CBD and Mental Health

There has been a growing popularity and interest in using CBD oil to treat a variety of mental health concerns.

 

As is the case with most new research there is a lot of hype and misunderstanding. CBD oil is being hailed as some kind of panacea to treat all aliments, which should cause warning sounds to most informed consumers. I frequently have clients asking me about it telling me that they heard it is everything from a cure to schizophrenia or just some hype people are using to rationalize their cannabis intake.

 

The aim of this article is to break down what the actual scientific literature says about the benefits and detriments of using CBD oil for mental health reasons

Background


Let’s start with CBD. What is it? CBD is shorthand for Cannadidol. It is one of the major active compounds in marijuana or cannabis. Cannadidol is also found in hemp. The hemp plant is similar to marijuana but not contain THC. THC (tetrahydrocannabinol) is the chemical most responsible for the psychological effects (the high) from marijuana. CBD is one of the hundreds of components of marijuana. CBD is thought to bind to the CBD1 and CBD2 receptors in our nervous system. Exactly how CBD affects these receptors is not fully understood but it is thought that it may interact with serotonin signaling.

 

CBD itself does not cause a high. As a recent report from the World Health Organization stated “In humans, CBD exhibits no effects indicative of any abuse or dependence potential…. To date, there is no evidence of public health related problems associated with the use of pure CBD.”

 

In 2015 the FDA eased regulations to allow medical researchers to conduct CBD trails. However, federally, the legality of CBD is somewhat confusing and rapidly changing. For the most part there is a bipartisan consensus in the house of representatives to make hemp and therefore most CBD legal. The federal laws depend on if the CBD that is being sold derives from the hemp plant or the cannabis plant. All 50 states have laws that make CBD legal (with various restrictions). In Texas a law was passed in June 2019 that solidified the legal status of CBD and hemp products.

 

Literature on CBD and Mental Health 

To date, there have not been many randomized controlled trails of CBD in humans, and even less of those trails focused on a mental health issues. None the less here is a brief review of the literature.

CBD and Anxiety

One 1990 study found that CBD was effective in reducing behavioral and psychological symptoms of stress and anxiety in rats (Guimarães et al., 1990). This study was replicated more recently and elaborated on the possible neurological mechanisms that are activated by CBD (Fogaça et al., 2018).  A promising study showed CBD might help ease public speaking anxiety in people who have been diagnosed with social phobia (social anxiety).  Just one dose of CBD before a simulated public speaking task “significantly reduced anxiety, cognitive impairment and discomfort in their speech performance” (Bergamaschi et al., 2011). Other studies have found CBD effective in reducing public speaking anxiety in “healthy subjects” who did not have mental health diagnosis(Linares et al., 2019).

 

Overall it seems like CBD could be helpful for a range of anxiety disorders. A review of the literature summarized the findings about CBD and anxiety by stating “We found that existing preclinical evidence strongly supports CBD as a treatment for generalized anxiety disorder, panic disorder, social anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder when administered acutely; however, few studies have investigated chronic CBD dosing” (Blessing et al., 2015). Another study which tracked over 100 subjects from previous studies found that “Cannabidiol may hold benefit for anxiety-related disorders” and some benefit for insomnia (Shannon et al., 2019). It also cautioned that more controlled clinical studies are needed.

CBD and Psychosis

To be clear, marijuana can produce a psychotic state. Additionally  it is well documented that marijuana use is linked to increase frequency and severity of psychotic episodes for people with psychotic disorders like schizophrenia (Hamilton, 2017; Nordentoft, 2006; Ortiz-Medina et al., 2018). It is unclear what aspects of marijuana are responsible for that effect. However, there have been a several studies with animals that show CBD can have antipsychotic properties. A clinical trial with humans found CBD in conjunction with traditional antipsychotic medication was effective at reducing psychotic symptoms and could represent a new class of antipsychotic drugs (McGuire et al., 2018). Another small scale placebo controlled study found a three week treatment with CBD was effective at lowering anxiety and reducing psychotic symptoms in patients with schizophrenia (Bhattacharyya, 2018). A larger scale study examined a 6-week treatment of CBD on schizophrenia found no significant effects and no improvement of psychotic symptoms (Boggs et al., 2018). A small scale study found that CBD alone (not in conjecture with traditional antipsychotics) is not effective at reducing symptoms of schizophrenia (A. W. Zuardi et al., 2006). In summary, CBD might have antipsychotic effects but more studies are needed to better understand if and how it can be effective for people.

CBD and Neurodegenerative Diseases 

A handful of studies with mice have found longer term use of CBD can serve as a protective factor against neurodegenerative diseases like Alzheimer’s disease(Karl et al., 2017) (Watt & Karl, 2017)(Cheng et al., 2014) (Aso et al., 2015).

