CBD Oil for ADHD: Research on Treating Symptoms
If you feel like you've been hearing an awful lot about CBD lately, you're not alone. Short for cannabidiol, CBD has begun cropping up in a wide range of consumer products, from topical oils to edible gummies. These products purport to treat or improve a vast number of health conditions and symptoms. But many medical professionals caution that it's too soon to say that CBD oil and other products that contain this component derived from the cannabis plant can treat certain conditions. Evidence of their medical efficacy is limited, and most of these products are unregulated by the FDA.
CBD vs. THC
CBD is short for cannabidiol, one of many cannabinoids that are produced by plants in the cannabis family. Another cannabinoid is tetrahydrocannabinal, or THC, the primary psychoactive element in marijuana, which is responsible for making you feel high after using marijuana. Unlike THC, CBD doesn't produce this high.
Despite these differences, CBD, like THC, interacts with your endocannabinoid system, a natural part of the body that produces naturally occurring cannabis-like molecules. These compounds, called endocannabinoids, act like neurotransmitters to maintain balance in the body. Using CBD or THC can stimulate the production of more of the body's own endocannabinoids, which some patients find helps reduce anxiety, pain and inflammation.
Dr. Jordan Tishler, a member of the medical advisory board for cannabisMD and president of the Association of Cannabis Specialists, says that there are more than 100 chemicals in cannabis. THC and CBD are just two of them. "Frankly, CBD hasn't been researched nearly as much as THC," he says. Some of that is related to the fact that cannabis, the plant from which both CBD and THC derive, has long been illegal across the United States and much of the funding for new medicines comes from the federal government. But as more states legalize the use of both medical and recreational marijuana, these CBD products are entering mainstream usage and being considered as a potential treatment for many diseases and conditions.
What Is CBD Oil?
Dr. Harrison Weed, an internal medicine specialist at the Ohio State University Wexner Medical Center, explains that CBD oil is an extract of the cannabis sativa plant. "Cannabis sativa can have a high content of the psychoactive chemical THC," short for tetrahydrocannabinol, in which case it's referred to as marijuana. In lower concentrations, it's referred to as hemp. "Extracts that contain mostly CBD and only very small amounts of THC are referred to as CBD oil."
Daniele Piomelli, professor of anatomy and neurobiology at the UCI School of Medicine and director of the UCI Center for the Study of Cannabis at the University of California, Irvine, says that "in the case of cannabis and CBD, we do not know a lot of what we think should be pretty clear. When we talk about CBD oil, one would expect that there should be a definition of CBD oil using a pharmaceutical or medicinal context. One would expect the appropriate authorities to define what it is. But right now, we have a situation where there as many definitions as there are companies that are marketing CBD oil."
That said, Piomelli adds that "in very general terms, CBD oil is an oil extract of a hemp plant or hemp variety that produces mostly CBD," instead of the more psychoactive THC compound.
When it comes to using CBD oil to treat any medical condition, the jury is still out, Piomelli says. He draws the distinction that while the compound CBD may eventually be proven effective in treating a few conditions, such as anxiety disorders and epilepsy, the CBD oil that we see on convenience store shelves today that claims to treat everything from insomnia to Alzheimer's is unlikely to be of much use. "A lot of those things are wishful thinking right now," Piomelli says.
More research needs to be done and a standardization of terms and dosages across the industry would go a long way toward making clear what people are buying when they pick up a CBD oil product.
CBD Oil As Treatment
The use of products that contain CBD, such as oils, to treat medical conditions is considered controversial, and many doctors, like Piomelli, warn that CBD oil is just a 21st-century version of snake oil that only cures people of a heavier wallet.
Still, because CBD works on the endocannabinoid system and has demonstrated anti-inflammatory effects, it's been theorized that it could potentially be useful in treating a range of disease and disorders including:
— Epilepsy. The neurological condition epilepsy, which causes seizures, is the only condition for which CBD has been proven an effective treatment. In 2018, the FDA approved Epidiolex, a pure CBD oil medication for the treatment of a rare form of severe epilepsy.
— Anxiety disorders. A 2018 study in the journal Epidemiological and Psychiatric Sciences concluded that CBD could be helpful in reducing anxiety symptoms, but that more research needs to be done.
