Review of: Baziar S et al, J Child Adolesc Psychopharmacol 2019;29(3):205–212

The search for an equally effective, yet better tolerated alternative to stimulant medications continues. We often hear reports on the benefits of various non-pharmaceutical supplements. Now we have a new study looking at saffron (Crocus sativus). Saffron is reported to affect dopamine, norepinephrine, NMDA, and GABA-α receptors, and it can improve depression, anxiety, and memory.

In this 6-week, randomized, double-blinded study conducted in an outpatient clinic affiliated with Tehran University, 54 youth (20% female, average age 8–9 years old) with ADHD were randomized to receive either saffron or methylphenidate (MPH). Psychiatric and developmental comorbidities other than ODD were excluded. MPH was titrated using a fixed schedule up to 1 mg/kg per day in divided doses. Saffron was dosed at 20 mg/day for kids weighing under 30 kg, and 30 mg/day for kids weighing more. Outcome data included ADHD-RS parent and teacher rating scales at baseline and weeks 3 and 6, as well as side effects. The ADHD-RS may be unfamiliar to people in the US but has been found to be reliable and valid across multiple cultures.

Juveniles receiving saffron did just as well as those who received MPH in both the parent and teacher rating scales. Both groups showed symptom reduction at week 3 and week 6, with no statistically significant differences in outcomes between treatment groups at either point in time. Parents reported an average ADHD-RS score improvement of 23.72 points for saffron (baseline score: 34.20 ± 4.69, week 3 score: 15.68 ± 5.86, week 6 score: 10.48 ± 3.80) versus a 23.04 point reduction in the MPH group (baseline: 33.56 ± 6.48; week 3: 13.56 ± 5.78: week 6: 10.52 ± 5.18). Teachers reported an average total score reduction of 9.56 points for saffron vs 9.24 for MPH.

Interestingly, there were no statistically significant differences in side effects, including insomnia and decreased appetite, though there was a trend toward improvement with the saffron group (16% reported anorexia or insomnia with saffron versus 46% in the MPH group).

CCPR’S TAKE
The results of this study are so impressive that they seem too good to be true. Hopefully, larger studies that include a placebo group will verify whether saffron indeed works just as well as methylphenidate with equal or better tolerability. Also, the dose of methylphenidate was low, and the market cost of saffron is exorbitant, not to mention the potential issues with pill-to-pill variability given the lack of regulatory oversight. Even so, for families who are not ready to embark on the road of prescription medications, saffron may be worth considering.