J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 38:4, APRIL
1999
PYCNOGENOL FOR ADHD?
To the Editor:
Despite a lack of double-blind, controlled studies
to support the claimed beneficial effects of alternatives and unconventional
medicines to treat medical as well as psychiatric disturbances,
their popularity seems to be increasing. It is not uncommon to see
advertisements in newspapers and magazines describing the beneficial
effects of agents such as St. John’s wort in depression, ginkgo
in vascular insufficiency, melatonin in insomnia, and the antioxidant
derived from pine bark (pycnogenol) in attention-deficit/hyperactivity
disorder (ADHD). A growing number of parents with ADHD-afflicted
children are requesting that practitioners provide information about
pycnogenol, if not an outright prescription. Unfortunately, not
much information about indication, dosing, safety, efficacy, bioavailability,
pharmacokinetics, and pharmacodynamic factors can be conveyed due
to a relative lack thereof. A Medline search revealed no information
supporting the use of pycnogenol for ADHD or any other psychiatric
illness. The following vignette highlights the use of pycnogenol
in a child:
J.M. was 10 years old when care was transferred from
a colleague, who maintained the patient on dextroamphetamine for
ADHD. Significant developmental delays in early childhood prompted
an evaluation at a well-respected autism center, which did not support
the presence of a pervasive developmental disorder, but rather ADHD.
The patient had difficulties with hyperactivity, impulsivity, and
inattention. Poor social skills led to frequent physical altercations
at school. Stimulants provided only a slight improvement in ADHD
target symptoms. Without notifying the treating psychiatrist, J.M.’s
parents began to give him pycnogenol in addition to his prescribed
dextroamphetamine. The parents noted significant improvement in
target symptoms during the manufacturer-mandated algorithm-defined
2-week titration phase.
The parents reluctantly agreed to give J.M. a trial
off of pycnogenol for 4 weeks to compare the effects of stimulant
plus pycnogenol to stimulant alone. Within 2 weeks of stopping pycnogenol,
the patient became significantly more hyperactive and impulsive,
marked by numerous demerits in school. He was also involved in several
physical altercations, which previously had abated with pycnogenol.
J.M.’s regimen of pycnogenol was reinstated, and again he demonstrated
significant improvement in ADHD target symptoms within 3 weeks.
Testimonials regarding the benefits of pycnogenol
in the treatment of ADHD abound on the World Wide Web, and anecdotal
case reports described by child and adolescent practitioners are
becoming more common as well. Could the antioxidant pycnogenol have
a beneficial effect beyond serving as a placebo? It may not be unreasonable
to consider a role for antioxidants in the CNS provided that they
cross the blood-brain barrier. Jenner and Olanow (1996) reviewed
the pathogenesis of Parkinson disease (striatal dopamine deficiency
syndrome), which links oxidative stress with subsequent oxidative
damage to the substantia nigra, along with damage to other lipids,
proteins, and DNA. Could similar oxidative damage to receptor sites,
autoreceptors, neurotransmitters, or second messenger systems contribute
to the neurobiochemical basis of ADHD? If so, then the use of antioxidants
such as pycnogenol could have a role in the treatment of ADHD. Certainly
well-controlled studies will be needed to answer many of these questions.
Steven W. Heimann, M.D.
Evansville, IN
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