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Ginkgo Biloba Director, Depression Clinical and Research Program David Mischoulon, MD, PhD Director, Depression Clinical and Research Program Massachusetts General Hospital Professor of Psychiatry Harvard Medical School

Introduction Slows down cognitive decline Cognition-enhancing drug Amri H et al. (2008). Ginkgo Biloba extract in cognitive disorders. Natural Medications for Psychiatric Disorders: Considering the Alternatives. Philadelphia: Lippincott Williams & Wilkins, pp.163-190. https://www.bigplantnursery.co.uk/Resources/uploads/670/Ginkgo-biloba-Beijing-Gold_4.jpg

Mechanism Stabilizing neuronal cell membranes in healthy brain cells Scavenges free radicals Protective effect in the brain

Studies on Ginkgo Meta-analyses Efficacious for dementia Vs Cholinesterase inhibitors Ginkgo biloba Vs More effective Better tolerated Combined synergistic or additive effect Weinmann S, et al. (2010). Effects of Ginkgo biloba in dementia: systematic review and meta-analysis. BMC Geriatr;10:14 Brondino N, et al. (2013). A Systematic Review and Meta-Analysis of Ginkgo biloba in Neuropsychiatric Disorders: From Ancient Tradition to Modern-Day Medicine. Evid Based Complement Alternat Med;2013:915691 Mazza M, et al. (2006) Ginkgo biloba and donepezil: a comparison in the treatment of Alzheimer's dementia in a randomized placebo-controlled double-blind study. Eur J Neurol;13:981-985

Can Ginkgo Prevent Dementia in Healthy People? Not known

Efficacy Recommended dose: 120 - 240 mg / day At least 8 weeks before determining efficacy Best in those who start early in the course of dementia Full assessment of its true impact in dementia At least 1 year treatment and follow-up Amri H, et al. (2008). Ginkgo Biloba extract in cognitive disorders. In: Mischoulon D, Rosenbaum J, editors. Natural Medications for Psychiatric Disorders: Considering the Alternatives. Philadelphia: Lippincott Williams & Wilkins, pp.163-190. Weinmann S, et al. (2010). Effects of Ginkgo biloba in dementia: systematic review and meta-analysis. BMC Geriatr;10:14

? Long term impact No data Most studies follow patients for no more than 1 year Antidepressant-induced sexual dysfunction Preliminary but encouraging evidence Amri H, et al. (2008). Ginkgo Biloba extract in cognitive disorders. In: Mischoulon D, Rosenbaum J, editors. Natural Medications for Psychiatric Disorders: Considering the Alternatives. Philadelphia: Lippincott Williams & Wilkins, pp.163-190. Weinmann S, et al. (2010). Effects of Ginkgo biloba in dementia: systematic review and meta-analysis. BMC Geriatr;10:14

Safety Safe Bleeding in patients: Side effects Mild gastrointestinal upset Inhibits platelet activating factor Taking anticoagulants Headaches Avoid in patients taking anticoagulants Having surgery Irritability Discontinue before surgery Dizziness Seizures in epilepsy Not clear Amri H, et al. (2008). Ginkgo Biloba extract in cognitive disorders. In: Mischoulon D, Rosenbaum J, editors. Natural Medications for Psychiatric Disorders: Considering the Alternatives. Philadelphia: Lippincott Williams & Wilkins, pp.163-190. Weinmann S, et al. (2010). Effects of Ginkgo biloba in dementia: systematic review and meta-analysis. BMC Geriatr;10:14

Pregnancy PAF inhibition may increase the risk of bleeding Not good for pregnant women to take ginkgo Unknown risk to breastfeeding infants Amri H, et al. (2008). Ginkgo Biloba extract in cognitive disorders. In: Mischoulon D, Rosenbaum J, editors. Natural Medications for Psychiatric Disorders: Considering the Alternatives. Philadelphia: Lippincott Williams & Wilkins, pp.163-190. Weinmann S, et al. (2010). Effects of Ginkgo biloba in dementia: systematic review and meta-analysis. BMC Geriatr;10:14

Key Points Ginkgo appears to be effective for slowing down the course dementia. It can be safely combined with cholinesterase inhibitors with a possible synergy between the two. Ginkgo appears safe although caution is required in patients taking anticoagulants or who are about to undergo surgery because it inhibits platelet activating factor.

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