Can Cannabis Help Tourette’s Syndrome?
Cannabis is arguably the most popular alternative treatment for Tourette syndrome. And it’s also true that a growing volume of clinical evidence suggests that cannabis-based medicine not only improve tics that characterize the condition but also the psychological conditions that often occur along with it, such as OCD, ADHD, anxiety, and depression.
Current findings have led researchers to speculate that the endocannabinoid system may be involved in Tourette’s syndrome. In addition, an ever-growing body of clinical evidence points to the efficacy of cannabis-based medicine in relieving not only tics in Tourette’s but also the associated psychiatric issues (among them anxiety, depression, sleep problems, OCD, and ADHD) in both adults and children. In this sense, cannabis appears to be a breakthrough therapy for Tourette’s syndrome that addresses the broad range of symptoms accompanying this disorder.
Research also indicates that cannabis is a safe substance for Tourette’s patients. Published reports have only mentioned minor side effects, and some studies even suggest that cannabis use by those with Tourette’s can even improve their cognitive performance, as in measures of attention.
Although clinicians in many parts of the world are still wary of prescribing cannabis for Tourette’s, this may very well change as more high-quality research evidence comes to light and laws around cannabis use continue to loosen.
The Endocannabinoid System
Consisting of molecules called endocannabinoids, the receptors they act on, and the enzymes that build and break them down, the endocannabinoid system helps the body maintain homeostasis, a healthy state of balance.
Accordingly, this system helps regulate a wide range of processes critical to our health, including cognitive function, immunity, mood, sleep, pain, and metabolism.
Anandamide and 2-AG, the two main endocannabinoids produced by our bodies, are the main components of this system. They exert their effects through two known cannabinoid receptors: CB1 and CB2. These receptors are found everywhere in the body, with CB1 being particularly abundant in the central nervous system and CB2 in immune cells.
CB1 and CB2 can also interact with phytocannabinoid, molecules produced by plants but structurally similar to the endocannabinoids produced by our bodies. The most prominent of these, THC and CBD, are found in large amounts in cannabis. Their similarity to endocannabinoids helps explain how cannabis can produce medicinal effects.
At this time, there isn’t a lot of direct proof for the involvement of the endocannabinoid system in Tourette’s syndrome. However, there is plenty of indirect and correlational evidence.
For starters, researchers know that CB1 receptors are abundantly found in the basal ganglia, a part of the brain associated with motor control whose malfunctioning is believed to play a central role in Tourette’s. This suggests that the endocannabinoid system is involved in regulating movement control.
In addition, there’s strong evidence that Tourette’s involves dysfunction of the dopaminergic (dopamine) system. The endocannabinoid system is known to exert significant influence on dopamine neurotransmission. Therefore, therapies targeting the endocannabinoid system may help with disorders characterized by dopamine dysfunction, including Tourette’s.
In particular, researchers speculate that the endocannabinoid system may play a role in suppressing overactive dopamine signaling in parts of the brain associated with the lack of movement control that results in Tourette’s tics; the hallmark of Tourette syndrome.
Furthermore, there’s some evidence that Tourette’s syndrome may involve dysfunction of other neurotransmitters in the brain, namely glutamate and GABA. As it happens, some studies have shown these neurotransmitters are also influenced by the endocannabinoid system.
Taken together, this evidence provides a plausible explanation for why cannabis-based medicine acting through the endocannabinoid system can be effective for many people with Tourette.
There’s a body of evidence indicating that cannabis can not only improve tics but also the co-occurring mental disorders that affect almost 90% of Tourette’s patients, including ADHD, anxiety disorders, depression, and obsessive-compulsive disorder (OCD).
The two most notable clinical studies of using cannabis to treat Tourette’s and related mental conditions were headed by Dr. Müller-Vahl, a leading expert on Tourette’s and other tic disorders.
In the first 2002 trial, 12 adults with Tourette were given one of three doses of pure THC or a placebo. THC treatment significantly improved tics. It also improved obsessive-compulsive behavior, one of the most common comorbid conditions that occur along with Tourette’s.
A follow-up trial in 2003 included 24 adult Tourette’s patients who were given placebo or up to 10 mg of THC a day for 6 weeks. Again, THC significantly improved tics.
In addition, a 1998 survey of 64 Tourette patients found that among the 14 who had used cannabis, 82% experienced tic reduction or complete remission, as well as improvement of premonitory urges and obsessive-compulsive symptoms. Similarly, a 2017 report examined the effectiveness of cannabis in 19 adults with Tourette’s. On average, tics were reduced by 60%, with 18 out of 19 people experiencing significant improvement. These studies showing cannabis consistently improving tics and other manifestations of Tourette’s is very encouraging.