— Migraines and frequent headaches. CBD and CBD oil products are often touted as being beneficial for pain relief, and when it comes to headaches and migraines, it could potentially be a useful treatment, according to one 2017 literature review.
— Psychiatric diseases such as schizophrenia. Because of its ability to reduce anxiety in some people, CBD has been suggested as a possible means of treating schizophrenia and other psychiatric disease that can trigger severe anxiety and psychotic episodes. A 2012 review noted that while more work needs to be done, CBD has potential to be used as an antipsychotic.
— Neurodegenerative disorders, such as Alzheimer's disease. Cognitive decline and other neurodegenerative disorders are often related to inflammation and oxidative damage to brain cells. A 2014 study in the Journal of Alzheimer's Disease suggested that CBD could slow some of this damage and prevent the development of memory issues and deficits in facial recognition among mice.
— Cancer. A 2019 review conducted in Slovenia noted that CBD has earned a place in palliative care for cancer treatment — to aid in pain management and to reduce anxiety and nausea. In addition, some studies have also suggested that it might inhibit the growth and spread of certain types of cancer cells.
— Diabetes. A 2016 study showed that CBD could reduce inflammation in the pancreas, which could benefit those with type 1 diabetes.
Can CBD Treat ADHD?
Attention deficit hyperactivity disorder, better known as ADHD, causes an inability to pay attention and a physical restlessness that may be inappropriate or disproportionate to the situation. ADHD can also cause people to act impulsively and may lead to difficulty in personal relationships and trouble at school or work.
Because CBD has been shown to alleviate anxiety in some people, it's thought that it might have applications in the treatment of ADHD. "CBD receptors are found on nervous system cells, and CBD can be sedating," Weed explains. "Some people find that CBD reduces their anxiety," and when you're desperate for some relief, some folks may become "susceptible to hoping that some 'new' treatment will help."
But Piomelli says "it's too soon" to conclude that CBD oil could be a treatment for ADHD. Weed agrees. "There is no current research supporting the use of CBD oil in the treatment of ADHD."
Weed points to a few studies that indicate there could be promise to the idea of eventually using CBD oil to treat ADHD including:
— A 2012 paper reported that mice with "reduced social investigative behavior, hyperactivity, as well as reduced attention span," were "normalized" when treated with cannabidiol.
Weed says this adds up to a lot of hope and some grounds for future investigation, but not a lot of hard evidence right now. "There is no reliable evidence that CBD reduces symptoms or improves cognition or behavior for people with ADHD."
While there's some hope that CBD oil could become a more common treatment for several diseases, Weed warns that "CBD can be dangerous." Adverse effects that have been commonly associated with CBD include:
— Liver enzyme increases to abnormal levels.
Because it's metabolized in the liver, CBD can increase the effects of other medications that are also metabolized in the liver, including:
— Warfarin (Coumadin), a blood thinner used to reduce the risk of blood clots, stroke, heart attack and other conditions.
— Cilostazol (Pletal), a vasodilator used to treat peripheral artery disease.
— Citalopram (Celexa), an anti-depressant used to treat depression, obsessive compulsive disorder and other anxiety disorders.
"Therefore, people who take medications should talk with their doctors about possible effects of CBD on their medications before taking CBD," Weed says.
Weed also raises the same concern Piomelli does about the lack of regulation over many sources of CBD and CBD oil products. Unless you're using Epidiolex or purchasing medical marijuana that's been tested and regulated, "CBD supplements are not regulated for purity and content."
In fact, there might be little relation between the label on the packaging and what's inside. "Testing of popular, commercially-available CBD products found that only 15% contained what was on their labels, and 40% contained less than one-fifth of the amount of CBD claimed on their labels, one-fourth of those (10% of the total) with no detectable CBD at all," Weed says.
It's not just about what's missing, either. "Some of the products contained high levels of solvents and dangerous gasses," Weed says, pointing to a 2019 case of an 8-year-old boy with a seizure disorder who had a dramatic increase in seizures (14 in 24 hours) after taking a CBD oil product that contained a synthetic cannabinoid known to cause seizures.
"Therefore, when you take commercially-available CBD, it can be difficult to know if you are unintentionally taking other drugs, and to know how much CBD you are actually taking, if any," Weed concludes.
