The source of any support received

Department of Pharmaceutical Marketing and Management,
K.L.E.S' College of Pharmacy, Vidyanagar,
Hubli- 580031, Karnataka, India.

Introduction

Attention deficit hyperactivity disorder (ADHD) is a neurobiological disorder of self-control. It consists of problems with attention span, impulse control, and activity level. Some of the factors responsible for ADHD in children include drug use during pregnancy, genetics, refined sugar or food additives, brain injury and toxins1. Behaviors associated with ADHD include- Trouble finishing daily tasks, Listening problems, Distracted easily, Difficulties finishing school work, Needing much supervision, Difficulty waiting in line for group activities, Excessively running and Climbing Difficulty sitting and staying seated₈.

Depression is a serious disorder that can cause significant problems in mood, thinking, and behavior at home, in school, and with peers₂. Depressive disorders come in different forms, just as is the case with other illnesses such as heart disease. This pamphlet briefly describes three of the most common types of depressive disorders. However, within these types there are variations in the number of symptoms, their severity, and persistence.

Major depression is manifested by a combination of symptoms (see symptom list) that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime.

A less severe type of depression, dysthymia, involves long-term, chronic symptoms that do not disable, but keep one from functioning well or from feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives.

Another type of depression is bipolar disorder, also called manic-depressive illness. Not nearly as prevalent as other forms of depressive disorders, bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression). Sometimes the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed cycle, an individual can have any or all of the symptoms of a depressive disorder ²⁰.

The risk factors include Family history, Stress, a loss of a parent or loved one, Abuse or neglect and other trauma, including natural disasters₃ Depressive symptoms include: irritability, depressed mood, persistent sadness, frequent crying, thoughts of death or suicide, loss of enjoyment in favorite activities, frequent complaints of physical illnesses such as headaches or stomach aches, low energy level, fatigue, poor concentration, complaints of boredom ,major change in eating or sleeping patterns, such as oversleeping or overeating₇. Treatment for depression can be done by - Electroconvulsive therapy (ECT), Conventional antidepressant medications, Herbal Therapy and Psychotherapy ²⁰.

Herbal medicine is referred to the use of plant products to treat or prevent a disease. It is also known as botanical medicine, herbalism, herbology, phytomedicine or Phytotherapy ₁₇. An herb is a plant or plant part valued for medicinal, savory, or aromatic qualities. Others consider herbs to be botanicals and therefore define them as a substance derived from plants, a vegetable drug, especially in its crude state. When added to foods as supplements, herbs have been also termed as “nutraceuticals” ₁₈. Herbal medicine is also known as a subset of the larger term “complementary and alternative medicine” (CAM) ₁₉. Long before the advent of modern medicine, herbs were the mainstream remedies for nearly all ailments. Knowledge of herbal medicines was common and use of herbal medicines was widely practiced. People commonly diagnosed their own illnesses, prepared and prescribed their own herbal medicine, or bought them from the local apothecaries₁₂. However, over the last few decades, people have been turning in increasing numbers to the use of herbal medicine as both an alternative and adjunct to modern drugs. The growth of this segment of society has been greatly accelerated within the last ten years₁₃. Research results from 9, 10, 11, 12, and 13 have shown that, ADHD and depression in children, adolescents and adults can be treated using various herbal drugs. Herbal medicines used for ADHD and depression are different preparations of Brahmi(Bacopa monniera) Ashwaganda, Ginkgo biloba, ginseng, chamomile, Bacopa moninera, St. John's wart(Hypericum perforatum) and Valeriana officinalis₄,₅,₆ .

Figure 1

Herbal Drugs Used For ADHD And Depression16

Objectives

• To determine and analyze the doctor's and pharmacist's opinions, views and experiences about use of herbal drugs in the treatment of ADHD and depression in children

• To determine and analyze self report of parents or caregivers of children with ADHD and depression, regarding their preference, views and experiences while treating with herbal drugs.

Methodology

Questionnaire survey is conducted among 100 doctors (60 children's psychiatrists and 40 pediatricians from mental health centers and hospitals in Karnataka, India), 50 retail Pharmacists (in different parts of Karnataka) and 100 caregivers of children (70 Parents and 30 primary caregivers) to collect and analyze data regarding treatment of ADHD and depression in children with herbal drugs.

Questionnaire developed was a 15-item self-report questionnaire that inquired about herbal medicines taken by the patients (Children) to treat symptoms of ADHD and depressive disorders. The questions were based primarily on published reports [₁₄, ₁₅] and were modified to specifically address the patterns of herbal therapy in children with psychiatric disorders versus herbal therapy in the general adult population.

The questionnaire focused specifically on caregivers' administration of herbal medicines in their children. If applicable, participants indicated current use of herbal therapy and specific herbal medicines administered the frequency of administration and/or discontinuation, the mental disorder or other conditions attempted to treat, reason for use and/or discontinuation, and their sources of information. Other items addressed were whether alternative therapy practitioners were visited, communication of the use of herbal therapy with physicians or other health care providers, whether the herbal therapy was supervised, whether herbal medicines were administered in conjunction with or in place of conventional drugs, and perceived benefits of herbal therapy. The 23-item questionnaire comprised mostly multiple-choice questions and 3 open-ended questions.

Results And Discussions

A. Views and opinions of children's psychiatrists and pediatricians.

1. Over All Opinion Of Doctors Regarding Herbal Therepy. Among total of 152 doctor surveyed, 41 %( 62 doctors) of them said Herbal therapy is useful. But 35% (53 doctors) were not aware of herbal therapy.

Figure 2

2. It was found from survey report that 33% of the Doctors favored herbal therapy, 10% neither favored nor opposed and 57% have opposed herbal therapy.

Figure 3

3. Factors Influencing To Prefer Herbal Therapy

• Patient request/pressure

• In general practice

• Lack of effective conventional treatment

• Belief in safety and/or efficacy

• Attempt to improve physician-patient relationship

• Profitability

• Training in or familiarity with a herbal therapy

• The alternative therapy fit the patients cultural beliefs

• The patient failed to respond to conventional treatment

• The patient had a “non-organic” disease

4. Results Of Herbal Therapy For Adhd And Depression

Emotional and Behavioral disorders before and after therapy (Table: 1)

Figure 4

5. Communication With Health Care Professionals In 20% Patients Takingherbal Medicines

Figure 5

6. Problems Or Patient Complaints

Figure 6

B. Views and opinions of pharmacists

Figure 7

C. Self report of parents and care givers.

1. Patient profile

Figure 8

2. Herbal Preparations Given To The Patients With ADHD Or Depression By Caregivers Of Children

Figure 9

3. Source Of Information

Figure 10

Conclusions

Doctors

Pharmacists

Caregivers and parents

Suggestions

Acknowledgements