Medical Cannabis, THC and mental health explored – Part 1

Consultant Psychiatrist Dr Niraj Singh recently spoke at the Medical Cannabis Clinicians Society discussing the usage and efficacy of not only CBD, but also the powerful component of THC, when treating mental disorders and illnesses. 

In the webinar Dr Niraj Singh appears with Hannah Deacon, executive director at MCCS, and Pious, a patient advocate from the Plea Community. 

The webinar was a huge success with an oversubscribed audience. To make it accessible to a wider global audience and to those who couldn’t make the event, we have provided a transcript of the event below. 

Hannah Deacon
I’m Hannah Deacon, director of Medical Cannabis Clinicians Society, and I’m going to be chairing this evening. We have Dr. Niraj Singh, who’s a consultant psychiatrist at The Medical Cannabis Clinics, and Pious who is a patient advocate for Plea Community, who will be talking about his experience as a patient.

Dr Niraj Singh
Thanks very much, Hannah. It’s a real pleasure to be here today – and I definitely would urge doctors and specialists to join the UKMCCS. It’s an absolutely fantastic organisation for peer support.  

Nearly two years ago I was exploring alternative ways of helping my patients, outside of conventional medicine. 

I like to think out of the box and do things differently and I happened to come across The Medical Clinicians Society and Professor Barnes’s training. I discovered that cannabis has been around for thousands of years. It’s been in lots of various scriptures and It’s been around as medicine for eons.

As a psychiatrist, I deal with people with major mental disorders – anxiety, depression, bipolar, schizophrenia – all major mental illnesses really. 

“I was apprehensive when I first started prescribing medical cannabis but it’s been an absolute revelation. Seeing the outcomes of many of my patients who receive treatment for various conditions, be it depression, anxiety, PTSD, insomnia, ADHD, has been really fantastic.” 

I’m a Hindu by background, so I was quite conscious of the scriptures and I figured there’s something in there really, and that it must be quite valuable, really.  

I was apprehensive, when I first started prescribing, because it’s an unknown territory. As a consultant psychiatrist, I deal with people with major mental disorders. So anxiety, depression, bipolar, schizophrenia – all major mental illnesses. But obviously, the evidence base is growing and is something that still needs to be built on. 

However, for me, it’s been an absolute revelation, and seeing the outcomes of many of my patients who receive treatment for various conditions, be it depression, anxiety, PTSD, insomnia, ADHD, and seeing the results and outcomes of that, it’s been really fantastic. 

I’ve known about CBD and the effects of that treatment, anxiety, and THC has had a bad rap, really. We know that that’s been there for many years, obviously, the war on drugs which carried over from America, and high dose THC street drugs which have resulted in quite significant chronic mental illnesses have created a huge stigma around this. And as a result of that, it negated the medical benefits of THC, which are there.  

So we all know about the endocannabinoid system, it’s a system within all of us that underlies all our other systems in our body, be it the respiratory, neurological and all of the circuits within the brain as well. Within our brain, we have lots of various receptors, but one of the most important ones is called the cannabinoid one receptor – and this is what THC binds on to. 

CBD also indirectly binds to CB one receptors. But CB one receptors are really important, really important for regulation of anxiety and pretty important for sleeping as well. And it’s one of the reasons we observe real improvements in patients with symptomatic relief in various conditions.

So take PTSD for example. It’s shown that people with PTSD actually have a higher number of CB one receptors. Why is that? It’s because they’ve got lower circulating levels of endocannabinoids in their blood.

You might have heard of a cannabinoid called anandamide, and they have lower circulatory levels of that. So as a result, the brain has to compensate. So what does it do? It expands a number of CB one receptors, because it needs to pick up as much of the endocannabinoids as possible, so THC binds on to that. So hence, treatment can be really beneficial. 

And obviously, in this country, we prescribe oil and flowers as my main source of formulations here. And this is what you know, I prescribe.

In ADHD as well, THC has real value in terms of the binding of the CB one receptor because that again, underlies what we call the dopamine circuits. So in ADHD, essentially, the brain is deficient of a neurotransmitter called dopamine, which is really important for focus, concentration and attention. 

So by the THC binding onto the CB one receptor, it then promotes the dopaminergic systems to premiere to produce more dopamine, and hence, improving symptoms of impaired attention, concentration and restlessness and that side of things. So as a real positive impact. 

THC is really important for sleep. CB one receptors are throughout the brain and in a structure called the hypothalamus, which is important for sleep as well. 

