It’s easy these days for all of us to at times feel pulled in many directions, distracted by media and the fast-paced life we live. So much so we often hear people nonchalantly saying something like, “I’m so ADD”. The reality though, is that normal distracted behavior and receiving the diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD) are two very different things.
ADHD is a complicated, life-altering condition. The term ADHD is a broad term referring to a range of behavioral disorders and is one of the most common neurodevelopmental disorders in childhood. Depending on the person, the symptoms of ADHD can range from mild to severe.
ADHD is usually first diagnosed in childhood and often lasts into adulthood. This condition is sometimes called Attention Deficit Disorder (ADD), but this term was outdated in the latest version of The Diagnostic and Statistical Manual of Mental Disorders (DSM-V). The DSM is the handbook created by the American Psychiatric Association used by health care professionals in the U.S. and abroad as the authoritative guide to the diagnosis of mental disorders.
People with ADHD have reoccurring patterns of inattention and/or hyperactivity-impulsivity, and these behaviors can interfere with functioning or development.
According to the DSM-V, to be diagnosed with ADHD, a person would need to show six or more symptoms of inattention and hyperactivity and impulsivity for children up to age 16 years, or five or more for adolescents age 17 years and older and adults; and the symptoms of inattention, hyperactivity and impulsivity needs to have been present for at least 6 months, and these symptoms fall into the category of being inappropriate for the developmental level:
The symptoms of inattention which show up often:
- Easily distracted
- Does not seem to listen when spoken to directly
- Forgetful, even in daily activities
- Unable to give close attention to details in schoolwork or other activities and makes careless mistakes
- Has trouble keeping attention on tasks or activities
- Ignores a speaker, even when spoken to directly
- Does not follow through on instructions or duties (loses focus, side-tracked)
- Fails to finish schoolwork or chores
- Has trouble with organization and tasks
- Dislikes and avoids tasks that require long periods of mental effort
- Loses vital things necessary for tasks and activities
The symptoms of inattention which show up often:
- Fidgets with or taps hands or feet, or squirms in seat
- Leaves seat in situations when remaining seated is expected.
- Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless)
- Often unable to play or take part in leisure activities quietly
- Appears to be always on the go
- Talks excessively.
- Blurts out answers before the other person finishes their question
- Has trouble waiting their turn
- Intrudes on and interrupts others constantly
Additionally, these criteria have to be met for a diagnosis from a professional; the symptoms must have been present before the age of 12, the symptoms showed up in two or more settings (i.e., home, work, school), there is clear evidence that the symptoms interfere or reduce the person’s quality of functioning socially (at school or work) the symptoms cannot be diagnosed by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder) and the symptoms do not happen only during the course of schizophrenia or another psychotic disorder.
Scientists are not sure what are the exact causes of ADHD. Studies suggest genes play a big role and a combination of other factors. In addition to genetics, researchers are looking at possible are studying how brain injuries, nutrition, and the social environment might contribute to ADHD.
While there is no cure for ADHD, the standard treatment for ADHD is a combination of behavior therapy and stimulant medications (the first-line medication prescribed) and non-stimulant medications (the second-line medication prescribed):
Stimulants increase dopamine and norepinephrine levels in the brain. Higher levels of these chemicals can help improve concentration and decrease the fatigue that’s common with ADHD.
But, these stimulants come with some potentially scary side effects according to Harvard Medical School including; blood pressure and heart problems, growth suppression in children, and the growing abuse and misuse of these stimulant drugs which can cause very serious side effects like psychosis, myocardial infarction, cardiomyopathy, dizziness, loss of appetite, headaches, and even sudden death.
Nonstimulants were approved for the treatment of ADHD in 2003. They are considered second-line medications and are generally used by people who do not respond to stimulants. These non-stimulants drugs only increase norepinephrine and do not increase dopamine. For example, Atomoxetine (Strattera) is the primary non-stimulant medication recommended. It is a potent norepinephrine reuptake inhibitor that lacks the potential for abuse but carries a whole host of potential side effects like sleeplessness and very significant abdominal pain, nausea, and drowsiness, especially when starting the medication.
Both of these categories of ADHD medications are increasingly used for adolescents and adults even though there are few published scientific studies on their efficacy and safety – especially in younger children. Lacking as well, are studies on the long-term effects of ADHD drugs in all ages, which means that the increased longevity of ADHD medication use may eventually bring new issues to the surface.
Given the known side effects of these approved medications for ADHD – and the potentially unknown long-term side effects of these medications – is there another treatment option that does not carry these kinds of life-changing effects?
Is cannabidiol (CBD) a candidate for the treatment of ADHD?
With these concern about the adverse side effects of first-line and second-line medications, combined with unknown potential issues related to the increased longevity of ADHD medication use, it’s not surprising that the new discoveries involving our endocannabinoid system has inspired researchers and people suffering from ADHD to look into CBD as a treatment option.
We now know the main function of our endocannabinoid system is to help our body maintain homeostasis — harmony, and balance — in response to changes in the environment, and it supports other systems in our body to operate at their peak performance levels.
