Attention Deficit Hyperactivity Disorder (ADHD) is considered to be one of the most diagnosed childhood disorders, with symptoms often remaining in adolescence and adulthood. An estimated 5-7% of children and adolescents and just under 3.5% of adults worldwide have been diagnosed as having ADHD.
Types of ADHD
According to the DSM-V diagnostic criteria, ADHD (previously called Attention Deficit Disorder (ADD)) can be divided into three subgroups: 1) inattentive, 2) hyperactive/impulsive, and 3) combined.
1) Inattentive type ADHD
Inattention is the inability to focus and is usually what was previously meant when referring to someone as having ADD. The individual displays symptoms of inattention and distractibility but lacks symptoms of hyperactivity and impulsivity. Symptoms include frequent and easy distractibility, a loss of focus and being easily side-tracked.
2) Hyperactive/impulsive type ADHD
Individuals with this type of ADHD are characterised as being hyperactive and impulsive, but do not show signs of inattention. They always appear to be “on the go”, talks excessively and tends to be interruptive and disruptive.
3) Combined type ADHD
As the name suggests, the combined type displays characteristics of both inattention and hyperactivity/impulsivity.
Causes of ADHD
Although researchers are not able to pin-point the exact causes of ADHD, the current view is that it is a multi-factorial condition consisting of a mix of genetic, neurobiological, and environmental factors that cause disruptions in the dopaminergic signalling system. A 2009 study showed that patients presenting with ADHD symptoms had lower dopamine levels – a neurotransmitter that controls memory and attention, and allows for the experiences of reward and motivation. The study also found that ADHD patients had fewer dopamine receptors and transporters in two areas of the limbic system; those responsible for emotion, and motivation/reward.
Conventional ADHD Treatments
Generally, treatments centre around behavioural therapy and, as mentioned previously, stimulant medications such as Ritalin and Methylin. These medications are not only expensive, with an approximate $42.5 billion spent on ADHD medication in the USA alone, but also riddled with side effects such as insomnia, nausea, stunted growth, tics and even hallucinations. These side effects often cause patients to stop using them.
In addition, over time, a resistance to these medications build up, leading to decreased effectiveness whilst, for still others, these substances are not particularly effective to begin with or even exacerbate symptoms such as anxiety and depression.
However, if left untreated, ADHD can cause severe developmental and practical problems for the patient. These can include lowered school/work performance, social stigmatisation and isolation and an inability to reach major developmental and personal milestones. Many children and adults struggling to cope with the symptoms of ADHD also report feelings of frustration, anger and depression, making it difficult to live a productive and fulfilling life.
Thus, for many patients, the side effects associated with stimulant medications are unbearable, but doing nothing about the ADHD also harmful. It is no wonder then that an increasing number of patients and caregivers are looking to either supplementary or alternative forms of ADHD treatment. And for many patients and caregivers, that means turning to cannabis, in order to ameliorate symptoms of either the medication or the disorder itself.
The Cannabinoid System and ADHD
A recent study showed that a qualitative analysis of 55 separate forum threads found that an estimated 25% of posters experienced therapeutic benefits with the use of cannabis for treating ADHD symptoms.
And there may be truth in these self-reported findings. Several studies have shown that there seems to be a cross-talk between the dopaminergic and endocannabinoid systems; specifically, the endocannabinoids anandamide and 2-arachidonylglycerol. Researchers found that cannabinoids excite dopaminergic neurons and increase dopamine release (see here for review) whilst another study found converging evidence that increased levels of cannabinoids combined with CB1 receptor activity are associated with lowered physical activity.
The Role of Endocannabinoids in Dopamine Release
Simply put, cannabis raises dopamine levels in the brain. But, unlike other drugs, the way in which it does this is different. Endocannabinoids increase dopamine levels indirectly by blocking the action of gamma-Aminobutyric acid (GABA). GABA reduces neuronal excitability in the nervous system and inhibits dopamine release. And when cannabinoids block the release of GABA, it causes an increase in the levels of dopamine release to occur. So, unlike stimulants that excite the dopaminergic system directly increasing the risk of dopamine “burn-out” over prolonged periods of use, cannabinoids instead allow normal dopamine release by blocking GABA.
It seems that it is this interaction between the endocannabinoid and dopaminergic systems that might provide a mechanism for the reported decrease in ADHD symptoms that many patients seem to experience when using cannabis to self-medicate. But without the side-effects generally associated with stimulant prescriptions such as Ritalin.
Additional scientific evidence for cannabis being a promising treatment for ADHD is evident in the 2016 study showing that Sativex (a cannabinoid medication with a 1:1 THC/CBD ratio) is consistently effective in improving behaviour and cognition in ADHD patients.
These results were later supported by German study where the results showed that cannabis regulates activity levels and that it has a positive impact on performance, behaviour and the individual’s mental state.
Another German study also found that 30 Ritalin non-responsive patients reported signs of improvement in sleep patterns, concentration as well as a reduction in hyperactivity and impulsivity symptoms.
Cannabinoids as Treatment for ADHD Symptoms
Cannabis compounds for the treatment of ADHD symptoms can be two-fold. For some, it is useful as a complimentary therapy to help alleviate the side-effects associated with prescription medications. Cannabinoids have repeatedly shown to be effective for treating insomnia and nausea without the side-effects generally associated with either over-the-counter or prescription medications. Others, however, prefer using cannabinoids as primary treatment for the alleviation of ADHD symptoms itself such as hyperactivity, behavioural problems, anxiety, and depression.
Although in cannabis and ADHD research is in its infancy, the increasing number of scientific studies being conducted, are starting to increasingly show that cannabis can be a valuable complementary, and even primary treatment for combating the difficulties and symptoms associated with ADHD.
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