CBD and ADHD

One study found very little difference between patients who used a placebo vs a Cannabinoid nasal spray, a slight improvement in impulsivity  but not statistically significant (Cooper et al., 2017).

CBD and Depression

To date there have been no human studies involving CBD and depression (Elsaid et al., 2019). A study identified a possible novel mechanism for antidepressants in the C1 antagonist properties of CBD (Witkin et al., 2005). A review of animal studies found that CBD did have antidepressant and anti-anxiety effects (de Mello Schier et al., 2014).

CBD and Bipolar Disorder 

I was only able to find one study that examined bipolar disorder or a related issue. This study that followed the effects of CBD on patients in a manic episode found it was ineffective at reducing manic symptoms. (A. Zuardi et al., 2010)

CBD and Post Traumatic Stress Disorder (PTSD)

A case series that tracked 11 subjects found that CBD might be helpful for PTSD symptoms if administered in addition to routine psychiatric care (Elms et al., 2019). A few other studies including a clinical trail found CBD was effective at reducing PTSD associated nightmares.(Fraser, 2009; Jetly et al., 2015).

CBD and Addiction

A clinical trial found CBD might be helpful in the treatment of heroin craving and relapse. CBD was found cue induced cravings even 2 weeks after a single dose(Ren et al., 2009). A different study that focused on CBD and morphine found CBD can interfere with the reward and “acute reinforcing properties  of opioids”(Katsidoni et al., 2013).

Overall, Caution Is Warranted

I have just reviewed some of the most pertinent studies regarding CBD and mental health. While there are some exciting results especially for certain conditions (Anxiety, PTSD, Psychosis) overall caution is warranted. The scientific study of CBD as a treatment for mental health conditions is still incredibly new and the mechanisms that is affects in our brains is not very well understood. A systemic meta-analysis of studies about CBD and mental health concluded “There is scarce evidence to suggest that cannabinoids improve depressive disorders and symptoms, anxiety disorders, attention-deficit hyperactivity disorder, Tourette syndrome, post-traumatic stress disorder, or psychosis” (Black et al., 2019). Furthermore, “there remains insufficient evidence to provide guidance on the use of cannabinoids for treating mental disorders within a regulatory framework. Further high-quality studies directly examining the effect of cannabinoids on treating mental disorders are needed ”(Black et al., 2019). In other words, it takes more than a few studies to make strong conclusions for treatment recommendations. Findings need to be replicated several times before a conclusion can be made.

Neurological mechanisms, dosage, and interactions

Furthermore, even in the studies where CBD was shown to have a positive effect, it is also unclear what neurological mechanisms CBC is activating and how it is helping. A much greater understanding of the neurophysiological effects of CBD are and how they can influence mental health conditions is needed. Additionally, what impact CBD has on other medications and any interactive affects.  This understanding is needed to begin to understand proper dosage and administration. Right now many people consume CBD pills or oils whenever they feel like it. Guidelines around dose and administration is needed to ensure the substance is actually helpful and that you are not taking more than you need (and risking other side effects). Or as one study puts it “Optimal therapeutic doses of CBD should be rigorously determined so that research findings can be adequately translated into clinical practice” (Linares, 2019).

Supplements are not regulated by the FDA

Currently, most CBD products you can buy in the store or online are classified as supplements. Unlike medications supplements are not regulated by the FDA. There is little oversight regarding purity, or safety, of these products. CBD products legally must contain 0.3% or less THC. However, one recent study analyzed 84 commercially available CBD products and found that 1 in 5 of contained over 6.4mg/ML of THC (Bonn-Miller et al., 2017). This is enough THC to cause impairment.  Aside from THC which is the main chemical in marijuana that produces the high, due to the lack of FDA oversight there may be other chemicals or compounds in CBD products. These other unknown compounds may interact with other medications or supplements a person is taking.

Conclusion

In summary there are several studies that suggest CBD may be beneficial for a variety of mental health concerns. However, there are many unknowns and risks associated with most commercially available CBD products. If you are interested in using CBD it would be wise to consult with a qualified physician to review any potential side effects, or interactions with other medications. Additionally, there is not much oversight or regulation for CBD products making it almost impossible to insure purity and proper dosage.

For now, I would recommend sticking with established treatments for mental health conditions like psychotherapy and FDA approved medications. Psychotherapy is a proven effective treatment for a wide range of mental health concerns and has several decades of research supporting this claim.

