CBD Potential for ADHD: New Perspectives in Treatment.

Attention Deficit Hyperactivity Disorder (ADHD) affects millions of people worldwide. Although treatments exist, they often have side effects, prompting the continued search for ADHD therapies. Cannabidiol (CBD), a non-psychoactive compound in cannabis, has emerged as a possible treatment option.

On the occasion of World ADHD Day, today on the Cannactiva blog we talk about current research and potential applications of CBD to treat ADHD, based on Cannabiscentia’s Cannabinology Principles Manual, by physician Fabio Turco and Viola Brugnatelli.

What is ADHD?

ADHD is a disorder affecting both children and adults, characterized by persistent patterns of inattention, hyperactivity and impulsivity that are more severe than typically seen in individuals of comparable developmental level. These symptoms can significantly affect various aspects of daily life, including school performance, work performance, and social relationships.

Diagnosis of ADHD

The diagnosis of ADHD is made through a clinical evaluation that includes interviews, behavioral questionnaires and direct observations. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Attention Deficit Hyperactivity Disorder is classified into three types: predominantly inattentive, hyperactive-impulsive and combined presentation.

Current treatments for ADHD

Current treatments for ADHD include mainly behavioral therapies and stimulant medications such as methylphenidate (Concerta ®, Medikinet ® and Rubifen ®) and amphetamines (Elvanse ®). However, these can have side effects such as insomnia and loss of appetite.

Medications are effective, but with potentially significant side effects such as insomnia, appetite suppression and abuse potential. Because of this, there is growing interest in exploring therapeutic alternatives, including the use of medical cannabis and CBD.

Potential of CBD for the treatment of ADHD

What is CBD?

Cannabidiol (CBD) is one of the main cannabinoids found in the cannabis plant. Unlike tetrahydrocannabinol (THC), CBD has no psychoactive effects, meaning it does not produce the “high” associated with marijuana use.

CBD interacts with the body’s endocannabinoid system, which plays a crucial role in regulating various physiological functions, including mood, sleep and pain response. Because of its therapeutic properties, CBD has been studied for its potential effects on a variety of medical conditions, including ADHD.

Clinical Trials and Studies

Recent studies have begun to explore how CBD can help treat Attention Deficit Hyperactivity Disorder (ADHD). An observational study conducted in Brazil in 2019 on 18 children with autism (ASD) showed promising results in children with ADHD who took CBD capsules. Although the study does not focus on ADHD, it has relevance because it addresses symptoms that overlap between ASD and ADHD, such as attention deficits and behavioral problems. Improvements in hyperactivity, inattention, and impulsivity were found without significant side effects.

Details: Observational study conducted in Brazil

The observational study conducted in Brazil in 2019 (4) showed promising results in 15 pediatric ADHD patients who received high-CBD capsules (THC:CBD, 1:75).

Doses were adjusted individually, starting with a mean of 2.90 mg/kg/day of CBD, and adjusting between 2.30 and 3.60 mg/kg/day depending on the severity of the case. During the first 30 days, intensive dose titration was performed, continuing with minor adjustments for the next 150 days. The final average dose of CBD was 4.55 mg/kg/day, ranging from 3.75 to 6.45 mg/kg/day. The average THC dose was 0.06 mg/kg/day, ranging from 0.05 to 0.09 mg/kg/day. The regimen consisted of two daily doses, one in the morning and one in the evening. The results showed improvements in hyperactivity, inattention and impulsivity without significant side effects.

A significant study contributing to the understanding of cannabinoids in the treatment of ADHD is the EMA-C (Experimental Medicine in ADHD-Cannabinoids) trial, published in 2017. This pilot, randomized, placebo-controlled, experimental pilot study investigated the effects of Nabiximols (Sativex) oromucosal spray, a cannabinoid medication (THC:CBD, 1:1) in 30 adults with ADHD.

The results did not show a significant difference in the main outcome between the active and placebo groups. However, the group receiving cannabinoid treatment generally exhibited better scores than the placebo group. Notably, Nabiximols was associated with significant improvement in hyperactivity/impulsivity and a cognitive measure of inhibition. In addition, there were trends toward improvement in inattention (5). Although the results were inconclusive, this study provides preliminary evidence supporting the theory that some adults with ADHD may benefit from the use of cannabinoids.

A systematic review published in 2020 found moderate evidence supporting the use of CBD compounds and CBD medications (such as Nabiximols and Sativex) to alleviate symptoms of ADHD and other disorders such as schizophrenia, social anxiety disorder, and autism spectrum disorder. (6)

Overall, the need for larger, well-designed clinical trials to further validate these findings is highlighted.

