Herbs for Attention-Deficit/

Hyperactivity Disorder

Eric Yarnell, ND, RH (AHG)

Abstract As with most mental health conditions, there is no gold

standard test available against which to compare these criteria to
Nootropic herbs can be very helpful in people with attention- determine if they are accurate. Though studies have been done to
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deficient/hyperactivity disorder (ADHD). Two herbs both called validate the criteria, the ongoing problem of what to validate
brahmi in the Ayurvedic tradition, Bacopa monnieri (bacopa) them in relation to remains a sticking point.1 In the real world,
and Centella asiatica (gotu kola), as well as formulas featuring diagnoses are often made relatively quickly, particularly without
these herbs, are discussed in great depth for this purpose. Ad- ruling out complicating diagnoses such as learning disabilities,
ditional general nootropic herbs discussed are Ginkgo biloba posttraumatic stress, and anxiety. The extremely variable rates of
(ginkgo) and Acorus calamus (sweetflag), including both diagnosis of ADHD between U.S. states, ranging from a low of
American and Eurasian varieties. Nootropic herbs from the 4.2% in Nevada to a high of 14.8% in Kentucky, raise questions
Lamiaceae (mint) family with a focus on Rosmarinus offi- about the accuracy of diagnoses.2 Studies around the world
cinalis (rosemary) and various species of Salvia (sage) are documenting that younger children within a grade cohort are far
also reviewed. The general failure of nervine herbs such as more likely to be diagnosed than older children suggests a fair
Hypericum perforatum (St. John’s wort) and Valeriana offi- number of relatively immature children are being inappropri-
cinalis (valerian) for ADHD is highlighted, giving further ately diagnosed with ADHD.3–5 Even more troubling is ample
impetus for the need to focus on nootropic herbs instead. The evidence that pharmaceutical companies selling medications
safety and clinical use of all relevant herbs is highlighted. for ADHD have used various nefarious means to drive over-
diagnosis and over-treatment.6,7
Keywords: attention-deficit/hyperactivity disorder, herbal This article will focus on treating those children and adults who
medicine, nootropic truly have ADHD. Large, carefully conducted surveys in pre-
dominantly white and predominantly African American children
in North Carolina suggest a prevalence of ADHD of 1–3% (with
significantly more boys than girls being affected).8,9 This group
Introduction may benefit from stimulant medications, which work, it is be-
lieved, primarily by affecting dopamine metabolism in the central
Attention-deficit/hyperactivity disorder (ADHD) is a fairly nervous system and not because they are stimulants. However,
self-explanatory though controversial condition. According following the naturopathic principle of using the least force
to the Diagnostic and Statistical Manual IV, it requires the necessary, starting with safer options including herbal medicines
presence of six or more of a list of symptoms of inattention and/ is reasonable. Medications can always be prescribed later if herbs
or hyperactivity/impulsivity for at least six months (with onset or other low-force options do not work. Dietary changes and
prior to seven years of age), with these symptoms being more nutrient therapies, such as hypoallergenic diets and omega 3 fatty
severe than that of peers at a similar developmental age. The acids, also play an important role in helping many people with
symptoms result in impaired function in two or more settings ADHD, but are beyond the scope of this article.10,11
(home, school, and/or work). The Diagnostic and Statistical
Manual V broadened the diagnosis, saying symptoms only had
to be present prior to 12 years of age, thus opening the diag- Nootropic Herbs: The Brahmis
nosis to adolescents and adults, and requiring only five or more
symptoms of inattention or hyperactivity/impulsivity to be The primary herbal treatments for ADHD are nootropics.
present for diagnosis. It now requires impairment in only one These are herbs that enhance cognitive function and memory,
setting, and adds mild, moderate, and severe categories based though they appear generally to have other beneficial effects,
on degree of dysfunction, as well as specifying three subtypes: including supporting nerve regeneration and growth. Many
predominantly inattentive, predominantly hyperactive-impul- clinicians reach first for nervine herbs (those that calm the
sive, and combined. nervous system), but generally these are not nearly as effective,

