cbd dosage for adhdDecember 15, 2021
Clinical Differences between ADHD Symptoms Frequency Subgroups.
A total of 16 (30%) patients reported current use of ADHD pharmaceutical medication consumption, the majority of them ( n =10, 19%) were in the high MC dose subgroup. Specifically, the low and high MC dose subgroup reported use of methylphenidate hydrochloride ( n =2, 4%; and n =1, 2%, respectively), methylphenidate hydrochloride slow release ( n =1, 2%; and n =3, 6%, respectively), amphetamine and dextroamphetamine combination ( n =1, 2%, for both), amphetamine and dextroamphetamine combination extended release ( n =1, 2%, for both), and lisdexamfetamine dimesylate ( n =1, 2%, for both). Two patients (4%) of the high MC dose subgroup reported use of methylphenidate hydrochloride extended release. In addition, there was an association between the high MC dose treatment and ADHD medication regimen. Specifically, the high MC dose subgroup reported significantly higher rates of changing (i.e. any type of change) their ADHD medication regimen since MC treatment initiated (OR 0.15, 95% CI 0.03 to 0.61; P <0.005). Furthermore, the high dose subgroup reported more on stopping all ADHD medications since MC treatment began (OR 5.8, 95% CI 1.1 to 60.0; P <0.05) ( Figure 5 ).
In this database population, 367 patients (11%) reported having a diagnosis of ADHD. Of them, 110 patients responded to our invitation to participate in the study (30% response rate). Upon confirmation that a physician diagnosed them with ADHD ( n =80), they were directed to complete the questionnaires. A total of 59 patients answered the study questionnaires, from which, 53 patients reported their MC monthly doses. Notably, most ( n =47, 89%) patients consumed inflorescences, either by smoking, vaporizing, or both. Five (9%) patients combined oil extracts and inflorescences, and one (2%) patient consumed only oil extracts. Medical cannabis treatment duration of our sample ranged from 1 to 16 years. The MC chemovar constituents dose consumption (i.e. cannabinoid and terpenoid amounts) could be calculated for 27 (50%) of the patients that consumed only MC inflorescence and reported fully on their MC treatment regimen.
In this study, we demonstrated that patients treated with MC stopped their ADHD medications, especially in the high MC dose and in the low ADHD symptoms frequency subgroups. Comparably, case reports have demonstrated similar ADHD medication-sparing effects. 23 Hence, these results might suggest that ADHD patients consume MC as a substitute treatment for their conventional ADHD treatment.
Data collection was carried out online by secure survey technology Qualtrics® (version 12018; Provo, UT, USA). 28.
ADHD Symptoms Frequency.
AD, Alzheimer’s disease; ADHD, attention deficit hyperactivity disorder; AIDS, acquired immune deficiency syndrome; ALS, amyotrophic lateral sclerosis; DS, disturbed speech; Dysp., dysphagia; ENDO, endometriosis; ES, epileptic seizures; GI, gastrointestinal; MD, muscular dystrophy; MS, multiple sclerosis; NP, neuropathic pain; OCD, obsessive compulsive disorder; PD, Parkinson’s disease; PLP, phantom limb pain; PMS, post-menstrual syndrome; PSD, preserved sleep duration; PTSD, post-traumatic stress disorder.
A: MC monthly dose consumption subgroup differences in percent of change in ADHD medications since MC treatment initiation; B: MC monthly dose consumption subgroup differences in percent of stopping all ADHD medications since MC treatment initiation.
These findings reveal that the higher-dose consumption of MC components (phyto-cannabinoids and terpenes) is associated with ADHD medication reduction. In addition, high dosage of CBN was associated with a lower ASRS score. However, more studies are needed in order to fully understand if cannabis and its constituents can be used for management of ADHD.
In summary, ADHD is a common psychiatric disorder in the adult population that is frequently unrecognized, under-diagnosed, and under-treated. It is often comorbid with other psychiatric disorders. Although MC is not directly indicated for ADHD, low ADHD symptom frequency and ADHD medication-sparing effects were found to be associated with MC treatment. In addition, high dosage of CBN was associated with lower ASRS, hinting at a possible combination effect in whole-plant MC treatment. Nevertheless, although we found the abovementioned association with CBN, it is minorly expressed in most MC cultivars, thus, we assume that other phyto-cannabinoids might be more essential for the effect on ADHD patients. These results, although not causal, might shed light on the potential beneficial effects of MC on ADHD symptom severity and motivate future prospective studies in order to validate our results and perhaps even consider making ADHD an approved indication for MC license in Israel in future.
