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2. 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

3. 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

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

5. 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:

6. Can Ginkgo Prevent Dementia in Healthy People?
Not known

7. 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
Weinmann S, et al. (2010). Effects of Ginkgo biloba in dementia: systematic review and meta-analysis. BMC Geriatr;10:14

8. ? 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
Weinmann S, et al. (2010). Effects of Ginkgo biloba in dementia: systematic review and meta-analysis. BMC Geriatr;10:14

9. 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
Weinmann S, et al. (2010). Effects of Ginkgo biloba in dementia: systematic review and meta-analysis. BMC Geriatr;10:14

10. 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
Weinmann S, et al. (2010). Effects of Ginkgo biloba in dementia: systematic review and meta-analysis. BMC Geriatr;10:14

11. 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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