Potential Benefits of CBD in the Reduction of ADHD Symptoms

• Improved concentration and attention: CBD can modulate neurotransmitters, potentially reducing symptoms of inattention and promoting greater cognitive clarity.
• Reduction of hyperactivity and impulsivity: The calming effects of CBD may help control these two core symptoms of ADHD. These effects are thought to arise from cannabidiol’s influence on the serotonin and dopamine systems, which are involved in mood regulation and behavioral control.
• Improved sleep quality: CBD has been shown to improve sleep quality by addressing factors such as anxiety and hyperexcitability, which can interfere with restful sleep. Improved sleep, in turn, improves mood and overall cognitive function, thus helping to alleviate ADHD symptoms during waking hours.
• Anxiety and stress reduction: Anxiety and stress are common problems that coexist in individuals with ADHD and can significantly worsen symptoms. CBD has well-documented anxiolytic properties (7). By reducing anxiety and stress, CBD can indirectly alleviate ADHD symptoms, making it easier for individuals to manage their daily activities and improving their overall quality of life.

Unlike traditional stimulant medications, CBD does not produce euphoric effects, making it a more attractive option for individuals sensitive to the side effects of conventional treatments.

Testimonials on the use of CBD for ADHD

A case study in the Cannabiscientia manual describes how a second grader with ADHD, R., experienced significant improvements in concentration and behavior when using CBD gum and CBD oil. His mother reported increased concentration and decreased hyperactivity during CBD use. This practical experience underscores the potential of CBD as a viable alternative to traditional ADHD medications.

In R.’s case, finding the right balance involved trial and error. The strong taste of the concentrated oil, even mixed with food, was rejected by R., as with most younger patients. In contrast, his mother noted that CBD chewing gum was particularly effective, although it required careful dosage adjustments to avoid excessive sedation.

Conclusion

Research on CBD as a treatment for ADHD is in its early stages, but preliminary studies and anecdotal evidence suggest that it may be a safer and more tolerable alternative to traditional medications. However, more research is needed to fully understand its efficacy and safety.

Before starting any CBD treatment, diagnosis and advice from a medical specialist is crucial. Only your physician can offer guidance on dosage and monitor possible interactions of CBD with other medications.

The information in this article comes from Cannabiscentia’s Manual of Cannabinology Principles, by Viola Brugnatelli and Fabio Turco and Prohibition Partners. A guide on medical cannabis and cannabinoids for healthcare professionals where the European medical cannabis landscape is extensively covered. The second edition is now available. Visit Cannabiscientia for more information.

Note: This is an informational article and is not intended to prevent, diagnose or treat any disease. Its content can complement, but should never replace, the diagnosis or treatment of any disease or symptom. Cannactiva products are not medicines and are intended for external use. There may be new relevant scientific evidence since the date of publication. Consult with your physician before using CBD. The therapeutic approach must always be personalized and depends on the professional assessment.

References

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2. Miriam Kessi, Haolin Duan, Juan Xiong, et al. Attention-deficit hyperactive disorder updates. Front Mol Neurosci. 2022; 15: 925049.
3. Athanasios Koutsoklenis, Juho Honkasilta. ADHD in the DSM-5-TR: What has changed and what has not. Front Psychiatry. 2023 Jan 10:13:1064141.
4. Fleury-Teixeira, P., Caixeta, F. V., Ramires da Silva, L. C., Brasil-Neto, J. P., & Malcher-Lopes, R. (2019). Effects of CBD-enriched Cannabis sativa extract on autism spectrum disorder symptoms: an observational study of 18 participants undergoing compassionate use. Frontiers in neurology, 10, 1145.
5. Ruth E Cooper, Emma Williams, Seth Seegobin, et al. Cannabinoids in attention-deficit/hyperactivity disorder: A randomised-controlled trial. Eur Neuropsychopharmacol. 2017 Aug;27(8):795-808.
6. Khan, R., Naveed, S., Mian, N., Fida, A., Raafey, M. A., & Aedma, K. K. (2020). The therapeutic role of Cannabidiol in mental health: a systematic review. Journal of Cannabis Research, 2(1), 1-21.
7. L Cinnamon Bidwell, Renée Martin-Willett, Carillon Skrzynski, et al. Acute and Extended Anxiolytic Effects of Cannabidiol in Cannabis Flower: A Quasi-Experimental ad libitum Use Study. Cannabis Cannabinoid Res. 2024 Jan 22.