Furthermore, there’s a large number of published case reports of Tourette’s sufferers who found relief for tics and co-occurring mental issues through cannabis use. One 1993 report described a 36-year-old man who smoked cannabis daily and reported being completely tic-free for a year.
Another 1999 report discussed a 25-year-old patient with advanced TS as well as ADHD, OCB, anxiety, and impulsivity who experienced improvement of all symptoms by smoking cannabis. This patient was then given a single 10 mg dose of THC, resulting in an 80% reduction of tics and other symptoms as well as improved attention and reaction time.
Meanwhile, a 2011 case study described a 42-year-old man who experienced a 75% tic reduction with THC treatment, as well as improvement in his concentration and visual ability.
A 2017 report described a 16-year-old boy with complex tics and related mental issues such as sleeping problems, anxiety, OCD, depression, and rage attacks. He was prescribed THC in vape form, experiencing significant improvement of both tics and the related mental conditions. The same report discussed a similar case of a 19-year-old boy with a rare form of Tourette’s who also experienced significant improvement when given medical cannabis daily.
There is also a report of a 7-year-old boy with severe TS and related ADHD and depression who was given THC after all other medications failed. The boy took THC daily alongside two Tourette’s medications, experiencing significant improvement of tics and related mental issues without any side effects, despite the large THC dose.
Case reports of Tourette’s patients using nabiximols (also known as Sativex), a cannabis-based spray drug containing THC and CBD, have also reported similar improvements.
Some research has shown that pure CBD alone without THC is not effective for improving Tourette’s tics, and that whole-plant cannabis preparations with medium-to-high THC levels are superior to THC-only medicines.
It’s widely known that cannabis use is associated with side effects that include anxiety, dizziness, tiredness, sleepiness, nausea, dry mouth, impaired memory, and that “high.”
Virtually all published reports of cannabis use in Tourette’s patients have noted these same effects. However, in every case, these effects were considered minor and temporary, with no serious adverse effects being reported.
It’s interesting to note that cannabis doesn’t necessarily worsen cognitive performance in people with Tourette’s. This is contrary to the decrease in mental performance reported in healthy individuals.
For example, one study found that patients with Tourette’s taking THC did not experience a decrease in reaction time, intelligence, attention, or other markers of cognitive performance. And another study found that THC actually improved verbal memory in subjects with Tourette’s. Lastly, there are even reports that THC can improve concentration and visual ability, resulting in improved driving ability in those with Tourette’s.
Taken together with improvements in attention and related cognitive issues reported by other studies, these findings suggest that people with Tourette may actually experience enhanced cognitive function with cannabis use.
About Tourette’s Syndrome
Tourette’s syndrome is a neurological disorder leading to repetitive noises or movements, called tics. The syndrome was first described by French doctor Georges Gilles de la Tourette in 1885, and is named after him.
Tourette’s is usually first diagnosed in childhood, most commonly between the ages of three and nine, generally beginning before the age of 18. It’s three-to-four times more likely to affect boys than girls, and it’s often accompanied by ADHD or ADD. While the condition is usually chronic and never goes away, the symptoms generally reduce in frequency during late teens and early adulthood. Only about 10-15% of people with Tourette’s find that their condition worsens throughout their lives.
Around 1% of children in the UK and about one out of every 160 children in the US have Tourette’s, making it a relatively common disorder.
Tourette’s syndrome is characterized by involuntary tics, movements and/or comments that the person makes without intending to. Usually, people with Tourette’s begin with simple tics, which are small movements that involve only one muscle group, and progress to complex tics that use multiple muscle groups. Tics can be motor tics, which involve movement, or vocal tics, which involve sounds and language.
Motor tics include:
- Blinking or darting eyes
- Nodding the head
- Opening and closing, twisting, or pouting the mouth
More complex motor tics involve gesturing, bending or twisting, hopping, smelling or touching things, stepping in a particular pattern, or copying someone else’s movements.
Vocal tics include:
- Coughing or clearing the throat
Complex vocal tics involve repeating the same words or phrases, repeating someone else’s words, or saying obscenities. Using obscenities is the most well-known type of Tourette’s tic, but it only happens to about 10% of all people with Tourette’s.
Copying someone else’s words or movements are both very common and typical Tourette’s tics.
Tics will generally have times when they are more severe and times when they ease up. Tics can get worse during times of illness, stress, tiredness, worrying, or excitement. They are generally at their worst during the teenage years, and then become milder in adulthood. Tics can also occur during sleep, but much less frequently.
People with Tourette’s usually feel sensations of discomfort, called a “premonitory urge,” before the tic occurs. It’s like an itch or tingle in some part of the body. Once the tic has happened, the feeling stops. Although people with Tourette’s can hold back tics, it takes a great deal of effort and they cannot do so indefinitely. In addition, they are often very uncomfortable around others who can see or hear their tics. This can also lead to anxiety and depression, along with more stress, which only leads to more tics.