The division into low and high ASRS score subgroups was corroborated by its associations with the ADHD rating scale scores for ADHD symptom severity. Specifically, inattentiveness, compulsivity/hyperactivity, and the total questionnaire scores were higher in the high ASRS score subgroup (14 [12–20], 12 [9.2–14], and 26 [23–31], respectively) than for the low ASRS score subgroup (9 [7–11], 7 [5–9], and 16 [12–20], respectively) (OR −0.97, 95% CI −1.5 to −0.39; OR −0.7, 95% CI −1.3 to −0.14; and OR −1.1, 95% CI −1.6 to −0.49; P <0.001 for all). Importantly, we did not find any difference between ASRS score subgroups and ADHD rating scale regarding the monthly MC dose consumption (40 [30–50] g for both subgroups of both measures) (OR 0.05, 95% CI −0.5 to 0.61; and OR 0.11, 95% CI −0.44 to 0.66; P =1.0, respectively].
Phyto-cannabinoid analyses were performed using a Thermo Scientific ultra-high-performance liquid chromatography (UHPLC) system coupled with a Q Exactive™ Focus Hybrid QuadrupoleOrbitrap mass spectrometer (MS) (Thermo Scientific, Bremen, Germany). 33 Identification and absolute quantification of phyto-cannabinoids were performed by external calibrations. 34.
The high MC dose (g) subgroup (i.e. 40–70 g, n =35) consumed MC more frequently, with a median of 6 (4–12) times per day, while the low MC dose subgroup (i.e. 20–30 g, n =18) consumed MC 3 (2.2–5.8) times per day (OR 0.85; 95% CI −1.5 to −0.23; P <0.05). Sample demographics were similar for both MC dose subgroups, the subgroups consisting of a majority of females ( n =31, 58%), with median age of 38 years (31–46) ( Table 1 ). Notably, anxiety scores, sleep quality, sleep latency, and sleep duration did not vary significantly between the MC dose subgroups.
All participants received written explanation of the study via email prior to their enrollment. They were asked to sign an electronic informed consent form before the start of data collection. Only patients that signed the informed consent form were allowed to participate in the survey. The study was approved prior to data collection by the institutional ethics committee of the Technion (# 011-2016).
Participants were eligible to participate if they were Hebrew-speaking, aged ≥18 years, reported a diagnosis of ADHD by a physician, and had a standing MC license for the treatment of any approved condition.
Mental illnesses were reported by most (37 of 53, 70%) patients of the sample. No significant differences were found between the low and high MC dose subgroups of these comorbidities ( P >0.05). Specifically, for the low and high MC dose subgroups, patients reported on past and current diagnosis of depression ( n =5, 9%; and n =11, 21%, respectively), anxiety ( n =7, 13%; and n =14, 26%, respectively), dyslexia ( n =6, 11%; and n =8, 15%, respectively), as well as substance abuse ( n =1, 2%; and n =6, 11%, respectively) and past alcohol abuse ( n =1, 2% and n =6, 11%, respectively). A current diagnosis of bipolar disorder was reported by three patients (6%) from the high MC dose subgroup only. No antisocial disorder was reported. Current pharmaceutical treatment for the abovementioned diagnoses was reported by two (4%) patients in the low MC dose subgroup and eight (15%) in the high MC dose subgroup.
Medical Cannabis Cultivar and Chemovar Characteristics.
The purpose of this cross-sectional study was to examine the differences between MC monthly dose and ADHD symptoms frequency scores subgroups of ADHD patients, their specific chemovar consumption, and ADHD medication use. Additionally, sleep and anxiety symptoms were evaluated as well as MC treatment AEs.
CBC, cannabichromene; CBD, cannabidiol; CBG, cannabigerol; CBN, cannabinol; High, high subgroup (patients that consumed 40–70 g MC per month); Low, low subgroup (patients that consumed 20–30 g MC per month); MC, medical cannabis; mg, milligrams; ppm, parts per million; THC, Δ-9-tetrahydrocannabinol; THC-C4, tetrahydrocannabinol-C4; THCV, tetrahydrocannabivarin.
ADHD, attention deficit hyperactivity disorder; ASRS, adult ADHD self-report scale; CBN, cannabinol; High, high subgroup (patients that reported total ASRS scores ≥3.18); Low, low subgroup (patients that reported total ASRS scores ≤3.17); NS, non-significant; THC, Δ-9-tetrahydrocannabinol.
The neurobiology of ADHD is reported as being similar to other psychiatric conditions, such as bipolar disorder, which may explain the report by Katzman et al. of strong familial links between the two conditions. 41 Similar regions and circuitry in the brain are involved in both ADHD and other psychiatric disorders, notably the limbic–cortical–striatal–pallidal–thalamic (LCSPT) circuit. 11 Neuronal activity within the LCSPT circuits is principally glutamatergic and is modulated by the gamma-aminobutyric acid (GABA) system. 42 This LCSPT circuitry is additionally modulated by a variety of other neuromodulators, including endocannabinoids. 43 The majority of participants in our study reported comorbid psychiatric conditions, supporting the assertion they are linked. Anxiety was also reported here as higher by participants with high ADHD symptom frequency scores, further highlighting this link. How the endocannabinoid system may modulate the circuitry involved in both ADHD and comorbid psychiatric conditions remains to be elucidated.
