Sunday, May 17, 2009

Ginkgo biloba for ADHD: A natural herbal treatment alternative?

A few weeks ago, I discussed the merits of ginseng for treating ADHD. What I did not mention is the fact that this special herb often works even better in tandem with another important "brain herb", Ginkgo biloba. It's benefits also extend beyond the nervous system, and the Ginkgo has been used to treat everything from increasing blood flow to Alzheimer's to glaucoma to hormone replacement to protection against neuronal degradation. While somewhat wary (personally) of using generalized "brain booster" nutrients for ADHD (it is a highly variable disorder of complex etiology and treatment methods), I am interested whenever new research publications arise on the topic. Just this week, a new paper came out on the merits of Ginkgo biloba as an ADHD treatment option.

Here are some of the major points of the publication:

  • Irritability is an often overlooked side effect of ADHD. Medications, especially over-prescription with stimulants such as methylphenidate and amphetamines can increase this unwanted side effect. However, Ginkgo exhibited a positive mollifying effect on irritability for the individuals in the study.

  • While one of the knocks against Ginkgo biloba is that it can sometimes result in sedative effects, the study found these to be extremely mild. However, to go along with the irritability-reducing benefits above, Ginkgo was able to improve the individuals' tolerance for frustration (to the degree that this behavior could be measured).

  • We have seen previously that oppositional defiant behaviors are often comorbid to ADHD (which can often manifest themselves alongside seemingly unrelated disorders such as auditory processing disorders or even bedwetting). One of the strongest suits of Ginkgo biloba may actually be in curbing these oppositional behaviors. This suggests that Ginkgo may be effective for the more Hyperactive/Impulsive or Combined Subtypes of ADHD, where comorbid oppositional behaviors are more often seen (as opposed to the predominantly inattentive subtype of the Disorder).

  • Nevertheless, Ginkgo biloba appeared to boost symptoms of attention and working memory as well. This may suggest Ginkgo's versatility, and that it could be used universally across the ADHD "spectrum", including for the 3 classic or traditional subtypes of the disorder.

  • The study highlights the relative success for co-treatment with methylphenidate and clonidine for individuals with ADHD and comorbid anxiety disorders. The authors suggest a functional comparison between Ginkgo and clonidine, and hint at its use as an alternative to clonidine/methylphenidate treatment (of course, it is also possible that Ginkgo may be used alongside lower doses of stimulant medications, which could be very useful in reducing unwanted side effects, which are often mild for low doses of stimulants, but typically begin to appear with greater frequency when stimulant dosing is increased). Thus, Ginkgo could possibly act as a side-effect-saving alternative to higher doses of medication.

  • As a precautionary measure, due, in part to some of its anti-clotting properties, there is some concern about Ginkgo triggering internal cerebral bleeding. Indeed, other studies have also addressed this possible concern, highlighting issues such as haemmorrhage risks, as well as herb-drug interactions with Ginkgo and anti-coagulant medications.

  • Keep in mind the extremely small nature of the study (only 6 individuals) should be met with healthy skepticism. However, the results were still notable. Statistically significant reductions in some of the trademark ADHD symptoms (fidgeting, restlessness, inattention, etc.) upon Ginkgo biloba treatment definitely highlight its potential as a more "natural" alternative treatment method for ADHD.

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ADHDeveloper said...

I had started taking medication for ADHD 3 months ago (first Adderall XR, then Concerta) and irritability was a big side effect for me. I am generally a pretty mild mannered man but my wife commented a few times that I had become a complete jerk. Still I kept the medication going because the benefits outweighed the drawbacks.

After reading this post I went and got myself a bottle of generic storebrand Gingko and started taking 1-2 tablets a day. It has been about 10 days now since I started doing that and irritability has certainly gone down tremendously.

Previously I could feel myself getting irritated by little things but could not control it. I knew it was abnormal and likely a side effect of the stimulants.

Just thought I`d post this so other readers may also give it a try. Thanks for posting this info!

The ADHD Treatment Guide said...

Thanks for the personal "success story" ADHDeveloper. A lot of times the highly-controlled clinical trials for a medication or natural ADHD treatment do not tell the whole story, since there may be dozens of studies which show little or no results and are simply not published (this publication bias is common, so we should take most of these findings with a grain of salt).

