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Can THC play a role in mental health care?

Dr Niraj Singh began prescribing medical cannabis through The Medical Cannabis Clinics two years ago.

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THC: Dr Niraj Singh of Medical Cannabis Clinics
Dr Singh highlights why THC can be a powerful component when treating mental disorders.

Dr Niraj Singh, a consultant psychiatrist and prescriber at The Medical Cannabis Clinics discusses the important role that THC can play in treating mental illness. 

As a consultant psychiatrist in the NHS, Dr Niraj Singh treats patients with serious mental health conditions, from anxiety and depression to bipolar disorder and schizophrenia. After exploring alternative treatments for his patients, around two years ago he began prescribing medical cannabis through The Medical Cannabis Clinics. Despite the stigma around THC, he describes the outcomes of his patients as a “revelation”. 

How did you become aware of medical cannabis and its potential as a treatment?

Dr Niraj Singh: I was searching for alternative ways to support patients and thinking about what I could do differently. This is veering off track from what I’ve been trained to do as a doctor and I think that’s something that hopefully will be rectified in the future.  We know our health can benefit from lots of different things, especially from what’s in our natural environment. 

Medical cannabis offers a viable opportunity for people to regulate the symptoms of their conditions and improve and this needs to be part of the holistic strategy. It’s important that the treatment is there, but that’s just one arm of healthcare. We need to be thinking about the effects of diet, exercise, good sleep patterns, recreational hobbies and work. I hope that in the future there is much more emphasis on that in medical training.

THC: A banner advert for the medical cannabis clinics

Why is this holistic view of healthcare important?

Dr Singh: Traditional medicine is very much about treating the symptom, but one of the great things about medical cannabis is that it can treat a myriad of things at the same time. It’s not uncommon for patients to come back to me and say ‘I’ve had this pain in my legs, and that’s gone as well and actually, I didn’t realise how much that was really hampering things and causing me more anxiety.’

The mind and body aren’t separate, although the system we have at the moment almost suggests that. Mental health impacts physical health and physical health problems also impact one’s mental health. It’s useful to have something that is not just focused on the symptom but actually getting to the foundation of the problem. 

Can you explain how THC can be a useful mechanism for treating certain mental health conditions?

Within our brain, we have various receptors, but one of the most important ones is the CB1 receptor, and this is what THC binds to. CB1 receptors are really important for the regulation of anxiety and for sleep, which is one of the reasons we observe real improvements in patients with symptomatic relief in various conditions.

It has been shown that people with PTSD, for example, have a higher number of CB1 receptors, because they’ve got lower circulating levels of anandamide in their blood. As a result, the brain has to compensate and it expands the number of CB1 receptors, which THC binds to, hence treatment can be really beneficial. 

In ADHD the brain is deficient in a neurotransmitter called dopamine, which is important for focus, concentration and attention. By binding onto the CB1 receptor THC promotes the dopaminergic systems to produce more dopamine, improving symptoms. 

THC is also really important for sleep, as it reduces what’s called REM sleep. Within REM sleep, we have intense dreams, so people with PTSD will often have nightmares, intrusive thoughts and flashbacks. THC also reduces what’s called sleep latency so the ability to get to sleep more readily improves.

Is THC helpful or harmful for anxiety?

There’s an assumption that THC is going to cause more problems and yes, in excessive amounts that can happen, but it can also be really beneficial. 

Every patient has what’s called a subjective therapeutic dose, depending on their receptor profile. We always start at a lower dose and gradually build up. If we go beyond a certain dose, it can promote anxiety, but if we hit that range it can reduce anxiety levels and panic symptoms.

It does this by balancing the neurotransmitters. In the brain, we have excitatory neurotransmitters – which might result in symptoms of panic – and inhibitory neurotransmitters which promote relaxation, and getting those in balance is absolutely crucial. 

THC: A male cartoon sitting on the floor thinking

What are the most common myths you’ve come across surrounding medical cannabis and mental health or in particular THC and mental health?

Dr Singh: One of the main myths is that people will become addicted and dependent on it. Street cannabis containing high levels of THC has caused problems in the past for people, that’s very true – and there is some evidence to suggest that it can increase the risk of psychosis – but when you look at the evidence, dependency is far lower compared to say alcohol, cocaine or smoking. Even recreationally, cannabis has around a nine per cent dependency rate compared to alcohol and cocaine (20 per cent) and tobacco (60 per cent).