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if at all, for people with ADHD. Nervines are discussed in more doses or placebo, and found the highest dose (750 mg once
detail below. The exact biomolecular mechanisms of action of daily) significantly improved memory and cognitive function
nootropics are fairly poorly researched but will be discussed compared to placebo.18 An older trial found gotu kola im-
where known. proved cognitive function in mentally handicapped children.19
Bacopa monnieri (bacopa, brahmi) in the Plantaginaceae One trial looked at a combination of Ginkgo biloba (ginkgo)
family is perhaps the best-studied nootropic for ADHD pa- leaf extract (240 mg daily) together with very low doses of gotu
tients. It is native to tropical wetlands around the world, though kola (68 mg daily) and docosahexaenoic acid (180 mg daily)
it is most notable for its historical use in India. Its Latin name is from fish oil and found it did not improve cognitive function in
frequently misspelled B. monniera. The whole plant (leaf, older adults without cognitive impairment compared to pla-
flower, stem, and root) are used as medicine. cebo.20 Several animal studies suggest gotu kola and its tri-
Bacopa has a strong historical reputation for enhancing mem- terpenoids have memory- and cognitive-enhancing properties,
ory.12 A meta-analysis of nine high-quality trials involving 437 in line with its traditional use.21–23 Gotu kola is extremely safe.
subjects found clear evidence that bacopa extracts significantly Combination formulas combining bacopa and gotu kola,
improved cognitive function compared to placebo, though the among many others, have also been studied for children and
effect size was modest.13 Seven of the studies involved healthy adolescents with ADHD. One meta-analysis looked at nine
subjects and two patients with memory problems. The studies trials covering four formulas, all of which contained both ba-
copa and gotu kola as major ingredients.24 Five of the trials
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took place in Australia, India, Thailand, and the United States, so

the results appear fairly generalizable across diverse populations. involved children with ADHD, and four of them found the
Most of the extracts studied were concentrated crude extracts, formulas studied significantly improved behavior (measured
while three used extracts standardized to  50% bacoside con- by a few different testing scales) compared to placebo. These
tent. Doses ranged from 250 to 600 mg daily. Only minor adverse formulas again had minimal adverse effects. The complete
effects were reported in these trials, primarily digestive upset. ingredients in the formulas tested are extremely extensive and
Another meta-analysis looked at five clinical trials involving so are not listed here, but daily bacopa doses ranged from 144
175 children and adolescents, many with diagnosed ADHD.14 to 864 mg and gotu kola doses ranged from 75 to 200 mg.
Three of the trials were double-blind and randomized, while
two were open trials. There was significant improvement in
cognitive and memory function compared to placebo, as well as Ginkgo
decreased hyperactivity and attention deficit. The effect sizes of
improvement ranged from modest to moderate depending on Ginkgo biloba (ginkgo), the sole remaining member of the
the specific measures used. A range of extracts and doses were once globally prolific Ginkgoaceae family, is a well-known
used. Again, adverse effects were mild and uncommon, with tree medicine. A special extract of the leaves standardized to
only 2.3% of total participants reporting that any occurred. As contain 24% flavone glycosides, 6% terpene lactones, and
will be discussed below, various herbal formulas featuring <5 ppm ginkgolic acids (which have urushiol-like toxic ef-
bacopa have also demonstrated efficacy at improving ADHD. fects) has been studied intensively for many purposes, in-
Mechanistically, the triterpenoid saponins known as baco- cluding as a nootropic in patients with dementia and ADHD.
sides from bacopa have demonstrated neuroprotective effects.15 An early open trial found that 240 mg of the extract daily led
Evidence exists for other mechanisms of action including in- to modest improvements in 20 children with ADHD.25 A
creasing cerebral blood flow, restoring cholinergic function, randomized, double-blind trial of this same extract at a dose of
modulating GABA and/or serotonin levels, reducing b-amyloid just 80–120 mg daily was compared to placebo in 60 children
levels and blocking nerve damage caused by it, reducing free with ADHD.26 Ginkgo extract significantly improved the pa-
radical damage, altering brain stress hormone levels, and de- rental and teacher ratings of attention compared to placebo.
creasing neuroinflammation.16,17 Adverse effects were minor and not different between the
Centella asiatica (gotu kola) shares numerous similarities groups. Another double-blind trial compared ginkgo extract at
with bacopa, though it is in the Apiaceae family. Gotu kola is 80–120 mg daily to methylphenidate 20–30 mg daily.27 Both
also a tropical species that likely originated in Southeast Asia, treatments improved attention compared to baseline, but meth-
but has now become quite a bit more widespread. It prefers to ylphenidate was significantly superior to ginkgo. The adverse
grow in extremely wet places. The entire plant is also used as effects of decreased appetite, headache, and insomnia were sig-
medicine: leaves, flowers, stems, and roots. Gotu kola is also nificantly worse and more common in the methylphenidate
sometimes called brahmi, further highlighting its similarity in group compared to ginkgo. Thus, ginkgo can be a safe treatment
actions to B. monnieri. Like bacopa, it contains triterpenoid in patients with ADHD.
saponins, though they are ursane not dammarane type. The
principal saponins in gotu kola are known as asiaticoside,
asiatic acid, madecassoside, and madecassic acid. Sweetflag as a Nootropic
Research on the nootropic effects of gotu kola by itself is not
as extensive as on bacopa. One clinical trial randomized 28 Acorus calamus (sweetflag; Fig. 1) is a grass-like wetland
healthy, elderly adults to gotu kola extract at three different plant, the only member in the Acoraceae family. It is either

