylphenidate (n = 27) and saffron (n = 36), in children and adolescents aged 7 to 17. Results show that the efficacy of saffron is comparable to that of methylphenidate. Saffron is more effective for treating hyperactivity symptoms, while methylphenidate is more effective for inattention symptoms.
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Affiliation(s)
- Hilario Blasco-Fontecilla
- Hospital Universitario Puerta de Hierro Majadahonda, 28222 Majadahonda, Spain
- Faculty of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain
- CIBERSAM (Centro de Investigación en Salud Mental), Carlos III Institute of Health, 28029 Madrid, Spain
- ITA Mental Health, 28043 Madrid, Spain
- Correspondence:
| | | | | | - María Rodrigo-Yanguas
- Hospital Universitario Puerta de Hierro Majadahonda, 28222 Majadahonda, Spain
- Faculty of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain
| | - Marina Martin-Moratinos
- Hospital Universitario Puerta de Hierro Majadahonda, 28222 Majadahonda, Spain
- Faculty of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain
| | - Marcos Bella-Fernández
- Hospital Universitario Puerta de Hierro Majadahonda, 28222 Majadahonda, Spain
- Faculty of Psychology, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Department of Psychology, Universidad Pontificia de Comillas, 28049 Madrid, Spain
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Shahbaz K, Chang D, Zhou X, Low M, Seto SW, Li CG. Crocins for Ischemic Stroke: A Review of Current Evidence. Front Pharmacol 2022; 13:825842. [PMID: 35991882 PMCID: PMC9388830 DOI: 10.3389/fphar.2022.825842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
Crocins (CRs) and the related active constituents derived from Crocus sativus L. (Saffron) have demonstrated protective effects against cerebral ischemia and ischemic stroke, with various bioactivities including neuroprotection, anti-neuroinflammation, antioxidant, and cardiovascular protection. Among CRs, crocin (CR) has been shown to act on multiple mechanisms and signaling pathways involved in ischemic stroke, including mitochondrial apoptosis, nuclear factor kappa light chain enhancer of B cells pathway, S100 calcium-binding protein B, interleukin-6 and vascular endothelial growth factor-A. CR is generally safe and well-tolerated. Pharmacokinetic studies indicate that CR has poor bioavailability and needs to convert to crocetin (CC) in order to cross the blood-brain barrier. Clinical studies have shown the efficacy of saffron and CR in treating various conditions, including metabolic syndrome, depression, Alzheimer’s disease, and coronary artery disease. There is evidence supporting CR as a treatment for ischemic stroke, although further studies are needed to confirm their efficacy and safety in clinical settings.
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Affiliation(s)
- Kiran Shahbaz
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- *Correspondence: Kiran Shahbaz, ; Chung Guang Li,
| | - Dennis Chang
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Xian Zhou
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Mitchell Low
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Sai Wang Seto
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- Reserach Centre for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Chung Guang Li
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- *Correspondence: Kiran Shahbaz, ; Chung Guang Li,
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