Pine Bark and ADHD

Pine Bark Extract Helps Calm ADHD in Jack but Not Jill By Neil Osterweil, Senior Associate Editor, MedPage Today Published: June 16, 2006 Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine. BRATISLAVA, Slovakia, June 16 — Pine bark extract, a substance known as Pycnogenol, seems to calm boys with attention-deficit hyperactivity disorder (ADHD), according to researchers here. Girls were not helped.Action Points -------------------------------------------------------------------------------- Explain to interested parents and children that this study appears to show that Pycnogenol, a standardized extract of pine bark, is effective at treating some symptoms of ADHD. Caution that this was a small, short duration study and was not sufficiently powered to detect a possible effect of gender. In addition some of the improvements noted did not reach statistical significance. The boys with ADHD given Pycnogenol, from the bark of the French maritime pine, had modest but significant reductions of hyperactivity and inattention, according to Jana Trebaticka, M.D., and colleagues, of the Child University Hospital at Comenius University, and the University of Münster in Germany. "These findings are especially notable for parents who are concerned about overmedicating children diagnosed with ADHD," said Peter Rohdewald of Münster, a co-author. "Many families are seeking natural options to avoid the potentially dangerous side effects of prescription drugs," he added. Unlike Ritalin (methylphenidate), the mechanism of action of Pycnogenol in ADHD is unclear, but it may involve alteration of the response to the catecholamines dopamine and norepinephrine, the authors wrote in the June 17 issue of European Child & Adolescent Psychiatry. In open-label studies and case reports, the extract has been reported to improve symptoms of ADHD, the authors said, prompting them to start a randomized, double-blind, placebo-controlled trial. The study was funded by Horphag Research Limited, UK, the maker or Pycnogenol. The investigators enrolled 61 children (50 boys and 11 girls), mean age 9.5 years (range six to 14) with diagnoses of ADHD. The children were randomized on a 2.5:1 ratio to either placebo or Pycnogenol at 1 mg/kg/day orally for four weeks. At baseline, after one month of treatment and at two months of follow-up the children were tested for ADHD symptoms with standard questionnaires, including the Child Attention Problems (teacher-rated) instrument, Conner's Teacher and Parent Rating scales, and a modified Wechsler Intelligence Scale. Analysis was by intention-to-treat. The investigators found that in the boys but not girls who received four weeks of therapy with the active drug. there were significant improvements over baseline and compared with placebo for teacher ratings on hyperactivity (P=0.008 over baseline) and inattention (P=0.00014 over baseline). At one month after the end of the trial, the apparent drug benefit had disappeared and ADHD symptom scores returned to baseline levels. On the Conner Teacher Rating Scale teachers noted following one month of treatment with Pycnogenol reduction of inattention which was not statistically significant (P=0.07) compared with start and marginally significant compared with placebo (P=0.049). "Hyperactivity was also lower compared with the start as well as with placebo following Pycnogenol treatment; however, the decrease failed to reach significance (P=0.45 and P=0.28)," they wrote. Parental ratings of inattention not differ significantly from baseline to study end, however, the authors noted. "Following one month of treatment with Pycnogenol, the lower score for hyperactivity compared to placebo was not stastiscally significant (P=0.065)," they wrote. "The tests for visual-motoric coordination and concentration-Weight scores-were also different for placebo and Pycnogenol group at start." No serious side effects were reported, although observers noted "a rise in slowness" in one patient, and moderate gastric discomfort in another. There were no changes over baseline in either the Pycnogenol or placebo groups in basic biochemical parameters such as bilirubin, glucose, liver enzymes, uric acid, or lipids after one month. "Our results point to an option to use Pycnogenol as a natural supplement to relieve ADHD symptoms of children," the authors wrote. Because there were only six girls in the Pycnogenol group and five in the placebo group, the study was insufficiently powered to detect a possible effect of gender, the authors acknowledged. They also pointed out that their data are limited by the small number of participants and the by the short duration of the study. Primary source: European Child & Adolescent Psychiatry Source reference: Trebaticka J et al. "Treatment of ADHD with French maritime pine bark extract, Pycnogenol"Eur Child Adolesc Psychiatry DOI 10.1007/s00787-006-0538-3 Additional ADHD/ADD Coverage Find this article at: http://www.medpagetoday.com/Psychiatry/ADHD-ADD/3563