Having said that, I want to thank you for your personal anecdote. Clinical studies are fine, but when real people begin to comment on positive effects of a particular treatment method, that carries a ton of weight in my book.

Here's to your continued success!

Rachel said...

From the second link:

'Bilobalide has been shown to be protective against glutamate-induced excitotoxic neuronal death.'

That's interesting because ADHD brains on average contain more glutamate, according to a couple of studies online.

Although I can't ever be sure, it does seem to me that meals containing artificially high levels of MSG stop me sleeping and feeling tired at night. They don't do that to others eating at the same places at the same time, so I do seem to react to unusually to ingesting large amounts of free glutamate, which I usually avoid (possibly explaining my sensitivity, but I don't know whether your regular exposure level affects your reaction at all), maybe because my brain's already got too much.

Anonymous said...

I have used ginkgo and found it helpful, but one of the studies found that in "healthy young people" most of the effect is lost pretty quickly.


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Julian said...

I was about to make a trip to the nearest Costco upon reading this post when I stumbled upon this information:

I'm not sure how this warning applies, if at all, specifically to the actual documented interactions between gingko biloba (in commercially available capsule format) and methylphenidate. However, it does mention some pretty gruesome side effects from ingesting the neurotoxin included in gingko.

I found your website and this post while surfing the web for information on Concerta, which I have just started taking. Judging by the description on the above page, would you say that's generic information that only warns potential users of theoritical dangers? Or should I really stay away from GB while I'm on Concerta for the fear of getting a seizure?

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The ADHD Treatment Guide said...

This is a response to Julian's comment from a couple months ago (sorry for not seeing or addressing it sooner) about the side effects of ginkgo and methylphenidate (Concerta, Ritalin, etc.)

To the best of my knowledge (at the moment), the negative side effects of ginkgo at reasonable doses and interactions with other drugs for ADHD is relatively low, and the dangers are predominantly theoretical at this point.

However, THIS DOES NOT MEAN THAT AN INCREASED RISK DOES NOT EXIST. When looking at things such as seizure potential, a number of ADHD stimulant meds have been shown to lower seizure thresholds (although a lot of contradiction and controversy exists among the design, results and conclusions of these studies).

As an individual who has worked with multiple seizure prone children who are on various medications, I know first-hand how volatile these situations can be.

I wrote an earlier post (about a year ago) on ADHD medications and epilepsy/seizure risks and cited how some studies say that stimulants increase the risk of seizure, while others highlight a decreased risk. Here's a link to this post on ADHD medications and epilepsy.

Although I'd rather not defer an answer to your question or use the usual cop-out "talk to your doctor" bit, I do need to make that suggestion (for liability reasons among other things!).

As far as compounds in Ginkgo go, one of the components called "ginkgo B component" does have potential anticoagulant (anti-clotting) factors, so if you suffer from some type of disorder with improper blood clotting, ginkgo may possibly trip this even further.

Finally, it's important to note that herbal treatments (at least in most countries) do not undergo the rigorous testing or regulations of prescription medications, and the variability in dosing from one capsule or bottle to the next can be quite pronounced.

(It is important to note that many of these herbal products contain literally hundreds or even thousands of compounds, which are not always distributed consistently or uniformly throughout the plant).

Please don't make the mistake of automatically associating "natural" with "safe".

I definitely don't want to rail on ginkgo biloba, especially after mentioning its positives in this blog post. However, please be aware that drug/herb interactions can be just as severe as drug/drug interactions, and may be even more of an issue because drug/herb or herb/herb interaction studies are often way more scarce and incomplete.

jmcleod76 said...

I have suffered from the primarily inattentive subtype of ADHD - cloudy mind, can't concentrate, get lost in daydreams for long periods of time - for as long as I can remember, but was not diagnosed until my early 30s. My experience with prescription treatments has been mostly negative. My psychiatrist first prescribed Strattera. The benefits were almost immediate. My mind felt sharper, and I no longer had trouble concentrating on tasks for more than a few minutes at a time. Unfortunately, I experienced extreme nausea as a side effect the entire time I took this medication. At first, this was mild, but it gradually grew worse, until it began to outweigh the benefits of the medication. No dietary changes or over-the-counter nausea remedies helped. My doc then switched me to stimulants, which had no effect at all. I stopped taking the stimulants after several months with no improvement. Recently, I've begun taking gingko and flax seed oil supplements, in addition to a multivitamin, on a daily basis. Right now, I'm taking only 60mg per day, and the difference in my clarity and alertness has been marked. I'm really amazed by the improvement. My reading indicates that the best benefit comes from taking at least 120mg per day, but right now I'm satisfied enough with the results to hold at 60mg.

jmcleod76 said...