There needs to be more balance in the narrative, certainly in medical training. We need to keep informing colleagues that this is a medicine and can be life-changing for individuals with serious chronic mental and physical problems.

How do you deal with stigma amongst colleagues when they learn that you prescribe medical cannabis? 

Dr Singh: I always have a spectrum of responses from colleagues when I start to mention this from the downright ‘what on earth you’re talking about, are you okay?’, to more of a curiosity, and a bit more interest in wanting to see more. Colleagues already have a series of barriers that they’ve been conditioned with and we need to tackle those. That comes with building the evidence base and sharing case studies, as well as the patient voice, which is extremely powerful. We need really strong advocates who can communicate the benefits that this medicine has. 

I have had some challenges to the point of things being taken to a higher level because of concerns, but ultimately for me, I believe in it and it’s about the patients benefiting from this.

How should a patient go about talking to their NHS consultants and convincing them that they can be on a cannabis-based product and start counselling or take it alongside other medications?

 Dr Singh: Communication is really important. I know it’s difficult for patients to have that conversation with an NHS doctor, but it’s very important that the medical cannabis prescriber has that communication bridge with any other prescribing doctors. 

As far as I’m aware, there’s no evidence to suggest any absolute contraindications between certain psychiatric medicines and medical cannabis prescriptions, and actually, some people prefer to have some additional medicine as well. 

I have spoken to NHS consultants and discussed treatment options and by-and-large they’re receptive. It’s almost like they are keen to explore, but they themselves are not willing to take the next step. 

Does a patient need to have exhausted all other treatments for medical cannabis to be prescribed?

Dr Singh: The patient must have had two licenced treatments before medical cannabis is considered. That doesn’t necessarily mean that that individual has to have taken an oral medication, it could be cognitive behavioural therapy (CBT) or any specific psychotherapies that that person has gone through. 

Sometimes patients have hesitancy around the side effects of conventional medicines because maybe a relative or friend or something has experienced that. We always have to consider things on a case by case basis.

To find out more about medical cannabis treatment visit www.themedicalcannabisclinics.com

BOOK AN APPOINTMENT 

The Medical Cannabis Clinics (TMCC) is the UK’s top medical cannabis clinic treating pain, psychiatric and neurological conditions. These include chronic pain, PTSD, anxiety and epilepsy. 

To book an online consultation with one of our specialist doctors visit www.themedicalcannabisclinics.com 

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Mental health

New data supports use of medical cannabis for anxiety and depression 

The study is thought to be the largest to date examining medical cannabis for anxiety and depression

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New data supports use of medical cannabis for anxiety and depression 
The symptom improvements seen were sustained for at least one year.

A Canadian survey has found evidence to suggest that medical cannabis is associated with sustained improvements in anxiety and depression.

In what is thought to be the largest dataset of its kind, Canadian researchers surveyed over 7,000 patients authorised to access medical cannabis products.

According to their findings, published in the journal Psychiatry Research, patients with symptoms of anxiety and/or depression report sustained improvements following the use of cannabis.

anxiety: A banner advert for the medical cannabis clinics

Authors reported “statistically significant improvements” between subjects’ baseline and follow up scores on validated measurements of anxiety and depression. 

Greater improvements were seen in patients who were actively seeking medical cannabis to treat these particular conditions. 

Furthermore, according to the study, the symptom improvements seen were sustained for at least one year.

Building the evidence

The survey is thought to be the largest to date, exploring the effects of medicinal cannabis on anxiety and depression.

Findings from the UK also indicate that patients are finding it helpful for symptoms of these conditions.

The UK Patient Registry, which now includes data from around 2,000 patients, showed statistically significant improvements in anxiety, pain and sleep quality scores following treatment with medical cannabis.

Meanwhile data from the observational study, Project Twenty21, shows cannabis may be more effective at improving mood during the first three months of treatment, than some commonly prescribed antidepressants.

The authors concluded: “To our knowledge, this study is the largest completed to date examining the impact of medical cannabis use on anxiety and depression outcomes utilising longitudinal data and validated questionnaires.

