- Posted by NORML Women's Alliance
- On August 6, 2013
- 33 Comments
- ADD, ADHD, Attention Deficit Disorder, benzedrine, cannabis, children, dopamine, Dr. Charles Bradley, Dr. Estelle Toby Goldstein, France, hyperactivity, marijuana, methylphenidate, NORML, NORML Women's Alliance, parenting classes, psychiatry, Psychology Today, psychopharmacologist, Ritalin, women
The first problem is whether or not ADHD (or without hyperactivity – commonly referred to as ADD) really exists as it has been described. Many of the adult males that I see describe the symptoms as having existed in their childhood – they were the little guys who ran around all the time and could not sit still in school long enough to get a decent grade. It seems to have existed in 1937 when Dr. Charles Bradley first described and tried to treat it in a very controlled social environment; a home for children founded by his own great-uncle.
Dr. Bradley seems to have been sensitive to the importance of the social environment in his study of benzedrine in the “misbehavior” of children, and does not seem to have ever been able to figure out why sometimes it worked dramatically and sometimes it made things worse. No matter – there seems to be a real problem with alleged attention deficit disorder – with or without hyperactivity – among children. I would venture to suggest that it is far and away the most prevalent psychiatric disorder in children as it affects approximately three to five percent of them.
I have mainly treated adult patients in my many years of practicing psychiatry. Generally, as a psychopharmacologist – I have avoided giving “stimulants” if I determined that there were safe alternatives available. I have reviewed the different kinds of medical screenings given to children that make it possible for a doctor to pose an ADD or ADHD diagnosis. In my reviews – I have generally felt that this diagnosis is used excessively and that the criteria can be met by any adult who finds the child-patient bothersome enough.
When I was in France, parenting classes were considered a great treatment in cases involving a hyperactive child – and really seemed to work. (See “Suffer the Children: The case against labeling and medicating children, and effective alternatives for treating them,” by Marilyn Wedge, Ph.D., Psychology Today March 8, 2012) Stimulants, amphetamines or amphetamine-like drugs are controlled substances and can be pretty dangerous stuff. The young people who were on them sometimes endured negative side effects – like becoming more nervous or even psychotic (i.e. hearing voices). There were actually enough cases of sudden death that most organizations that deal with putting patients on these kinds of drugs suggest that patients get a “cardiocentric” examination, including listening to the patient’s heart and obtaining an electrocardiogram before giving the drug.
Although the question about why stimulants work on some children and not others was addressed in 1937 – I do not think it is the most important one. After all, no drug works the same on everybody – especially not on every human brain. A far more interesting inquiry is how it works, and what else might work with less negative side effects.
The brain is a complex system in which many cells have the function of stimulating or inhibiting other cells. The mechanism of attention deficit disorder seems to be a lack of inhibition of cells that are “gateways” of sensory messages to the deep, central part of the brain. The neurotransmitter in question seems to be dopamine. Stimulant medicines like methylphenidate (Ritalin) seem to work by increasing extra-cellular dopamine in the brain.
Scientists have been looking for a long time for the specific brain mechanism that makes children with attention deficit disorder inattentive. (Depressed Dopamine Activity in Caudate and Preliminary Evidence of Limbic Involvement in Adults With Attention-Deficit/Hyperactivity Disorder, JAMA Psychiatry, August 2007, Vol. 64, No. 8). This study was very rigorous – including double-checking the diagnosis of adult ADHD before conducting special brain scanning to look at dopamine receptors – and showed depressed dopamine activity in those with ADHD. The results revealed a direct link between dopamine levels and the inattentiveness of a person diagnosed with ADHD – specifically, the lower the dopamine levels, the more inattentive the diagnosed person. This is what I would consider a powerful finding!
Given all those men who came to me and told me about the hell they gave their mothers and schoolteachers as kids – before marijuana – lead me to the next obvious question, which is: How does Cannabis effect dopamine levels?
Through animal testing, scientists have confirmed that Cannabis raises dopamine activity. Oh, others want to use this modulation of dopamine (known in many sectors as “the pleasure neurotransmitter”) to make drugs. But Cannabis is currently available to those who need it. Before we rejoice, this is still a complex system.
Chronic (regular, repeated) use of Cannabis may work on the dopamine system in a different way. It may even be related to the still debated “amotivational” syndrome – where folks who consume Cannabis seem to be, well, less motivated. But just like the early studies with benzedrine, Cannabis can have great results with ADD and/or ADHD, and it seems as if it has the capacity to change lives. (See the following Case Report: Cannabis improves symptoms of ADHD, by Peter Strohbeck-Kuehner, Gisela Skopp, Rainer Mattern, Institute of Legal- and Traffic Medicine, Heidelberg University Medical Centre, Voss Str. 2, D-69115 Heidelberg, Germany).
There are some really angry horrible articles that respond to the idea of Cannabis for ADHD more politically than realistically. There are several would be experts who just say “no” for no good reason. The truth of the matter is somewhere in between. I have no trouble giving marijuana for adult ADHD. I am careful with minors, who should be evaluated on a case-by-case basis. I just think we need to know more about the effects of Cannabis on the developing brain.
Nobody can deny that the safety profile of Cannabis is far more impressive than that of stimulants, which have many potential problematic side effects. The interplay of neurotransmitters in the brain is complex. The number of patients who report to me that the use of Cannabis has allowed increased focus in school and on job related milestones consider it an unqualified blessing. It has helped plenty of folks – by their own report – to get job promotions and university degrees.
By Dr. Estelle Toby Goldstein, MD