As part of the endocannabinoid system, we have CB1 and CB2 endocannabinoid receptors that are dispersed throughout our body impacting our physiological processes affecting pain modulation, anti-inflammatory effects and other immune system responses.
For example, CBD the “non-intoxicating” cannabinoid, is what science calls a “promiscuous chemical”, meaning it can interact with CB1 and CB2 endocannabinoid receptors along with many other receptors systems within our body, affecting each one differently. This means CBD can either fully activate a receptor, or it can operate as an antagonist whereby blocking the activity of a receptor.
As it turns out, CBD upregulates and enhances serotonin. Serotonin, sometimes called “the neurotransmitter of happiness” is involved in behaviors as wide-ranging as sleep, cognition, aggression, learning, appetite, and reward activity. CBD’s potentially far-reaching ability to interact with our serotonin receptors is what scientists believe may underlie its anti-anxiety effects.
So, what does science say about CBD as a potential treatment for ADHD?
So far, scientific studies like this one on the medicinal cannabis oromucosal spray Sativex as a treatment for ADHD, shows evidence that the cannabinoids found in cannabis and hemp help alleviate hyperactivity and impulsivity, two major components of ADHA symptoms, but specific research into CBD in particular as a treatment for ADHA is in its infancy stages.
Here’s what we know so far.
Evidence shows CBD can provide relief for people suffering from anxiety.
Although research on CBD is in its early stages, there is a mounting amount of evidence that CBD can provide relief for people suffering from anxiety.
In a 2015 research review of CBD as a potential treatment for anxiety disorders, they concluded that current evidence indicates CBD has considerable potential as a treatment for multiple anxiety disorders. These findings and many other current studies on humans and mice appear to support that the anxiolytic (anti-anxiety) effect of CBD, “exerts therapeutically promising effects on human mental health such as inhibition of psychosis, anxiety, and depression.”
CBD helps maintain brain health.
As we age, the creation of new neurons in our brains slows down. In order for our body to prevent degenerative diseases and to maintain brain health, we need to create new cells.
As it turns out, CBD and THC are “neurogenic” substances that both promote neurogenesis, the process by which new neurons are formed in our brains.
A 2019 Brazilian study showed that “cannabinoid signaling modulates several aspects of brain function, including the generation and survival of neurons during embryonic and adult periods”.
The neuroprotective effects of cannabinoids appear to be related to several actions they have on the brain, including the removal of damaged cells and critical homeostatic processes.
CBD also has anti-inflammatory effects on the brain and is presently under intense preclinical research in numerous neurodegenerative disorders.
CBD may help to increase dopamine levels.
Low dopamine function is understood to be one of the causes of ADHD. Evidence has demonstrated that CBD strongly modulates the mesolimbic dopamine (DA) system and may possess promising anti-psychotic properties which may help enhance cognitive processes such as learning, mood, memory, and attention.
CBD has been shown to be a broad-spectrum drug and is being researched with increasing interest as a treatment for a range of neuropsychiatric disorders
According to researchers at the New York University School of Medicine, “Existing preclinical evidence strongly supports CBD as a treatment for generalized anxiety disorder, panic disorder, social anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder when administered acutely; however, few studies have investigated chronic CBD dosing. Overall, current evidence indicates CBD has considerable potential as a treatment for multiple anxiety disorders, with the need for further study of chronic and therapeutic effects in relevant clinical populations.”
The studies on CBD for ADHD.
An Israeli study published in 2019 reported on the experiences of parents who administered oral CBD oil to their children diagnosed with autism spectrum disorder (ASD) who commonly exhibit co-morbid symptoms of hyperactivity, self-injury, aggressiveness, restlessness, anxiety and sleep disorders.
Their findings suggest, “cannabidiol may be effective in improving ASD comorbid symptoms [stats below]; However, CBD efficacy and safety should be further evaluated in children with ASD in large-scale clinical trials.”
Fifty-three children and young adults between the ages of 4 and 22 received CBD for a median of 66 days. Self-injury and rage improved in 67.6% of the participants but worsened by 8.8%. Symptoms of hyperactivity reduced in 68.4% of participants, remained unchanged among 28.9% and increased among 2.6%. Anxiety reduced in 47.1% of children but increased among 23.5%. Adverse effects included sleeplessness and change in appetite, but they were noted as mild.
A 2019 Finish study by the Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland studied the effects of CBD on mice. The mice were deficient in the AMPA receptor located in the central nervous system. This makes the mice a suitable model for hyperactivity disorders such as ADHD.
The researchers found that CBD infused into the hippocampus, the region of the brain responsible for the formation of new memories, learning, and emotions, alleviated behavioral hyperactivity. They concluded that “The precise brain circuitry and pharmacological targets involved in the CBD effect require further elucidation, our data contribute to the possibility that CBD actions on glutamatergic transmission in the hippocampus could be therapeutically applied to dampen hyperexcitable hippocampal and other brain circuitries.”
At this point, science and research is still in its emerging stage in terms of uncovering the potential treatment capabilities for CBD for the management of specific symptoms associated with ADHA.
And, there is one thing we know for sure, CBD has a highly favorable safety profile.