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its complete volatile oil are actually anti-carcinogenic.30 Rapid

catabolism of b-asarone to non-carcinogenic metabolites may
explain the lack of any reports of cancer associated with
sweetflag use as food or medicine in humans.31,32
Sweetflag is traditionally regarded as a nootropic, neuro-
protective, and anti-dementia agent in various cultures around
the world.33 While sweetflag by itself has not been studied in
ADHD, a herbal formula known as Shenwu Capsule with
substantial amounts of Asian sweetflag has been studied as a
nootropic in patients with mild cognitive impairment related to
age in two double-blind, randomized, controlled trials.34,35
Each 450 mg capsule contains Pueraria montana var lobata
(kudzu, gé g
en) root 30%, Polygonum multiflorum (polygonum,
hiflorum 30%, lsients A. calamus var angustatus (sweetflag—
Asian variety) rhizome 19%, Epimedium brevicornum (horny
goat weed, yı́n yáng huò) herb 14%, Ligusticum chuanxiong
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(Szechuan lovage, chu
an xi
ong) root 14%, and Panax ginseng

(Asian ginseng, rén sh
en) root 4%. The dose used was five
capsules q.d. or t.i.d. In one trial, Shenwu was shown just as
effective as aniracetam, a nootropic drug, at enhancing memory
in 166 subjects. Similarly, the formula was just as effective as
donepezil at improving memory and cognitive function in 324
subjects. Studies are needed to confirm these benefits would
transfer to ADHD, but clinical experience suggests they would.
A typical dose of tincture of American (diploid) sweetflag is
1 mL t.i.d. It also makes a good cold infusion, and the crude
root can be chewed. Despite its name, this herb is not sweet
tasting, but somewhat unpleasant and a little bitter. Combi-
nation with ginger or another pungent herb is recommended to
make it palatable.

Figure 1. Acorus calamus. Drawing by Meredith Hale and reprinted

with permission. Minty Nootropics
Quite a few species in the Lamiaceae family are also noo-
native all around the Northern Hemisphere or else was intro- tropic, though they have not been studied formally in ADHD.36
duced from Eurasia into North America. Two varieties are Clinically they have been helpful, combined with either bacopa
currently recognized and are quite distinct (see Table 1). The or gotu kola and sweetflag. Here, some of the best-known and
difference in chromosome number (ploidy) between the vari- studied among these herbs will be reviewed. Most of their
eties is particularly notable, with a resulting wide difference in nootropic effects have focused on their effects in healthy adults
the content of b-asarone in the plant’s oil. This is important or in patients with dementia. These studies do not directly
because of concern that b-asarone is carcinogenic.28,29 How- prove a benefit for people with ADHD, but they suggest
ever, an isolated constituent is not the same thing as the whole they are worth studying and trying clinically, supported by
plant, and attributing the effects of the one to the other is empirical evidence that they are helpful for hyperactivity and
fraught with error. Several studies suggest whole sweetflag and inattentiveness.

