Plant extracts for ADHD

The presentation about plant extracts in ADHD is only for completeness. The presented remedies are not sufficiently scientifically studied in ADHD. Massive side effects are possible. Therefore, an urgent warning must be given against their use.

Basically, plant extracts have the disadvantage that they contain a collection of active ingredients and thus often unfold a broad and not well controllable spectrum of mechanisms of action - some of which may be desired and some undesired. Individual active ingredients, on the other hand, can be used much more precisely and selectively to achieve only the desired effects and avoid the undesired ones.
The example of antidepressants is a good way to track this. Whereas tricyclic antidepressants, which brought about considerable improvements in the treatment of depression when they were introduced several decades ago, were often serotonin, dopamine and norepinephrine reuptake inhibitors at the same time, more modern antidepressants are much more selective (e.g. SSRIs: selective serotonin reuptake inhibitors) and can thus serve the needs of the affected person much more precisely precisely precisely because of this selectivity.
Another disadvantage of plants as medicinal products is the natural variations of the ingredients. Therefore, it makes a big difference whether you get plants and brew a tea, or buy the extract of the plant as a medicine in the pharmacy. Only the control of the type and quantity of the ingredients enables reliable efficacy and dosage at all.

A - sometimes rather emotionally driven - search for explicitly “alternative treatment methods”, on the other hand, is a logical short-circuit within a medium period of time. If an “alternative treatment method” were as effective as mainstream treatments, they would very quickly become very successful - and thus mainstream - through simple word-of-mouth (such as in the ADHD forum.adxs.org). Conversely, it follows that alternative treatment options that have been known for some time are hardly successful - otherwise they would no longer be alternative.

• 1. Ginseng
  • 1.1. Dopaminergic mechanisms of action of ginseng
  • 1.2. Ginseng for ADHD
• 2. Ginkgo biloba
• 3. Yizhidan (YZD)
• 4. Tiaoshen Liquor (TL)
• 5. Rehmanniae Radix Preparata, Catalpol
• 6. Kratom
• 7. Lycium chinense
• 8. Saffron

1. Ginseng¶

1.1. Dopaminergic mechanisms of action of ginseng¶

Ginseng contains

• Ginsenosides. These are known as powerful antioxidants with neuroprotective properties¹
• Saponins
• Phenols
• Polyacetylene
• Alkaloids
• Polysaccharides.
• Gintonin, a non-saponin polymer and lysophosphatidic acid receptor agonist²

Ginseng root is said to influence neurotransmitters in the brain:³

• Dopamine
  • after 2 weeks
    • increased in the PFC (which could be beneficial in ADHD in terms of organizational problems)
    • in the striatum is reduced (which would be detrimental in ADHD in terms of drive and motivation)
  • after 7 weeks
    • reduced in many areas of the brain (which would be detrimental in ADHD overall)
      • PFC, striatum, hippocampus, hypothalamus, limbic lobe, midbrain, cerebellum, and medulla oblongata
• Norepinephrine
  • after 2 weeks
    • in PFC increased
  • after 7 weeks
    • reduced in many areas of the brain (which would be detrimental in ADHD overall)
      • PFC, striatum, hippocampus, hypothalamus, limbic lobe, midbrain, cerebellum, and medulla oblongata
• Serotonin
  • after 2 weeks
    • increased in the striatum
    • increased in the cerebellum
    • in the hypothalamus is reduced
  • after 7 weeks
    • increased in the cerebellum
    • in the remaining brain areas is reduced
      • PFC, striatum, hippocampus, hypothalamus, limbic lobe, midbrain, and medulla oblongata

Korean red ginseng protected the blood-brain barrier and, probably by reducing oxidative processes, protected against dopaminergic neuronal damage in the striatum in a Parkinson’s disease model.⁴ One hypothesis is that this may be caused by ginsenosides²

Gintonin appears to regulate dopamine transmission in PC12 cells and alleviate MPTP-induced motor impairments by increasing TH levels in the striatum.⁵ Besides, gintonin seems to decrease synuclein in substantia nigra and striatum and thereby be neuroprotective for dopamine neurons, which would be helpful in Parkinson’s disease .⁶

However, these mechanisms cannot be easily transferred to ADHD.
Except for the increase in tyrosine hydroxylase in the striatum, no mechanisms are apparent that would be helpful for ADHD.

