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Thursday, July 9, 2015

Pycnogenol and ADHD Treatment

Recently, an article in ADDitude magazine's online site recently recommended pycnogenol as a possibly helpful herbal supplement for the treatment of ADHD.  Pycnogenol is a proprietary extract of the bark of the French maritime pine.  It has been tested as a potential treatment for many conditions due its antioxidant properties.  How good is the evidence for ADHD?

Effectiveness
Pycnogenol has been evaluated in a number of trials in patients with ADHD.  Most of these trials have measured various substances which reflect oxidative stress, and most of them have shown decreased oxidative stress.  However, it isn't clear that oxidation is definitely a cause of ADHD. 

There are two trials which measured ADHD symptoms in response to pycnogenol.  One trial was a placebo controlled, blinded study which involved 61 children with ADHD.   This means that only around half of the children took the actual study drug.   This study showed pycnogenol to be helpful in reducing ADHD symptoms, but the numbers are not big enough to be statistically significant.  The second trial involved 24 adults in a double blind, placebo controlled, double crossover study.  It compared pycnogenol, methylphenidate, and placebo.  Placebo was most effective in controlling ADHD symptoms, suggesting that either pycnogenol is ineffective or that the dosing was not right.

A 2012 Cochrane review of the subject (which involved all studies available today on the topic of ADHD and pycnogenol) concluded that the evidence that pycnogenol is helpful for ADHD is still lacking and that bigger studies need to be done to produce convincing statistics.

Side effects
One might argue that if pycnogenol is potentially effective, at least it will do no harm to try it.  Unfortunately, this is a potentially dangerous line of reasoning.  So far, in small trials run for short periods of time (usually less than 12 weeks), pycnogenol has been fairly well tolerated with no shocking side effects reported.  However, pycnogenol is an antioxidant, and we know that the body uses oxidative products as part of the immune response.  It is possible that pycnogenol may cause long term problems such as autoimmune disease, cancer, or immune deficiencies.  One need only look to the example of vitamin E and lung cancer to understand how important it is to run clinical trials to pick up on side effects such as these.  Additionally, pycnogenol has been shown in some clinical trials to possibly inhibit blood clotting, which raises the question as to whether it could also cause unwanted bleeding.

Overall, we just don't know what the side effects of pycnogenol are, though potentially it could have some significant ones.

Who should try pycnogenol for their ADHD?  This supplement is promising in its effectiveness, but no more than promising, and it does have the potential to have some serious side effects in the long term.  Until it is clear that the benefits outweigh the risks, most patients with ADHD should skip this supplement.  However, patients who have tried multiple medications and other proven nondrug therapies, and who still have significant symptoms may consider trying this as a last resort over therapies which have little efficacy and proven severe side effects, such as marijuana.


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