A recent literature review by PhytoSciences Ghana has provided a summary of the preclinical evidence for the medicinal use of cannabinoids as an alternative treatment for mental health disorders. In light of these conclusions we have interviewed a patient who uses medicinal cannabis to manage ADHD and OCD, to explore how the findings of this research relate to her experiences.

In summary, the study concluded that cannabis has the potential to significantly improve symptoms associated with depression, PTSD, generalised anxiety disorder. Furthermore, the conclusions from this study also found that the antipsychotic properties of cannabis had no significant benefit on the symptoms relating to schizophrenia. The findings also reaffirmed the evidence basis for the adverse impact that cannabis use has on patients with schizophrenia, including a discussion of the biochemical processes involved.

In relation to anxiety disorders, the study found that cannabis has the potential to significantly improve symptoms. However, it also concluded that dosing is an important element for treating anxiety, because there’s a fine line between helping and exasperating anxiety with cannabis. For example, where too much THC is administered, patients reported anxiety-like symptoms. On the other hand, where there was an optimum balance between CBD and THC patients reported a reduction or loss of symptoms associated with anxiety. 

Researchers also found that this sensitive balance with dosing is also crucial where treatment for depression is concerned. One of the studies reviewed found that those who smoke cannabis were more likely to develop depression. However, another conclusion determined that those who have depression and use cannabis reported significantly lower depressive symptoms than those who did not use cannabis.

With regards to ADHD, there were a number of illuminating findings reported in paper. Firstly, it concludes that cannabis is used by those with ADHD as a method of coping with symptoms associated with the disorder. One study explored the effects of Sativex on the behaviour, cognitive performance, activity level and emotional state of those with ADHD. While they found there was no significant improvement on cognitive performance, there were slight improvements where hyperactivity, impulsivity, inattention and emotional lability were concerned. 

It must also be stated that there are limitations to this research, for example, the trial sampled only 30 participants. Moreover, the study has only examined the effects of Sativex on those with ADHD, therefore these findings have limited application to the use of cannabis flower and oils for treating ADHD.

As it stands much of the research considering ADHD and cannabis is exploring the harms. It’s important that more research is done to better understand the therapeutic benefits, and limitations of cannabis as a treatment for ADHD. Medicinal cannabis is now prescribed privately for ADHD in the UK. However, it’s not a line of treatment that is recommended, or prescribed by the NHS because NICE RCTs are still underway. While it’s great that patients can now access medicinal cannabis suitable for their mental health needs, many still remain reliant on the illicit market. The findings from this review highlight the delicate balance of dosing where mental health is concerned, and therefore the importance of medically supervised cannabis treatment for mental health disorders. 

ADHD is a cognitive developmental disorder, which is prevalent in around 5% of children and 3% of adults worldwide. Although ADHD presents during childhood, some go on to be diagnosed in adolescence, and even adulthood. Moreover, ADHD is generally under-diagnosed in girls, and in tune with Latisha’s experience, late diagnosis is more common in women. 

“So how it came about was I did this thing with a disability network and it was all women around my age. As women we get diagnosed in our thirties, late twenties with ADHD. In this network they were saying this, and they were also saying the symptoms of ADHD; and I thought this is me, this is me! Then I wrote to a friend of mine, who is so proud of her ADHD, and she knows so much about it. She said, “I didn’t want to say, but I know you got it”, and now I’m on the waiting list; which is two years and I cannot afford a private diagnosis.” 

While there are many barriers to getting an ADHD diagnosis, having an assessment is a crucial step towards effective management. Moreover, working with an ADHD specialist is an important part of this process. They can inform patients on how they can best utilise medication, and non-pharmaceutical therapies, to help them to cope with day to day challenges inherent to living with ADHD. 

Latisha is currently awaiting for her diagnosis, and feels it is a necessary step forward. But she is uncertain about the treatment options. In the meantime she has begun self-medicating with cannabis. 

“At the end of it you don’t know whether that medication they’re going to give you is going to work for you. I mean, it’s basically speed (amphetamines) anyway. Then for people like myself, who’ve got addiction problems with hard drugs and alcohol, it’s not particularly something I want it to be getting into. So I started smoking cannabis again.” 

Medication is a common reality for many who are living with diagnosed a mental health disorder. The two main lines of pharmaceutical treatment for ADHD are stimulants and SNRIs. However, these medications aren’t suitable or effective for everyone, and often come with unavoidable side effects. Moreover, where stimulants are concerned there is also a risk of addiction. Although, it’s worth noting that there are medications designed to mitigate the risk of dependency, but generally those who have a history of problematic drug use may not be well suited to this line of treatment. 

While ADHD medication may not be suited to Latisha’s needs, she feels that adaptation is the most effective approach she can take to manage ADHD.

“Every now and again we need a couple of ADHD days, because they are good, but in small amounts. I find that they make me quite free spirit. You have to learn to adapt because in my world things just change day by day, for example the focus on a project.” 

When asked how cannabis affects her cognitive performance (i.e. learning, thinking, reasoning, recall) Latisha reported improvements with her ability to read material she would have once found un-stimulating.

“I can now read extended amounts, and not just stuff that I’m interested in. So not just the book I’m reading, for instance, but I’ll read the news, and the whole thing. Where previously I’d only read the first paragraph, that was the most noticeable effect there. But also on the other side cannabis helps to reduce the anxiety and guilt associated with these ADHD behaviours we exhibit. Just being able to reduce the anxiety as well means that it’s not as stressful. Yeah. So that’s my most exciting one is I can actually read things, it’s great. 