Oh, forgot to mention: I experience frequent irritability and sudden mood shifts - not drastic, but noticeable - as part of my ADHD. The gingko seems to be helping with that, as well. My moods have been much more stable since I began taking it. I feel really good.

NB said...

jmcleod76 - thanks so much for your personal account. i have been wrestling with the decision to take Ritalin or not. i have not had good luck with meds in the past (Lexepro was a disaster), although I've never tried Ritalin so I'm not sure what would happen if I did. for now, it's sitting in my cabinet until I feel the absolute necessity to try it.

in the meantime, i'm trying some supplements (Mg, Zn, Iron, B6...) to see if these will alleviate my issues. I've been reading about Ginkgo Biloba and it seems that of any of the herbal rememdies, this is the most safe and has been proven to help with memory enhancement. i appreciate personal accounts b/c of the over generalization of some of the articles. hopefully I will have a positive personal account to post on here at some point in the near future. :)

jmcleod76 said...

Hi NB - I hope you have as good of luck with Gingko as I did - several weeks now, and it still seems to be helping - but I don't want my endorsement of it to come across as anti-medication. Bottom line is, stimulant medication didn't work for me. I have other ADHD friends for whom Ritalin was a lifesaver. I think there is something to the correlation the blogkeeper here makes between the effectiveness of Gingko and other non-stimulant medications. Strattera worked for me, but made me sick. Stimulants did not. Gingko seems to work in the same way Strattera did (only maybe less dramatically, if I'm honest), but without the nasty side-effects.

As a side note, I did end up increasing my dosage to 120mg per day. I find the Gingko works better fo me if I take a breakfast dose and another at lunchtime.

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Sharon said...

That is awesome that you have had found help with Ginkgo Biloba. It is hard to break away from conventional medicine and try something natural and I applaud you. I take VAXA Attend. It is a homeopathic medicinal that also contains vitamins including Ginkgo Biloba and have had enormous success with helping with my OCD's and problems not being able to stay on one task. It has been three months now and I feel the best I have in years.

Sharon said...

That is awesome that you have had found help with Ginkgo Biloba. It is hard to break away from conventional medicine and try something natural and I applaud you. I take VAXA Attend. It is a homeopathic medicinal that also contains vitamins including Ginkgo Biloba and have had enormous success with helping with my OCD's and problems not being able to stay on one task. It has been three months now and I feel the best I have in years.

Clearly Miracles said...

Is there a recommended dose for young children? Tks a lot for the post, I will definitely get my suspected add husband back on his ginkgo.

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Katrina said...

I started taking Ginko 1200mg slow release tablets a month ago. I take 1 a day. I noticed it helps my memory and I just turned 40. It decreases my anxiety level, while ADD meds increased my anxiety and I had way too many side effects with antidepressants and antianxiety meds. I feel more calm and my mind doesn't feel so cluttered. I'm a believer in Ginko Biloba. I take no other medication except birth control.

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Anonymous said...

Thanks for your blog! I was taking ginseng/ginkgo daily for adhd-inattentive type,depression, anxiety, and lethargy. Didn't really help much. But then decided to add caffeine one day on a whim. Wow, the caffeine really increased my energy and I felt so much quicker and sharper. But didn't notice that any of it helped me to focus more though I felt more mentally sharp and motivated, which for now is good enough for me. I don't really want to do more than a cup of coffee a day, so i'm thinking of just doing the ginkgo/ginseng in the latter half of the day to see what happens. Being scatterbrained, unfocused and forgetful is no fun, but being no fun and flat and mentally lethargic and unmotivated is even worse. I am going to try out the adhd-i med and an antidepressant but at least I know I can fall back on my alternative supplement cocktail if things don't work out. I also take a b complex, fish oil, and a multi daily. Nothing has improved my memory or ability to focus on tasks that are not interesting or stimulating to me but at least I'm sharp and witty again. This add game is all about trial & error. this crap was untreated for 40 something years as a result I have built up years of automatic negative self talk and trying to build my self esteem back up. Good luck to you all!!

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