Under the current regulatory framework in Israel, adjusting the dose of MC consumption is difficult. Getting approval to increase the dose may take months to years. Thus, it was not surprising to find that the higher dose subgroup had significantly longer MC license duration. In Israel, patients select cultivars that they prefer and/or that they find to be available each month, based on their approved monthly dose. Their licenses specify the condition(s) for which they are approved to take MC; however, they may self-titrate available cultivars for an effect they find therapeutic and comforting for both the conditions they are approved for and for other non-indicated comorbidities, such as ADHD. The complexity created with whole-plant products that include over 144 phyto-cannabinoids 33 and scores of terpenoids 35 eludes simplistic conclusions about the effect of MC on the management of ADHD symptomatology. 22 Noteworthily, in the case report of Strohbeck-Kuehner et al., 22 it was suggested that cannabis treatment and synthetic THC administered to a 28-year-old man with ADHD resulted in a marked change in ADHD symptomatology without investigation of other cannabis constituents.
Previous studies considered cannabis as a single product in ADHD research, 40 disregarding its inherent complexities and variability between cultivars and combinations of cultivars, which leads to a unique amount of consumed cannabinoid and terpenoid constituents in each patient. The novelty of this study is that we did not neglect these complexities. In this study, we found that patients that consumed higher total MC monthly doses also consumed higher doses of several phyto-cannabinoids and of one terpene, but not of all of them. This finding may indicate that some constituents of the cannabis plant contribute more than others to its neurobiological effect, and may explain why some participants in our study reported substitution of conventional ADHD medications.
Medical cannabis treatment is very complex, firstly because of the variety of cultivars in Israel (about 150 different “strain names”) and secondly because patients consume in general more than one cultivar as well as different dosages. Consequently, in the current study we have 27 unique combinations of MC cultivars. Figure 2 shows only single cultivar variability between the most prevalent phytocannabinoids in the most frequent cultivars that were consumed by the study sample, without showing the different possible combinations of chemovars used. Additionally, the most frequent cultivars and most abundant terpenoids relative content was analyzed by GC-MS/MS analysis. Figure 3 demonstrates the variability between the most prevalent terpenoids in the most frequent cultivars (without combinations) that were consumed the study sample.
Terpenoid Identification and Quantification by GC-MS/MS.
A: Approved indications for medical cannabis (MC) treatment (total n =3,143); B: Comorbidities (total n =3,218); and C: Comorbidities symptoms (total n =3,218).
Currently there is a gap in the literature concerning the clinical effects of the specific cannabis plant cannabinoid and terpenoid components, best termed “chemovars” rather than utilizing “strain names,” otherwise termed “cultivars.” 24 Thus far, many specific phyto-cannabinoids 25 and many terpenoids 26 have been identified and quantified, making it possible to use this information in clinical trials. However, current studies on ADHD and MC disregarded MC treatment complexity, and evaluated it as if it was a single compound. 21 In reality, patients consume combinations of cannabis cultivars, tailoring their own specific treatment by trial and error, making dosing of cannabinoid and terpenoid constituents different for each patient. In Israel, ADHD is not a qualifying condition for MC treatment. 27 However, of the 51,000 patients in Israel currently approved for MC treatment, a significant cohort report a comorbidity of ADHD.
Questionnaires collected demographic information that included age, gender, education, body mass index (BMI), and approved MC treatment duration (years). Data on ADHD comorbidities included the past or present diagnosis of: clinical depression, anxiety disorders, antisocial disorders, bipolar disorder, dyslexia, substance abuse, alcohol abuse, and the past or present pharmaceutical treatment of at least one of these comorbidities. Validated questionnaires included the adult ADHD self-report scale (ASRS-v1.1), 29 the ADHD rating scale, 30 the Pittsburgh Sleep Quality Index (PSQI), 31 and the General Anxiety Disorder (GAD-7) scale. 32 Participants also reported on their MC treatment characteristics and related adverse effects, including administration route, cultivator brand, cultivar name, total monthly dose (g), and monthly dose of each specific cultivar named (g).
Medical cannabis-related AEs were reported by a total of 28% ( n =15) of the sample; AEs were not significantly different between the MC dose subgroups ( P >0.05). Reports of AEs included central nervous system ( n =7, 13%), gastrointestinal ( n =7, 13%), psychological ( n =6, 11%), cardiovascular ( n =3, 6%), ophthalmic ( n = 3, 6%), musculoskeletal ( n =2, 4%), and auditory ( n =2, 4%) AEs.
Database Population Clinical Characteristics with the Number of Patients and Percentage Displayed.