Table 1. b-Asarone Content of Varieties of Acorus calamusa–c

Variety Ploidy Habitat b-asarone content in oil
Americanus 2n North America none
Angustatus* 3n, rarely 4n, 6n Europe, India 10–90%

*Also sometimes referred to as A. tatarinowii.

a
Stahl E, Keller K. The classification of calamus. Planta Med 1981;43:128–140 [in German]; bMcGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products
Association’s Botanical Safety Handbook. Boca Raton, FL: CRC Press, 1997:134–136; cMittal N, Varshney VK, Song BH, Ginwal HS. High levels of diversity in the phytochemistry,
ploidy and genetics of the medicinal plant Acorus calamus L. Med Aromatic Plants 2015;S1:002.

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Rosmarinus officinalis (rosemary) is one such Lamiaceae modulating effects, and other properties are believed to ex-
nootropic. Its association with improved memory was im- plain the nootropic effects of rosmarinic acid and related
mortalized by one of Ophelia’s speeches in Shakespeare’s compounds.43–45 The flavonoid nepitrin from rosemary has
Hamlet, when she declares, “There’s rosemary, that’s for re- also been demonstrated to be nootropic in rodents, in part by
membrance,” and hands some of that plant to her brother La- inhibiting cholinesterases.46
ertes, presumbly so he’ll remember her in health and not in her The Salvia genus contains multiple nootropic members,
depressed, anguished state. Its common name is a folk ety- particularly S. officinalis (common sage) and S. lavandulae-
mology; it originates from the Latin words ros “dew” and folia (Spanish sage) from the Mediterranean basin, S. apiana
marinus “sea,” referring to its preferred habitat growing at the (white sage) from the Sonoran desert, and S. sclarea (clary
edge of the Mediterranean. The word sounded a lot like rose, sage) from the Mediterranean and Central Asia among many
which it is not related to, but the name has stuck. Its leaf, others.47 Single doses of Spanish sage volatile oil orally (25–
flower, and volatile oil are used as medicine. 150 mcl) were shown to improve cognitive performance and
Clinical trials with rosemary have focused on memory and memory in healthy young adults compared to placebo in two
cognitive improvement. In one crossover, double-blind, ran- different double-blind trials reported in one paper.48 A third
domized trial, 28 elderly adults were randomized to single double-blind, placebo-controlled trial by the same group in
doses of powdered rosemary in four amounts or placebo.37 The 24 healthy adults found similar results with Spanish sage
volatile oil.49 Another double-blind trial involving 36 healthy
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lowest dose (750 mg) significantly improved memory com-

pared to placebo, while the highest (6 g) degraded it. Another young adults randomized them to single doses of Spanish
double-blind trial compared rosemary leaf 500 mg b.i.d. to sage volatile oil 50 mcl or placebo.50 They again found sig-
placebo in 68 university students over one month.38 Memory, nificant cognitive benefits of Spanish sage compared to pla-
anxiety, and depression all significantly improved in the cebo. They demonstrated this specific oil potently inhibited
rosemary group compared to placebo; sleep quality and speed acetylcholinesterase. A comparison of common sage volatile
of sleep onset did not differ between them. Compared to no oil inhalation, Spanish sage volatile oil inhalation, and placebo
odor, vaporized rosemary volatile oil improved cognitive in 135 healthy young adults found that only common sage
performance and memory in healthy young adults in another aromatherapy improved memory compared to placebo.51 At
randomized trial.39 One other trial in 40 healthy young adults least two trials have also found common sage helpful for pa-
with low energy found that single doses of encapsulated tients with Alzheimer’s disease.52 Doses are very similar to
rosemary 1.7 g taken while wearing a nose clip to prevent odor that of rosemary.
identification had no benefit over placebo on mood or congitive Several others in the Salvia genus show promise and are
effect.40 There were no significant adverse effects of rosemary listed in Table 2. Combinations of these and other Lamiaceae
in any of these trials. A typical dose of rosemary tincture is 1– nootropics show some promise as well. For example, a com-
2 mL t.i.d., while of crude leaf it is 500 mg b.i.d.–t.i.d. bination of common sage, rosemary, and lemonbalm improved
Animal trials confirm that a rosemary leaf extract inhibits one measure of memory in the subset of 44 healthy adults <63
acetyl- and butyrylcholinesterases and leads to enhanced years of age in a double-blind, placebo-controlled trial.53
memory.41 Rosmarinic acid (see Figure 2), a caffeic acid de- Massage with lavender and Pelargonium graveolens (rose
rivative, originally identified in rosemary in 1958 is now geranium) oil lowered markers of stress and raised serum
known to be prolific in many plants in the Lamiaceae family brain-derived neurotrophic factor significantly compared to
and contributes to nootropic effects of these herbs.42 Inhibi- no treatment in a group of 25 women with ADHD.54 Clearly,
tion of cholinesterases, antioxidant effects, inflammation- more research is merited.