References 

Aso, E., Sánchez-Pla, A., Vegas-Lozano, E., Maldonado, R., & Ferrer, I. (2015). Cannabis-based medicine reduces multiple pathological processes in AβPP/PS1 mice. Journal of Alzheimer’s Disease: JAD, 43(3), 977–991. https://doi.org/10.3233/JAD-141014

Bergamaschi, M. M., Queiroz, R. H. C., Chagas, M. H. N., de Oliveira, D. C. G., De Martinis, B. S., Kapczinski, F., Quevedo, J., Roesler, R., Schröder, N., Nardi, A. E., Martín-Santos, R., Hallak, J. E. C., Zuardi, A. W., & Crippa, J. A. S. (2011). Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naïve social phobia patients. Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology, 36(6), 1219–1226. https://doi.org/10.1038/npp.2011.6

Bhattacharyya, S. (2018). EFFECT OF CANNABIDIOL ON SYMPTOMS, DISTRESS AND NEUROPHYSIOLOGICAL ABNORMALITIES IN CLINICAL HIGH-RISK FOR PSYCHOSIS PATIENTS: A PLACEBO-CONTROLLED STUDY. Schizophrenia Bulletin, 44(1), s28.

Black, N., Stockings, E., Campbell, G., Tran, L. T., Zagic, D., Hall, W. D., Farrell, M., & Degenhardt, L. (2019). Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: A systematic review and meta-analysis. The Lancet. Psychiatry, 6(12), 995–1010. https://doi.org/10.1016/S2215-0366(19)30401-8

Blessing, E. M., Steenkamp, M. M., Manzanares, J., & Marmar, C. R. (2015). Cannabidiol as a Potential Treatment for Anxiety Disorders. Neurotherapeutics: The Journal of the American Society for Experimental NeuroTherapeutics, 12(4), 825–836. https://doi.org/10.1007/s13311-015-0387-1

Boggs, D. L., Surti, T., Gupta, A., Gupta, S., Niciu, M., Pittman, B., Schnakenberg Martin, A. M., Thurnauer, H., Davies, A., D’Souza, D. C., & Ranganathan, M. (2018). The effects of cannabidiol (CBD) on cognition and symptoms in outpatients with chronic schizophrenia a randomized placebo controlled trial. Psychopharmacology, 235(7), 1923–1932. https://doi.org/10.1007/s00213-018-4885-9

Bonn-Miller, M. O., Loflin, M. J. E., Thomas, B. F., Marcu, J. P., Hyke, T., & Vandrey, R. (2017). Labeling Accuracy of Cannabidiol Extracts Sold Online. JAMA, 318(17), 1708–1709. https://doi.org/10.1001/jama.2017.11909

Cheng, D., Spiro, A. S., Jenner, A. M., Garner, B., & Karl, T. (2014). Long-term cannabidiol treatment prevents the development of social recognition memory deficits in Alzheimer’s disease transgenic mice. Journal of Alzheimer’s Disease: JAD, 42(4), 1383–1396. https://doi.org/10.3233/JAD-140921

Cooper, R. E., Williams, E., Seegobin, S., Tye, C., Kuntsi, J., & Asherson, P. (2017). Cannabinoids in attention-deficit/hyperactivity disorder: A randomised-controlled trial. European Neuropsychopharmacology: The Journal of the European College of Neuropsychopharmacology, 27(8), 795–808. https://doi.org/10.1016/j.euroneuro.2017.05.005

de Mello Schier, A. R., de Oliveira Ribeiro, N. P., Coutinho, D. S., Machado, S., Arias-Carrión, O., Crippa, J. A., Zuardi, A. W., Nardi, A. E., & Silva, A. C. (2014). Antidepressant-like and anxiolytic-like effects of cannabidiol: A chemical compound of Cannabis sativa. CNS & Neurological Disorders Drug Targets, 13(6), 953–960. https://doi.org/10.2174/1871527313666140612114838

Elms, L., Shannon, S., Hughes, S., & Lewis, N. (2019). Cannabidiol in the Treatment of Post-Traumatic Stress Disorder: A Case Series. Journal of Alternative and Complementary Medicine (New York, N.Y.), 25(4), 392–397. https://doi.org/10.1089/acm.2018.0437

Elsaid, S., Kloiber, S., & Le Foll, B. (2019). Effects of cannabidiol (CBD) in neuropsychiatric disorders: A review of pre-clinical and clinical findings. Progress in Molecular Biology and Translational Science, 167, 25–75. https://doi.org/10.1016/bs.pmbts.2019.06.005

Fogaça, M. V., Campos, A. C., Coelho, L. D., Duman, R. S., & Guimarães, F. S. (2018). The anxiolytic effects of cannabidiol in chronically stressed mice are mediated by the endocannabinoid system: Role of neurogenesis and dendritic remodeling. Neuropharmacology, 135, 22–33. https://doi.org/10.1016/j.neuropharm.2018.03.001