1.2. Ginseng for ADHD¶

There are very few studies on the use of ginseng in ADHD. On this basis, it is necessary to warn against its use.
An observational clinical study of 18 children with ADHD reported that 1000 mg of Korean red ginseng over 8 weeks improved inattention.⁷
A double-blind randomized placebo-controlled study found a statistically significant improvement in inattention and hyperactivity and a decreased theta-beta ratio in QEEG with 2 g Korean red ginseng extract/day after 8 weeks. Salivary cortisol and DHEA levels were unchanged.⁸ Another study investigated a combination of ginseng with omega 3.⁹

A case study on 3 adolescents with ADHD reported improved inattention and hyperactivity/impulsivity in the parent report by Panax Ginseng, which was a dopamine and norepinephrine reuptake inhibitor.¹⁰ The same author also reported improvements in ADHD by St. John’s Wort¹¹ and Real Chamomile¹² on apparently the same 3 sufferers each time. Scientific weight should not be given to these studies. Why a meta-study nevertheless names this study without comment as an argument for the effectiveness of ginseng in ADHD is incomprehensible.¹

2. Ginkgo biloba¶

There are very few studies on the use of Ginkgo biloba in ADHD. On this basis, it is necessary to warn against its use.
A randomized double-blind trial found Ginkgo biloba less effective than MPH for ADHD.¹³ MPH showed more frequent side effects of loss of appetite, headache, and insomnia. Significantly, the effect was rated much higher in parent ratings than in teacher ratings - a pattern that is common with emotionally desired treatments.
Up to 240 mg of Ginkgo biloba improved ADHD behavioral symptoms and brain electrical activity in children in a very small study (n = 20).¹⁴
A randomized, placebo-controlled trial in children and adolescents with ADHD found that ginkgo biloba, as an additional treatment alongside 20 to 30 mg of MPH, improved its effects.¹⁵

Concurrent treatment with ginkgo biloba and ginseng alleviated ADHD symptoms in children, with few side effects, in a small study (n = 36).¹⁶

The extract from the leaves of Ginkgo biloba is used as a herbal medicine against dementia.¹

3. Yizhidan (YZD)¶

Yizhidan is said to have a comparable level of efficacy to methylphenidate with lower side effects.¹⁷¹⁸

Yizhidan seems to be a Chinese medicinal plant.¹⁹

Since there is no study on this other than the one mentioned, the study was designed to be only single-blind (which can potentially bias in favor of the desired outcome), and the study itself cannot be verified, the result is in no way certain.
The study report also has a peculiar parallel with that on Tiashen Liquor, since in both cases the impairments to be eliminated by the drug in the test animals were caused by the same agents and are described in the same wording, and it appears to be the same journal.

4. Tiaoshen Liquor (TL)¶

Tiaoshen Liquor is said to be made from Chinese medicinal herbs. A study on 100 children had shown a high reduction of symptoms.²⁰

Since there is no other study on this besides the one mentioned and the study itself cannot be verified, the result is in no way certain.

The study report also has a peculiar parallel with that on Yizhidan (YZD), since in both cases the impairments in the test animals to be eliminated by the drug are caused by the same means and described in the same wording, and it seems to be the same journal.

5. Rehmanniae Radix Preparata, Catalpol¶

In an article (which at least complies with scientific formalities), the efficacy of Rehmanniae Radix Preparata as a remedy frequently used in Traditional Chinese Medicine (TCM) for ADHD was investigated. However, trials with test persons are completely missing and it is openly communicated that the financier of the article influenced the publication.²¹

Another article confirmed a positive effect of catalpol, a component of Rehmanniae Radix Preparata, on ADHD symptoms in rats ²²
Catalpol is said to increase the levels of

• BDNF (Brain-Derived Neurotrophic Factor)
• Cdk5 (Cyclin-Dependent Kinase 5)
• P35
• FGF 21 (Fibroblast Growth Factor 21)
• FGFR 1 (FGF 21 receptor)

which should have a positive effect on learning ability, which is reduced in ADHD due to decreased levels of BDNF and other neurotrophic factors.

6. Kratom¶

Kratom (Mitragyna speciosa) is a tree found in Asia. The dried leaves are used. Other names are biak, gra-tom, biak-biak, katawn, krton, mabog or mambog.

Use of kratom for ADHD has been reported,²³ particularly as a self-medication.²⁴
Since the effect of Kratom can be extremely different up to opposite depending on tree species and dose, and the effect is not yet secured, must be urgently warned against self-medication.

There are indications of an addictive potential²⁵ and of the potential to trigger seizures,²⁶ each described on the basis of individual cases.

7. Lycium chinense¶

A fruit extract of Lycium chinense showed significant improvement in verbal learning test, digit span forward test, digit span backward test, auditory continuous CNT performance, and FAIR performance score in a double-blind randomized study against placebo compared to the placebo group.²⁷ ADHD was an exclusion criterion for the subjects. Application to ADHD sufferers has not been reported to date.
As always, such study results are not robust until replicated by other study teams.

8. Saffron¶

A randomized double-blind trial found the same improvement in ADHD symptoms in children and adolescents for saffron as for MPH, with the same rate of side effects.²⁸
A nonrandomized study with conflicts of interest of the authors claimed an equivalent effect size of saffron extract on ADS(H)S symptoms as methylphenidate with, in addition, a better effect on hyperactivity than MPH, whereas MPH had a better effect on inattention.²⁹ seven patients in the methylphenidate group (25.9%) and 10 patients in the saffron group (31.2%) reported side effects.
Two randomized double-blind clinical trials found an improved effect of MPH plus saffron compared with MPH alone.³⁰³¹