“It provides evidence on the effectiveness of medical cannabis as a treatment for anxiety and depression that otherwise is not currently available, demonstrating that patients who seek treatment with medical cannabis for anxiety and depression can experience clinically significant improvements.”

They added: “This study offers reasonable justification for the completion of large clinical trials to further the understanding of medical cannabis as a treatment for anxiety and depression.”

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The most common reasons Australians are being prescribed medical cannabis

Medical cannabis has been prescribed over 140 conditions since 2016

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The most common reasons cannabis is being prescribed in Australia
248,000 prescriptions have been approved for Australians since 2016

New data from Australia, shows cannabis has been prescribed over 140 conditions since 2016, with anxiety among the most common.

The first in-depth study of Australia’s medicinal cannabis programme, shows the treatment has been prescribed for over 140 different conditions since it began in 2016. 

In total, 248,000 prescriptions have been approved for Australians since the inception of the scheme. 

Researchers at the University of Sydney’s Lambert Initiative for Cannabinoid Therapeutics, analysed data from the Therapeutic Goods Association’s (TGA) medical cannabis dataset  – Australia’s Special Access Scheme B – which is the only one of its kind in the world. 

No other country has monitored prescriptions in this way since launching their own medical cannabis programmes.

anxiety: A banner advert for the medical cannabis clinics

The study found anxiety was among the top three reasons for patients being prescribed cannabis, the other two being pain and sleep disorders.

This reflects similar patterns in the UK, where chronic pain and anxiety are the most frequently prescribed for conditions, according to data from Project Twenty21. 

The team also found that the number of medicinal cannabis prescriptions have increased significantly since 2020 – over 85 percent of total prescriptions to date have been given since January 2020. They are currently unable to say whether the rise was pandemic related.

Lack of clinical evidence 

However, the researchers have warned that there is a limited number of high-quality clinical trials investigating the drug’s efficacy for these conditions.

Senior author Dr Elizabeth Cairns said the current evidence base for medicinal cannabis for anxiety is limited to only a few studies investigating CBD-dominant products, rather than THC-containing products

“Historically, the effects of THC have been described as anxiety-inducing, although this may depend on dose size and other factors.”

The evidence of effectiveness for medicinal cannabis in the treatment of pain is controversial, at least in Australia, where the Australian Faculty of Pain Medicine suggests not to prescribe medicinal cannabis for this purpose. Very few studies have also been done examining cannabis for the treatment of sleep disorders.

Study co-author and medicinal cannabis prescriber in her capacity as a GP, Associate Professor Vicki Kotsirilos AM from Western Sydney University, says the top reasons for prescriptions didn’t surprise her.

“Pain, anxiety and sleep issues are often interconnected – chronic pain can also cause mental health and sleep issues,” she says. 

Associate Professor Kotsirilos, who prescribes medical cannabis for pain, says this should only be done as a last resort, after more evidence based behavioural and drug therapies, such as counselling, exercise and deep breathing for pain, anxiety and/or sleep disorders, have failed or are of limited clinical benefit. 

Other interesting findings

The size of the dataset allowed the researchers to find prescribing patterns in small, but significant, populations that otherwise might have been overlooked.

“Apart from the link between anxiety and flower products, we found other interesting associations, for example, prescriptions of topical CBD for convulsions,” Dr Cairns said.

“This usage has not been extensively explored.”

The authors note, however, that the data doesn’t include patient outcomes.

Dr Cairns said: “Unfortunately, we just don’t know if these treatments were effective for these patients, but this data highlights where we can focus our attention next – to do focused studies and/or clinical trials.”

“There is a clear, unmet need for effective drug treatments across a variety of conditions that may be being helped with medicinal cannabis. For example, it could be worth conducting high-quality clinical trials on the use of flower products for anxiety, and that is certainly something that the Lambert Initiative and its collaborators may look to do in future.”

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Medical cannabis and neurodivergence – “It helps me tune in to sensory experiences”

Justin Clarke shares how cannabis has helped him find the freedom to enjoy life.

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Medical cannabis and neurodivergence - "It helps tune in to sensory experiences"
Justin says cannabis helps him enjoy sensory experiences such as eating or listening to music.

My quality of life has improved significantly since starting to use medical cannabis, writes Justin Clarke, who is neurodivergent, in that he is autistic and has ADHD.