Latisha’s experiences are somewhat aligned with the findings of this particular study, where Sativex was found to have a slight improvement to cognitive performance, without causing impairment. Although it’s worth considering that these findings were not significant enough to draw concrete conclusions. 

“I don’t know entirely what I can attribute to my epilepsy and the medication I’m on, that sometimes blurs the lines with some stuff. The epilepsy that I have is temporal lobe epilepsy, which affects language. Specifically I’ll have days where I find it really difficult to like recall stuff. So you have a lot of feelings of existing in a different world, which is very weird.”

It seems that for Latisha, who is already a proficient reader, cannabis doesn’t necessarily improve her ability to read, but rather helps her cope with the frustrations which arise with these kinds of tasks. Moreover, having temporal lobe epilepsy makes it difficult to know whether it’s ADHD, epilepsy or medication which is impairing Latisha’s cognitive performance, and whether it’s the medication or cannabis which is helping. 

“My medication has been effectively controlling my seizures, and about four months ago I began smoking cannabis again; which is helping me in other areas. In this time I’ve noticed that my vocabulary has opened up incredibly. I’ve also lost a lot of my memories, but I’m now starting to remember more from the past.”

Hyperactivity is a well known symptom of ADHD. The hyperactive aspect of this disorder is most noticeable in children, nonetheless it certainly carries through for many adults with ADHD. For Latisha hyperactivity remains a pervasive issue in her life, which she now uses cannabis to manage.

“I’m very hyper, in some certain ways specifically. I will wake up around two or three in the morning, and really I need to go back to sleep. I know I need to sleep, but my head just goes straight into loud noise. We’ve got disco music going on, we’ve got yesterday’s plans, and tomorrow’s plans, I’m analysing everything. My heart starts racing because I’m excited to get up. But if I wake up in the morning and I smoke, for example where I’m having a really anxious moment, I’ll be able to go back to bed and wake up at a better time. I’m still learning how to build that into my day. But all the time the hyperactivity is there.”

The findings of this research concluded that administration of Sativex resulted in nominally significant improvements to impulsivity and hyperactivity. Impulsivity is another symptom of ADHD which can be particularly difficult for young people to manage, due to ongoing cognitive maturation. For adults with ADHD impulsive behaviours can often lead to strong feelings of guilt and regret, because the brain has a stronger capacity to evaluate the repercussions of actions and behaviours. 

When asked whether cannabis improves her impulsivity Latisha noted that it gives her time to thoroughly think through decisions. 

“Oh, my gosh yeah! I now make really informed decisions rather than just go. Even for example, when deciding whether I need to buy more cannabis. I now think about whether I really need it, rather than buying it thinking I’ll get that money back. I don’t buy ‘street weed’, I don’t buy it off the dark web. If I can’t get hold of medicinal cannabis, I’ll go without.”

Some of the most difficult ADHD symptoms to manage are emotional regulation and  hypersensitivity. Those with ADHD often experience heightened emotions, which are triggered more easily, and feel more intense than those with neurotypical thinking. Moreover, those with ADHD can find it more difficult to regulate and express these emotions, leading to ‘breakdowns’ and ‘outbursts’. The findings from this study suggest that Sativex may improve emotional lability in those with ADHD, which corresponds with Latisha’s experiences.

“If I feel myself getting to a frantic state, I’ll smoke, which definitely helps to reduce that. But the lasting effects of it also mean that I’m just not as moody.”

Hyperfocus is an aspect of ADHD which many aren’t aware of, and isn’t considered in this trial. It’s a state of intense focus which is experienced when the ADHD brain is stimulated by a task or project which is of great interest to them. It can be an extremely productive state, however in reality those with ADHD cannot rely on moments of spontaneous hyperfocus to carry out their daily lives. 

“The hyper-focus gives me the ability to navigate whatever I need it for. But I have to actively avoid stimulating things like inspirational podcasts, because otherwise it will just send me into this frantic state of ‘I need to know everything’, I need to research everything. For instance, when I got engaged, I planned my wedding within two weeks. Less than that two weeks. But this current of energy can be difficult to deal with.”

It would be interesting to see clinical research explore how cannabis affects hyper-focus in those with ADHD, to see whether it is an effective tool to manage this ‘current of energy’ described by Latisha. From Latisha’s experiences it’s clear that she has felt the medicinal benefits of cannabis. Whilst also being aware of the limitations, and potential harms associated with unregulated cannabis, and with problematic cannabis use.

Finally, we asked Latisha whether there were any key issues around ADHD and medical cannabis which she felt were important to speak about. 

“We need to change the language surrounding ‘weed’ culture, because it’s still obviously seen as a negative thing. When people are not so afraid of it then I think the resistance to reform is going to loosen. It would give politicians more room to make these decisions, rather than thinking they’re going against the grain….I’ve also had this thought about young boys at school, who are using cannabis, and the possible correlation with ADHD. Because we always look down on these people, but what if that’s the only thing they can do to cope?” 

The findings of this research are an illuminating starting point where re-informing the narrative around cannabis and mental health are concerned. Cannabis and mental health can seem like a double edge sword at times. Many doctors urge those with diagnosed mental health conditions to avoid cannabis, and other drugs. Meanwhile many with mental health conditions find that cannabis helps to cope with their symptoms. The prevalence of self-medication with cannabis highlights the importance of researching the most effective way to utilise it as a treatment for mental health disorders.  

The preclinical evidence suggests that while medicinal cannabis products show some therapeutic potential for treating mental health disorders, there are also limitations; and even the possibility to exacerbate symptoms, or drive the development of mental health disorders.

This piece was written by Ella Walsh, Content Officer at Volteface

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