Dividing our sample by the ASRS questionnaire total score of ADHD symptoms frequency (1–5 score range, n =59) responses into low ASRS score (i.e. fewer ADHD symptoms, patients with ≤3.17 score, n =30) or high ASRS score (i.e. more ADHD symptoms, patients with ≥3.18 score, n =29) subgroups by our sample distribution, we found few significant differences between the subgroups (9 patients did not respond regarding analgesic medication consumption). Specifically, ADHD medications were changed more since the initiation of MC by the low ASRS score subgroup than by the high ASRS score subgroup (OR 8.6, 95% CI 1.9 to 56; P <0.005). The low ASRS score subgroup stopped all ADHD medications since MC treatment began more than the high ASRS score subgroup (OR 0.22, 95% CI 0.04 to 0.85; P <0.05). Notably, anxiety scores were higher in the high ASRS score subgroup (median 10 [IQR 7–13]) than for the low ASRS score subgroup (4.5 [3–7]) (OR −0.9, 95% CI −1.5 to −0.31; P <0.01). Importantly, the low ASRS score subgroup consumed higher (28 [17–41] mg) monthly CBN doses than the high (15 [12–20] mg) ASRS score subgroup (OR 0.58, 95% CI −0.24 to 1.4; P <0.01). However, although CBN is a metabolite of THC, we found no significant differences of monthly THC doses between the low (5000 [3400–6700] mg) and high (4600 [3200–5900] mg) ASRS score subgroups (OR 0.26, 95% CI −0.54 to 1.1; P =0.56) ( Figure 6 ).
In this study we evaluated reports of patients under MC treatment who had a comorbidity of ADHD. By calculating these patients’ monthly dose consumption of specific MC chemovar constituents, we were able to find the specific cannabinoid monthly dose in association with their ADHD symptom frequency.
The current study has a few limitations. Firstly, the small sample size could have biased our results. Nonetheless, we used non-parametric models as is customary. Secondly, self-report bias could have occurred. However, the questionnaire was anonymous, letting patients answer with no effect on their current treatment by their physician. Thirdly, due to our study design, we did not have access to patients’ data before initiation of MC treatment, making it impossible to draw causal conclusions. Fourthly, this cohort had a diagnosis other than ADHD for which they were approved to use MC, so the data for ADHD were essentially a secondary endpoint. Nonetheless, we evaluated ADHD symptom severity by validated questionnaires.
This doesn’t always work, as there are many different factors that contribute to ADHD. The condition is generally thought of as a collection of symptoms rather than a disease (we will discuss this further later).
What this means is ADHD is more of a symptom or quality than it is a diagnosable medical disease. There are multiple different factors that come together to cause ADHD.
A large meta-analysis published in 2006 found a correlation between low dopamine gene expression and ADHD . This suggests that ADHD is characterized by low dopamine function. Although this is disputed, it does give doctors something to focus on. This is why children with ADHD are often prescribed drugs designed to stimulate dopamine concentrations.
What is ADD/ADHD?
Determining the dosage of CBD can be a challenge for first-time users. You can use our CBD oil dosing guide to assess the daily dose of CBD based on your desired strength and weight.
ADD is considered a milder version of ADHD — but “mild” isn’t quite the right word. For some, this condition can be severe, making it nearly impossible for people to study effectively.
ADD and ADHD are usually thought of more as a scale than a box — with ADD on one end and ADHD on the other.
Nutrient deficiencies and blood sugar irregularities are common in ADHD sufferers. It’s best to speak with a registered dietitian or nutritionist before consuming any nutritional supplements.
*Sympathetic nervous system (SNS) = the part of the nervous system that makes us feel alert and stimulated. It’s heavily involved with the stress response.
One of the biggest problems with ADD and ADHD is that day-to-day activities at school or at work become difficult. This requires those affected to adapt their learning styles to something that’s going to work for them. This can involve tutoring sessions, interactive lesson structures, or homeschooling.
1. Attention Deficit Disorder (ADD)
Many people are reaching for a bottle of CBD oil to help with ADD or ADHD instead — here’s why.
When using CBD for the first time, we recommend taking the smallest applicable starting dose and building up slowly over the course of a week. This is a wise thing to do whenever starting any new supplement to see how it affects your individual body.
5 / 5.
Some research suggests ADHD is caused by low dopamine, while some suggest high dopamine causes the condition.
Symptoms of ADD/ADHD.
Here’s an example of some of the symptoms common to ADHD that change depending on what part of the nervous system is hyperactive:
This is generally caused by changes in neurotransmitter levels. Although this may be true, it’s far more complex than that.
This form of the disorder involves hyperactivity.
This is a rare, contradictory symptom of the condition — but nonetheless, it exists in some people with ADHD.
CBD gummies are an excellent option for both children and adults alike. Just make sure to check the dose and store the gummies far out of your child’s reach, just like any other medication.