St. John's Wort No Help for ADHD

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A popular herbal remedy for treating attention deficit hyperactivity disorder (ADHD) in children actually does little to improve symptoms of the disease, according to a new study. Researchers at Bastyr University in Washington state report in the Journal of the American Medical Association (JAMA) that St. John's wort, a commonly used botanical to treat depression, does not help children with ADHD to concentrate or curb hyperactivity any more than a rice-protein placebo over an eight-week period. It's the first such study to tackle the question of St. John's wort's effectiveness against ADHD in a randomized, placebo-controlled trial.

Led by Wendy Weber, a naturopathic physician at Bastyr, the group decided to study St. John's wort after the Food and Drug Administration approved atomoxetine — an agent that keeps nerve endings in the brain flooded with the neurotransmitter norepinephrine — for treating ADHD in children. They knew from previous studies that at least one of St. John's wort's active ingredients, hyperforin, has the same effect on brain neurons, and speculated, as have other proponents of alternative therapies, that the botanical might help to relieve symptoms of ADHD without a prescription. But among the 54 children between six and 17 years old involved in the study, those receiving 900 mg of St. John's wort daily were no better off than those not receiving the treatment when it came to controlling hyperactivity and improving mental focus.

Weber notes, however, that hyperforin tends to oxidize and therefore lose potency in pill form. More recent formulations, she says, may retain this potency slightly longer, and therefore may have greater effects on ADHD symptoms — but only an additional study can establish whether that's the case.

As the first study of St. John's wort and ADHD in a randomized, placebo-controlled trial, these findings are important not only for ADHD patients but for the even larger community that relies on naturopathic and alternative therapies to relieve everything from infections to depression. "One lesson from this paper is that it shows that a lot of alternative therapies can be studied in a rigorous way," says Dr. Eugenia Chan, director of the ADHD program at Children's Hospital in Boston.

For decades, doctors and patients have been at odds over how effective natural remedies can be in treating medical illnesses, with physicians concerned by the lack of consistency and regulation among such alternative therapies. Studies like this one, says Chan, can set a useful precedent for teasing out which therapies may actually help patients and which might be doing them little good or, in some cases, even harm. "Herbs and dietary supplements are akin to medications," she says, "so there is no reason why they can't be studied in the same rigorous way as pharmaceutical medications."