Common Sense Precautions
If you're determined to use CBD products, Weed recommends taking some precautions. In addition to talking with your doctor first to avoid any potentially dangerous drug interactions, make sure that any CBD products you use are:
1. Certified as organic by the U.S. Department of Agriculture.
2. Labeled as having been tested for pesticides and herbicides.
3. Labeled as meeting Good Manufacturing Practices by the FDA.
"In addition, some experts recommend using European CBD products, because Europe has a more established regulatory system for these products and because European CBD products have a lower allowed concentration for tetrahydrocannabinol, THC, the psychoactive component of marijuana," Weed says. In Europe, CBD products are limited to a THC content of 0.2% versus 0.3% in the United States.
CBD For ADHD: What Does Science Say About CBD & ADD?
As part of our continuing look at the science of cannabinoids, we thought we’d look at what current research says about using CBD for ADHD and ADD.
We all have trouble concentrating and controlling our impulses from time to time. But for a considerable number of children and adults, these problems can disrupt their lives. In the United States, approximately 8.1% of the population struggles with attention deficit hyperactivity disorder (ADHD) at some point in their lives.
Although research is still preliminary, a growing body of evidence shows cannabinoids could be beneficial in ADHD treatment, not only by alleviating symptoms but by also improving the chemical imbalances that cause them.
Below we’ll look at what the current science suggests about using CBD for ADHD, including its safety.
What is ADHD?
A neurobiological disorder, doctors typically diagnose ADHD during childhood or adolescence, though it often persists into adulthood. Characterized by inattentiveness and hyperactivity-impulsivity, there are three subtypes:
- Inattentive type, or attention deficit disorder (ADD), involves inattentive symptoms. These include being easily distracted and having trouble concentrating.
- Hyperactive-impulsive type is the opposite of ADD. Symptoms include excessive talking and inability to sit still.
- Combined type, as the name suggests, is when both groups of symptoms are more or less equally present.
Additional symptoms can include problems with managing stress, insomnia, anxiety, aggression, and self-focusing behavior (the inability to recognize the needs or wants of others).
Probable causes of ADHD
An extremely complex disorder, ADHD is thought to be caused by a combination of genetics and environmental factors. Widespread brain abnormalities, spanning from the prefrontal cortex to the cerebellum, are associated with the disorder.
Whether dependent on genes or environment, individuals who do develop the disorder have lower than average levels of dopamine and norepinephrine. Both of these neurotransmitters play a critical role in the motor and reward systems, which may explain the inattentive and hyperactive-impulsive symptoms.
Environmental & genetic factors
The chances of inheriting ADHD from a parent is somewhere between 60-90%. This suggests genetics are the primary cause but not the only one. Chromosomal deletions and duplications, where parts of the genetic code are either missing or repeated, are common in individuals with the disorder. These likely cause the associated brain abnormalities.
Environmental factors during fetal development and infancy can aggravate pre-existing genetic issues. Prenatal exposure to alcohol and nicotine, low birth weight, malnutrition, and a lack of socialization early in life may increase the risk of ADHD.
Of course, it is not possible to alter genes using cannabinoids or any other medications. However, CBD may help with addictions, possibly reducing fetal exposure.
People with ADHD have lower levels of dopamine, which affects reward-motivated behavior. Pharmaceutical stimulants, like Ritalin and Adderall, increase the availability of dopamine in the brain. Unfortunately, these medications do not work for everyone. They also pose a risk of severe or life-threatening side effects.
Some cannabinoids, like the psychoactive tetrahydrocannabinol (THC), may increase dopamine activity in the bain. They do this in the same way as stimulants, and all other drugs with a potential for abuse, by triggering the reward system.
CBD may also increase availability but in a very different way. In a preclinical trial, mice with lower than average numbers of G protein-coupled receptors (GPR6) in the brain showed higher levels of dopamine than mice with a normal amount of these receptors. This indicates that reducing activity in GPR6 increases either dopamine production or release.
A brain receptor is a sort of parking lot for different neurotransmitters, with spaces for them to ‘park’ and produce their effects. Because CBD can ‘park’ on GPR6 but does not do anything once there, it reduces activity in the receptor by taking up space. Theoretically, this may increase dopamine levels.
A neurotransmitter and hormone vital to everything from movement to blood pressure, norepinephrine levels are also lower than average in people with ADHD. Nonstimulant medications, like atomoxetine and clonidine, increase levels of norepinephrine. This improves attention span and lowers hyperactivity and impulsivity.