Figure 2. Rosmarinic acid.

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Table 2. Miscellaneous Mint Family Nootropics

Herb Part used Native habitat Evidence of nootropic activity
Prunella vulgaris (heal-all) Leaf/flower Northern Hemisphere Qu 2017 (in rats)a; Park 2015 (in rats)b; Lee 2017
(in vitro)c
Melissa officinalis (lemonbalm) Leaf/flower Mediterranean basin Katz 2010 (in humans, combined with other
herbs)d; Ozarowski 2016 (in rats)e
Mentha spicata (spearmint) Leaf Eurasia Herrlinger 2018 (in humans)f; Adsersen 2006
(in vitro)g
Nepeta menthoides Leaf Iran Sarahroodi 2012 (in mice)h; Ahmadian-Attar
(ostokhodus, Iranian catnip) 2014 (in rats)i
Lavandula angustifolia (lavender) Leaf/flower Mediterranean basin Adsersen 2006 (in vitro)g; Dohi 2009 (in vitro)j;
and related species Xu 2016 (in mice)k
a
Qu Z, Zhang J, Yang H, et al. Prunella vulgaris L, an edible and medicinal plant, attenuates scopolamine-induced memory impairment in rats. J Agric Food Chem 2017;65:291–
300; bPark SJ, Ahn YJ, Lee HE, et al. Standardized Prunella vulgaris var lilacina extract enhances cognitive performance in normal naive mice. Phytother Res 2015;29:1814–1821;
c
Lee S, Lee D, Baek J, et al. In vitro assessment of selected Korean plants for antioxidant and antiacetylcholinesterase activities. Pharm Biol 2017;55:2205–2210; dKatz M, Levine AA,
Downloaded by 119.94.9.205 from www.liebertpub.com at 05/30/19. For personal use only.

Kol-Degani H, Kav-Venaki L. A compound herbal preparation (CHP) in the treatment of children with ADHD: A randomized controlled trial. J Atten Disord 2010;14:281–291;
e
Ozarowski M, Mikolajczak PL, Piasecka A, et al. Influence of the Melissa officinalis leaf extract on long-term memory in scopolamine animal model with assessment of mechanism
of action. Evid Based Complement Alternat Med 2016;2016:9729818; fHerrlinger KA, Nieman KM, Sanoshy KD, et al. Spearmint extract improves working memory in men and
women with age-associated memory impairment. J Altern Complement Med 2018;24:37–47; gAdsersen A, Gauguin B, Gudiksen L, Jäger AK. Screening of plants used in Danish
folk medicine to treat memory dysfunction for acetylcholinesterase inhibitory activity. J Ethnopharmacol 2006;104:418–422; hSarahroodi S, Jafari-Najafi R, Nasri S, et al. Effects of
Nepeta menthoides aqueous extract on retention and retrieval of memory in mice. Pak J Biol Sci 2012;15:1085–1089; iAhmadian-Attar MM, Ahmadiani A, Kamalinejad M, et al.
Chronic cold-water-induced hypothermia impairs memory retrieval and Nepeta menthoides as a traditional “hot” herb reverses the impairment. Iran J Pharm Res 2014;13:185–193;
j
Dohi S, Terasaki M, Makino M. Acetylcholinesterase inhibitory activity and chemical composition of commercial essential oils. J Agric Food Chem 2009;57:4313–4318; kXu P, Wang
K, Lu C, et al. Protective effect of lavender oil on scopolamine induced cognitive deficits in mice and H2O2 induced cytotoxicity in PC12 cells. J Ethnopharmacol 2016;193:408–415.