I consider both my being autistic and ADHD to be linked – this is because both significantly impact my sensory processing. I consider them to be ways to describe differences in the way my mind works to the perceived norm. 

I suffer in terms of mental health from anxiety and depression and I am working through complex trauma in therapy. I attribute many of my mental health struggles to the challenges of living as a neurodivergent person in a world that is frequently invalidating and rarely tries to understand or accommodate without a fight.

I’m now 33, and was officially diagnosed as autistic during my last semester at university at the age of 22, and as being ADHD (Combined Type) just two years ago.

Anxiety: Banner for the Medical Cannabis Clinics

Autism is a lifelong neurodevelopmental difference, which affects how people communicate and interact, as well as emotional and sensory processing – amongst many other things. 

Autism tends to be described as being like a spectrum and it can affect people in many different ways. I view it as a spectrum of varying colours and shades, with a lot of complexity to it, rather than as a straight line that goes from ‘mild’ to ‘severe’. Things aren’t that simple at all.

Functioning labels such as ‘high functioning’ and ‘low functioning’ are losing favour in recent times, as we begin to recognise and accept that one’s level of “functioning” is not static and can vary significantly from day to day depending on how it is defined and by whom.

I describe the sensory overwhelm I often experience as being like having all of my senses with the sliders turned up on a figurative stereo equaliser, with no ability to turn them down. 

Cannabis makes them easier to control and process.

Meanwhile, ADHD is a neurodivergence that can involve impulsive behaviours and unusual levels of hyperactivity as well as difficulties with motivation and attention span. 

As with autism it is usually diagnosed in childhood and the way it affects people can vary significantly. There are commonly described to be three types; ‘Inattentive’, and ‘Impulsive’, and ‘Combined’.

Justin Clarke, 33.

Discovering cannabis

I was first prescribed medical cannabis for anxiety following the establishment of Project Twenty21 by Drug Science in 2020. 

Anxiety has been a frequent visitor and presenter of challenges to me as a neurodivergent person living in a world designed for the fabled ‘default human’ or neurotypical. 

Sensory and social anxiety are the main forms of anxiety that I find cannabis to be helpful for – the way it helps with these mainly is by allowing me to better filter and modulate my senses.

I am more socially relaxed and can better participate in conversation when I am not experiencing sensory overwhelm. I don’t get overloaded so quickly by lots of sensory info of different kinds coming in at once.

I can better ‘tune in’ to sensory experiences such as eating food and listening to music. I can enjoy these things without cannabis but it helps me to better immerse myself in them and the experience.

With my sensory processing figuratively eased by cannabis, I also find that executive functioning-related challenges such as staying focused and motivated on tasks to become more achievable.

Social situations

My quality of life has improved significantly since starting to use medical cannabis.

Another thing I find cannabis helpful for is social situations and being around people like in crowded places such as music gigs. This again is mainly because of how it enables me to better tolerate sensory discomfort and anxiety. With it’s help I am able to feel more relaxed in crowds and in unfamiliar social situations.

I am also working through some emotional trauma in therapy and have found cannabis to be helpful in enabling me to talk more openly, as well alleviating some of the trauma-related anxiety that has sometimes resulted from my sessions.

A gentler medication 

From 2014 to 2018, I was prescribed sertraline, an antidepressant that belongs to a group of drugs called selective serotonin reuptake inhibitors. I would describe it as having been very emotionally numbing most of the time, although it was helpful in some ways.

Using cannabis for my anxiety and depression has enabled far better quality of life compared with sertraline in hindsight. It has especially been helpful in topically alleviating anhedonia – the loss of the ability to enjoy things.

I’ve also taken prescribed amphetamines to cope with ADHD which have been useful at times depending on the situation, but they kill my appetite and disturb my sleep, so I tend to use cannabis alongside them to calm down and stimulate my appetite.

Both help my concentration and motivation in different ways, however cannabis is far gentler.

Amphetamines are like an on switch, whereas cannabis gives me the freedom to choose to tune in to what I’m doing and often tends to induce a state of calm inquisitiveness in me.

More often than not, I’ve been able to entirely replace my use of amphetamines with medical cannabis. Unfortunately with it only available privately it is significantly more expensive which means replacing the NHS-prescribed stimulants with them entirely isn’t yet really an option.

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