What THC essentially does is reduce what’s called REM sleep. So folks may have heard of REM sleep and non REM sleep. Non REM sleep is slow wave sleep, which is a really important part and part of the sleep cycle, and we go through several cycles of that every night. But within REM sleep, we also have quite intense dreams, so people with PTSD, will often have nightmares, and intrusive thoughts and flashbacks. 

Essentially what THC does is help reduce the REM sleep as well, but also reduce what’s called sleep latency. So the ability to get to sleep more readily as well improves. Its importance cannot be overemphasised.  

With anxiety, typically because of history, and what we know, we understand that there’s this kind of assumption that THC is just going to cause more problems – and yes, in excessive amounts, etc. that can happen. 

However, we need to also understand that actually, it can be really beneficial for anxiety, and for each and every person, we have what’s called a subjective therapeutic dose.  

So depending on your receptor profile, the number of receptors that you have, it’s very, very important that we reach that kind of subjective therapeutic dose. And we do that by actually starting at a lower dose and gradually building up. 

But at times, we need to understand that if we go beyond a certain dose, it can actually promote anxiety. 

But if we hit that range, and we hit that range where it’s actually benefiting the individual in reducing the anxiety levels, and reducing the panic symptoms, that can be really really great for them. And it does it by balancing those neurotransmitters so we know that what cannabis does essentially promote homeostasis. 

So balancing the equilibrium of the system, and in the brain, we might have excitatory neurotransmitters, which might result in more kind of panic symptoms and we have inhibitory neurotransmitters which results in more relaxation and getting those imbalances absolutely crucial – and that’s where THC can be really important in helping regulate one’s anxiety levels.  

So those are just a few examples of where THC is really important actually and what I use in my prescribing. We need to understand also that when we do prescribe CBD it is there also to counteract any potential negative effects of THC that may be there. CBD does do that kind of balancing act and vice versa as well so THC does have a bit of CBD. I cannot overemphasise the importance of it. 

The cannabis plant is incredibly complex with hundreds of cannabinoids – they don’t work in silo. As well as THC and CBD you have to think about terpenes, the flavonoids – the total real kivar.  We’re just scratching the surface at the moment and I think we’re going to be learning more as time goes on.

Hannah Deacon
Thank you, Dr. Singh that was really interesting. 

Q: Pious, would you like to talk about your experience as a patient and mental health patient and your journey and how this plot is benefiting you?

Pious
My mental health journey originally started in childhood, I was diagnosed with anxiety and depression. I went through the usual rigmarole of going through CAMS, and then on to adult mental health services, etc. And it was about 2014, where my mental health took a real downturn and I ended up going to my GP and ended up being assessed. And then again, diagnosed again with chronic anxiety, depression. 

And I just started off with various antidepressants, benzodiazepines, different tranquilizers, different beta blockers. I just wasn’t responding to anything. I was also attending therapies like cognitive analytical therapy, dialectical behaviour therapy, just anything my doctor could think of and it just wasn’t working. 

It was actually my own GP in the end who said I think we need to consider medical cannabis and told me about drug science, because I think he kind of reached the end of his own tether, he communicated with the mental health team and the mental health team, were helping and it kind of got to the point where they basically admitted they couldn’t do anything anymore. And I wasn’t ready to accept that. So I looked into the benefits of CBD etc. 

Originally, I was uneducated – using things like CBD isolates, and I wasn’t getting any response. So I just thought that’s not working for me. And then after that conversation with my doctor I ended up looking into different clinics and in contact with the clinic and went through the process. And initially, I was quite put off because I thought I couldn’t imagine that a psychiatrist would entertain the idea of prescribing cannabis for mental health issues, because I think to me, there’s a lot of stigma around mental health and cannabis. So I was like, okay, there’s no point, putting it off for a while. And then I thought, well, actually, what do I have to lose? 

I applied and then it was quite – not a rigorous process – but there were a lot of questions. I felt reassured and I was able to ask what questions I wanted – things about psychosis and THC, but to me it was more important to pass that on to an expert like I’ve been trying to like manage my own mental health for many years of not great success. 

I thought, what else do I lose by allowing someone else who is an expert in mental health and who has been trained in cannabis to help,  and actually that was the best thing for me personally, I think that was in itself a removal of anxiety for me.

End of Part 1 – We’ll be uploading parts 2 and 3 from this webinar over the coming weeks, so make sure you check back for more.