Nervines: Far Less Effective secondary problems such as insomnia secondary to stimulant
medications, though this has not been definitively proven.
Another group of herbs are traditionally referred to as ner-
vines. We have previously written about these herbs in more
depth.55,56 These herbs are more used for their anxiolytic and Case Study
sleep-enhancing effects. Though on the surface such herbs
would seem well suited to treat ADHD because they are calm- A four-year-old Jewish boy born with meningomyelocele
ing, they generally have not proven very effective for ADHD. presented with neurogenic bladder and bowel. No mention was
This is likely due to differences in their effects compared to made in the initial visit of the fact he had also been diagnosed
nootropic herbs. with ADHD. He was ambulatory with the assistance of braces
Hypericum perforatum (St. John’s wort) leaf and flower is and a walker and had a ventriculoperitoneal shunt in place and
one such nervine. A small case series suggested that St. John’s working well. He was on a combination product containing
wort might help teen boys with ADHD.57 However, a ran- probiotics, D-mannose, cranberry extract, vitamin C, and some
domized, double-blind trial failed to find any benefit from St. fruit extracts for bladder infection prevention as well as oxybu-
John’s wort extract compared to placebo in 54 children with tynin for his neurogenic bladder. The latter drug was causing him
ADHD.58 Passiflora incarnata (passionflower) leaf is another to have a dry mouth and to have facial flushing. His father ad-
nervine that faired better in the one trial assessing its effects in ministered him a morning enema to help regulate bowel func-
ADHD. In this one double-blind trial, tablets providing 0.4 mg/ tion, which was time consuming for the family. He was initially
kg/day (in two divided doses) of passionflower were compared started on a combination of gotu kola glycerite 50%, Astragalus
to methylphenidate 1 mg/kg/day (in two divided doses) in 34 membranaceus (astragalus) root glycerite 40%, and Rosmarinus
children with ADHD.59 Both treatments led to equal effective- officinalis (rosemary) leaf tincture 10% at a dose of 2 mL t.i.d.
ness at improving symptoms, while methylphenidate caused with the goal of trying to restore as much nerve function as
significantly more appetite suppression and anxiety compared to possible, as well as a separate tincture of Atropa belladonna
passionflower. Another clinical trial failed to find any difference (belladonna) leaf 5 gtt t.i.d. This replaced the oxybutynin and
between a dilute tincture of Valeriana officinalis (valerian) root was slowly titrated up until he hit a dose that managed urination
and a homeopathic dilution of the same medicine in 30 children well with just the slightest hint of dry mouth developing.
with ADHD.60 Over five months of treatment, he gained far superior bladder
Other nervines have simply not been studied, but it is un- control with no adverse effects and ultimately got to seven
likely they will be as effective as nootropics and so should only drops t.i.d. of the belladonna tincture safely. His parents no-
be supporting agents in an individualized formula, and not the ticed good improvement in bowel function and then revealed
lead herbs. In some cases, nervines may be useful to treat significant improvement in his ADHD symptoms (including

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both reduced hyperkinesis and better focus). This came as quite 4. Morrow RL, Garland J, Wright JM, et al. Influence of relative age on
a surprise, as it had not been brought up as an issue before. His diagnosis and treatment of attention-deficit/hyperactivity disorder in children.
CMAJ 2012;184:755–762.
parents were so impressed with the effects, they asked if they
could have one of his siblings take the formula for his ADHD. 5. Zoëga H, Valdimarsdóttir UA, Hernández-Dı́a S. Age, academic perfor-
mance, and stimulant prescribing for ADHD: A nationwide cohort study.
After six months of treatment, his formula was adjusted to Pediatrics 2012;130:1012–1018.
contain Centella asiatica (gotu kola) glycerite 30%, As-
6. Schwarz A. The selling of attention deficit disorder. New York Times, De-
tragalus membranaceus (astragalus) glycerite 15%, Rosa spp. cember 14, 2013. Online document at: www.nytimes.com/2013/12/15/health/
(rose) glycerite 13%, Rosmarinus officinalis (rosemary) tinc- the-selling-of-attention-deficit-disorder.html Accessed February 15, 2018.
ture 10%, Nepeta cataria (catnip) glycerite 12%, Acorus cal- 7. Watson GL, Arcona AP, Antonuccio DO, Healy D. Shooting the mes-
amus var americanus (sweetflag) tincture 10%, and Bacopa senger: The case of ADHD. J Contemp Psychother 2014;44:43–52.
monnieri (bacopa) tincture 10% at a dose of 0.5 tsp t.i.d. The 8. Angold A, Erkanli A, Farmer EMZ, et al. Psychiatric disorder, impairment,
goal was to see if any better results could be obtained with and service use in rural African American and White youth. Arch Gen Psy-
added synergistic herbs. This formula did lead to even better chiatry 2002;59:893–901.
bowel and bladder control, as well as improvement in ADHD 9. Costello EJ, Mustillo S, Erkanli A, Keeler G, Angold A. Prevalence and
symptoms, and has been maintained for more than three years development of psychiatric disorders in childhood and adolescence. Arch Gen
Psychiatry 2003;60:837–844.
to date, with ongoing excellent results and no adverse effects.
10. Pelsser LM, Frankena K, Toorman J, Rodrigues Pereira R. Diet and ADHD,
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reviewing the evidence: A systematic review of meta-analyses of double-blind

placebo-controlled trials evaluating the efficacy of diet interventions on the
Conclusion behavior of children with ADHD. PLoS One 2017;12:e0169277.
11. Cooper RE, Tye C, Kuntsi J, et al. The effect of omega-3 polyunsaturated
A group of herbs that improve cognitive function known fatty acid supplementation on emotional dysregulation, oppositional behav-
collectively as nootropics are the key to botanical treatment of iour and conduct problems in ADHD: A systematic review and meta-analysis.
people with ADHD. Several of these herbs, most notably bacopa J Affect Disord 2016;190:474–482.
and ginkgo, have received moderately good research attention 12. Russo A, Borrelli F. Bacopa monniera, a reputed nootropic plant: An
overview. Phytomedicine 2005;12:305–317.
and their benefits for ADHD have been fairly well documented.
Even if they are not as potent as amphetamines, they are clearly 13. Kongkeaw C, Dilokthornsakul P, Thanarangsarit P, et al. Meta-analysis of
randomized controlled trials on cognitive effects of Bacopa monnieri extract.
safer and have a definite role in a holistic treatment protocol for J Ethnopharmacol 2014;151:528–535.
ADHD. Other herbs of the nootropic type that have mostly been
14. Kean JD, Downey LA, Stough C. A systematic review of the Ayurvedic
studied for dementia and memory loss are clinically helpful for medicinal herb Bacopa monnieri in child and adolescent populations. Com-
ADHD, but have not been rigorously evaluated for ADHD, in- plement Ther Med 2016;29:56–62.
cluding most of the nootropic herbs in the Lamiaceae family 15. Rastogi M. Ojha R. Prabu PC. Devi DP, et al. Prevention of age-asso-
reviewed. Ideally one of the better-studied nootropics would be ciated neurodegeneration and promotion of healthy brain ageing in female
combined with one of the Lamiaceae family nootropics and other Wistar rats by long term use of bacosides. Biogerontology 2012;13:183–195.
less well-confirmed nootropics to create an individualized for- 16. Kamkaew N, Norman Scholfield C, Ingkaninan K, et al. Bacopa monnieri
mula for each ADHD patient. increases cerebral blood flow in rat independent of blood pressure. Phytother
Res 2013;27:135–138.
There is no reason to believe any of the herbs discussed here
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metabolic enzymes including glutathione S-transferase, lactoperoxidase, To order reprints of this article, contact the publisher at (914) 740-2100.

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