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 Pycnogenol for ADHD? by Steven W. Heimann, M.D.

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

Jenner P, Olanow CW (1996), Oxidative stress and the pathogenesis of Parkinson’s disease. Neurology 47(6 suppl 3):S161-S170.

 

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