Tourette’s syndrome is diagnosed mainly by ruling out other causes for the tics that characterize it. As part of the diagnosis, the doctor will make sure that:
- You have both motor and vocal tics (although they might not occur at the same time).
- Your tics change over time, becoming more or less frequent, severe, and complex, and moving to different locations and different types.
- You have had tics multiple times a day for more than a year, almost every day.
- The tics began before you turned 18.
- Your tics aren’t caused by medications, other underlying medical condition, or other substances.
Some people may just have motor tics while others may just have vocal tics. The diagnosis of Tourette’s is only given when both are present.
Many of the tics that are symptoms of Tourette’s syndrome might be mistaken for other medical conditions, like incessant blinking being mistaken for eye problems and sniffing thought to be allergies.
To help rule out other causes of tics, you might need to do blood tests or MRI scans, or both, to check for other neurological issues.
The exact cause of Tourette’s syndrome is still unknown. It is likely multifactorial, meaning it is likely a combination of several different factors including both genetic and environmental factors. Chemicals in the brain called neurotransmitters—like dopamine, serotonin, and norepinephrine—that help nerve cells to communicate, likely play a significant role.
Tourette’s syndrome is more common among boys than girls, and often comes together with hyperactivity disorder and obsessive compulsive disorder, but there are no other known risk factors. It’s not even clear whether the risk of developing Tourette’s is higher if one has a close family member with the syndrome.
Tourette’s doesn’t have a cure, but there are several ways to treat it so that people can reduce its impact on their lives. Treatment for Tourette’s generally includes a combination of medication and therapies.
There’s no single medication that works for everyone with Tourette’s. What’s more, no medication is 100% effective in stopping tics, and they all carry their own list of side effects, so few people with Tourette’s take medication continually throughout their lives. Medication is a good choice when Tourette’s is severe, or while someone is still learning how to manage their Tourette’s symptoms.
- Neuroleptics (antipsychotic medications), like haloperidol (Haldol) and pimozide (Orap) block or reduce the passage of dopamine in the brain, and are the most effective medications for Tourette’s. However, they can have significant and burdensome side effects that include tremors, parkinsons-like symptoms, sedation, and weight gain. If you’ve been taking them for a long time, you need to come off them slowly, otherwise your tics can get far worse.
- Anti-hypertension medications like clonidine (Catapres, Kapvay) and guanfacine (Intuniv) can also decrease the number of tics. They aren’t as effective as neuroleptics, but they have fewer side effects—mainly sedation.
- Antidepressants like fluoxetine (Prozac) can help with symptoms of depression, anxiety, and OCD that often come with Tourette’s syndrome.
- Botox injections into a muscle that repeatedly causes tics can help prevent simple or vocal tics, but doesn’t solve complex motor tics.
People with Tourette’s can often learn how to control their tics for a short time, but it takes a lot of hard work to do so, and then they come back again. Often, children who put in a lot of effort to decrease their tics in school will experience a whole wave of them when they get home and can relax their guard.
There are a few different therapies that help people with Tourette’s to stay on top of their symptoms:
- Cognitive Behavioral therapy such as cognitive behavioral interventions for tics (CBIT) includes habit reversal therapy to help you to notice your premonitory urges and voluntarily move in a way that reduces tic symptoms. This can be a very effective treatment for Tourette’s and is a mainstay in treatment for children and adolescents.
- Exposure with response prevention (ERP) deliberately provokes the urges that precede tics, and then teaches you to tolerate the uncomfortable feeling until it passes without a tic.
- Psychotherapy (talk therapy) can help you to cope with your tics as well as dealing with the hyperactivity, obsessions, and depression that often come with Tourette’s.
- Deep brain stimulation (DBS) is still in its very early stages, but it’s showing success. For DBS, a doctor implants a battery-operated device into the brain to electrically stimulate certain areas of the brain that control movement, in order to prevent tics. It’s only used for those suffering from severe Tourette’s syndrome that has failed virtually all other therapies and does not respond to other treatment options.
Tics are generally less noticeable and less frequent when you are distracted, and focusing on something else, like playing a musical instrument, and when asleep. As a result, many people with Tourette’s find that any techniques they can use to help themselves relax, relieve stress, and distract themselves from the urge to express tics brings down their level of involuntary movements. People with Tourette’s use various options like meditation and hypnosis, deep breathing techniques, and involving themselves in activities that they enjoy to overcome the tics.
Taking cannabidiol (CBD), in the form of CBD oil, gummies, or infusions, can potentially help reduce tics by helping the brain to relax. CBD is a non-addictive extract from the cannabis plant that doesn’t get you high, but it does help the brain to let go of stress and involuntary movements.