The locus coeruleus (LC) region of the brain, which plays a role in the ability to concentrate, is a principal source of this neurotransmitter. CBR1 cannabinoid receptors appear throughout the LC. Stimulating these receptors seems to increase the release of norepinephrine into the rest of the brain.
Study shows some synthetic cannabinoids created in the lab may increase norepinephrine activity in the LC, consequently raising dopamine levels. Cannabinoids also show the potential to regulate this area of the brain by preventing over-activation, which can reduce the ability to focus. Because these chemicals mimic naturally occurring cannabinoids, plant-based treatments may produce similar results.
The beneficial effects are possible due to the ability of cannabinoids to inhibit monoamine oxidase (MAO), which helps metabolize dopamine and norepinephrine. Slowing the breakdown process of these neurotransmitters can lead to higher levels throughout the brain.
Studies on cannabinoids, including CBD, and ADHD
While the body of research on the effect of cannabinoids in the brain is quite large, there are very few studies specifically on ADHD. The few that do exist show there is potential, but further research is necessary.
In a preclinical trial, researchers used a drug called MK-801, which induces inattentiveness and hyperactivity in rats. This mimics the symptoms of ADHD. Pretreatment with CBD reduced hyperactivity but did not appear to affect attention span.
A clinical trial conducted in 2017 compared the effects of a placebo treatment to Sativex (an oral spray containing a 1:1 ratio of CBD to THC) in 30 adults with ADHD. The adults given Sativex showed improvements in hyperactivity-impulsivity, attention span, and emotional control, while the placebo group did not.
Is it safe to use CBD for ADHD?
While the existing studies show cannabinoids indeed have potential, the likelihood of ADHD treatment beginning during childhood means more research is needed to determine their safety. Although 5.2% of children already take traditional stimulant or non-stimulant medications, most are not recommended for use in patients under six years old, and the effects of long-term use are not clear.
Over 20 weeks, a group of 20 children took a cannabis extract containing 100 mg/ml CBD and 2 mg/ml THC. Most of the participants had mild adverse effects, such as tiredness and poor balance, but these resolved themselves within eight weeks.
While these results are encouraging, further study is needed to determine the long-term effects. Behavioral therapy is the recommended frontline ADHD treatment for younger pediatric patients. Medication is only appropriate in older patients, when therapy proves ineffective. And we just don’t know enough about the effect of cannabinoids on young minds.
When it comes to adults, there’s a growing body of evidence suggesting that CBD has very few side effects. Even the World Health Organization reported that CBD is safe and nonaddictive.
Final thoughts on CBD and ADHD
Approximately 26.5 million Americans struggle with ADHD at some point in their lives. If cannabinoids can help even a fraction of them, an enormous amount of lives could be improved.
We can’t stress this enough, but it’s vital to consult with a medical professional before beginning any treatment program. This is even more true when it comes to children and adolescents. It’s also important not to change your existing treatment plan without medical advice. Abruptly discontinuing behavioral or pharmaceutical therapies can be extremely detrimental and is not recommended in any circumstance.
We think it’s clear that CBD and other cannabinoids could help some people with ADHD. We hope scientists continue to investigate and we’ll continue to report back when they do.
CBD Oil and ADHD Management: Too Big a Leap
Cannabidiol oil, most often referred to as CBD oil, is a product of the marijuana plant. I've been hearing a few parents utilizing it as an alternative treatment for ADHD, and I was a bit concerned as I had not heard of any research supporting the claims made. As psychologists, it is important that we disseminate factually-based information. Here is the conclusion from one reputable source:
The research on CBD oil and other cannabis products as a possible intervention for ADHD does not show effectiveness for managing symptoms, and actually shows increased mental and physical health risks. “We don’t want to misrepresent things, and with CBD oil, it is getting misrepresented,” Dr. Mitchell says. “When people say this works for ADHD, this is going way beyond the data. That’s too big of a leap.”
For the complete article, please click on the following link:
The article goes on the discuss the research-based interventions that are supported, including parent-training to better understand ADHD and how to implement tools that work for your child, and medication, particularly stimulants. (The type of medication is outside our scope, this is best chosen in consult with a pediatric psychiatrist).
Two resources that I find helpful and often recommend to parents are as follows: