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St. John’s Wort in ADHD

A small trial showed no evidence of benefit.

St. John’s wort (Hypericum perforatum) is one of the most common herbal treatments given to children with attention-deficit/hyperactivity disorder (ADHD). Like atomoxetine (Strattera) — which is approved for use in children with ADHD — St. John’s wort is a norepinephrine reuptake inhibitor.

In a clinical trial conducted at a college of naturopathic medicine, 54 children and adolescents who met DSM-IV criteria for ADHD (age range, 6–17 years; mean age, 10) were randomized to thrice-daily St. John’s wort (300 mg) or placebo for 8 weeks after a 1-week placebo run-in. Nearly half the children previously had taken medications for ADHD. Based on blinded clinical evaluations and standardized assessments at 1, 2, 4, 6, and 8 weeks, no difference was observed in mean clinical improvement or in the proportion of children who met criteria for clinically significant improvement, on both intent-to-treat and per-protocol analyses. In addition, the number of adverse events did not differ between groups.

Comment: This study, purported to be the first placebo-controlled trial of St. John’s wort in children and adolescents, showed no benefit in ADHD. The study also is a good example of the type of rigorous research needed to assess many unstudied remedies, both "conventional" and "complementary."

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine June 10, 2008

Citation(s):

Weber W et al. Hypericum perforatum (St John’s wort) for attention-deficit/hyperactivity disorder in children and adolescents: A randomized controlled trial. JAMA 2008 Jun 11; 299:2633.

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