Abstract
Psychiatric disorders among children and adolescents, including depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), and sleep disturbances, require therapeutic approaches that balance clinical effectiveness with tolerability. Herbal medicines such as Bacopa monnieri, Crocus sativus, Ginkgo biloba, and Hypericum perforatum have demonstrated therapeutic potential in psychiatric care, although evidence regarding their combined use in adolescent populations remains limited. This study aims to evaluate the preliminary effects and tolerability of a standardized formulation combining these four herbal medicines in adolescents with mild to moderate psychiatric conditions. A one-month, open-label, dose-response pilot study was conducted with 40 adolescents aged 12–18 years diagnosed with mild to moderate depression, anxiety, ADHD, or sleep disturbances. Participants received escalating doses of the standardized herbal formulation ranging from 100 to 600 mg/kg. Outcomes were assessed using the Children’s Depression Inventory (CDI), Screen for Child Anxiety Related Emotional Disorders (SCARED), Continuous Performance Test (CPT), Pediatric Sleep Questionnaire (PSQ), and Parenting Stress Index (PSI). The findings indicate dose-dependent improvements across the assessed domains, with the most favorable responses observed at 300–400 mg/kg. Higher doses produced no additional improvements and were associated with mild gastrointestinal discomfort. Cognitive function, mood stability, and sleep quality improved significantly during the intervention, accompanied by reductions in caregiver stress. The study concludes that the combined herbal formulation demonstrated promising preliminary effects and tolerability in adolescents and may have potential as an adjunctive approach in child and adolescent psychiatric care. However, given the open-label pilot design and limited sample size, larger randomized controlled trials are required to confirm efficacy, establish optimal dosing, and further evaluate safety. The study contributes preliminary evidence to the emerging literature on integrative and herbal approaches in child and adolescent psychiatry.