Fraser, G. A. (2009). The use of a synthetic cannabinoid in the management of treatment-resistant nightmares in posttraumatic stress disorder (PTSD). CNS Neuroscience & Therapeutics, 15(1), 84–88. https://doi.org/10.1111/j.1755-5949.2008.00071

Guimarães, F. S., Chiaretti, T. M., Graeff, F. G., & Zuardi, A. W. (1990). Antianxiety effect of cannabidiol in the elevated plus-maze. Psychopharmacology, 100(4), 558–559. https://doi.org/10.1007/bf02244012

Hamilton, I. (2017). Cannabis, psychosis and schizophrenia: Unravelling a complex interaction. Addiction (Abingdon, England), 112(9), 1653–1657. https://doi.org/10.1111/add.13826

Jetly, R., Heber, A., Fraser, G., & Boisvert, D. (2015). The efficacy of nabilone, a synthetic cannabinoid, in the treatment of PTSD-associated nightmares: A preliminary randomized, double-blind, placebo-controlled cross-over design study. Psychoneuroendocrinology, 51, 585–588. https://doi.org/10.1016/j.psyneuen.2014.11.002

Karl, T., Garner, B., & Cheng, D. (2017). The therapeutic potential of the phytocannabinoid cannabidiol for Alzheimer’s disease. Behavioural Pharmacology, 28(2 and 3-Spec Issue), 142–160. https://doi.org/10.1097/FBP.0000000000000247

Katsidoni, V., Anagnostou, I., & Panagis, G. (2013). Cannabidiol inhibits the reward-facilitating effect of morphine: Involvement of 5-HT1A receptors in the dorsal raphe nucleus. Addiction Biology, 18(2), 286–296. https://doi.org/10.1111/j.1369-1600.2012.00483.

Linares, I. M., Zuardi, A. W., Pereira, L. C., Queiroz, R. H., Mechoulam, R., Guimarães, F. S., & Crippa, J. A. (2019). Cannabidiol presents an inverted U-shaped dose-response curve in a simulated public speaking test. Revista Brasileira De Psiquiatria (Sao Paulo, Brazil: 1999), 41(1), 9–14. https://doi.org/10.1590/1516-4446-2017-0015

McGuire, P., Robson, P., Cubala, W. J., Vasile, D., Morrison, P. D., Barron, R., Taylor, A., & Wright, S. (2018). Cannabidiol (CBD) as an Adjunctive Therapy in Schizophrenia: A Multicenter Randomized Controlled Trial. The American Journal of Psychiatry, 175(3), 225–231. https://doi.org/10.1176/appi.ajp.2017.17030325

Nordentoft, M. (2006). [Cannabis and psychosis]. Ugeskrift for Laeger, 168(45), 3896–3898.

Ortiz-Medina, M. B., Perea, M., Torales, J., Ventriglio, A., Vitrani, G., Aguilar, L., & Roncero, C. (2018). Cannabis consumption and psychosis or schizophrenia development. The International Journal of Social Psychiatry, 64(7), 690–704. https://doi.org/10.1177/0020764018801690

Ren, Y., Whittard, J., Higuera-Matas, A., Morris, C. V., & Hurd, Y. L. (2009). Cannabidiol, a Nonpsychotropic Component of Cannabis, Inhibits Cue-Induced Heroin Seeking and Normalizes Discrete Mesolimbic Neuronal Disturbances. The Journal of Neuroscience, 29(47), 14764–14769. https://doi.org/10.1523/JNEUROSCI.4291-09.2009

Shannon, S., Lewis, N., Lee, H., & Hughes, S. (2019). Cannabidiol in Anxiety and Sleep: A Large Case Series. The Permanente Journal, 23, 18–041. https://doi.org/10.7812/TPP/18-041

Watt, G., & Karl, T. (2017). In vivo Evidence for Therapeutic Properties of Cannabidiol (CBD) for Alzheimer’s Disease. Frontiers in Pharmacology, 8, 20. https://doi.org/10.3389/fphar.2017.00020

Witkin, J. M., Tzavara, E. T., Davis, R. J., Li, X., & Nomikos, G. G. (2005). A therapeutic role for cannabinoid CB1 receptor antagonists in major depressive disorders. Trends in Pharmacological Sciences, 26(12), 609–617. https://doi.org/10.1016/j.tips.2005.10.006

Zuardi, A., Crippa, J., Dursun, S., Morais, S., Vilela, J., Sanches, R., & Hallak, J. (2010). Cannabidiol was ineffective for manic episode of bipolar affective disorder. Journal of Psychopharmacology (Oxford, England), 24(1), 135–137. https://doi.org/10.1177/0269881108096521

Zuardi, A. W., Hallak, J. E. C., Dursun, S. M., Morais, S. L., Sanches, R. F., Musty, R. E., & Crippa, J. A. S. (2006). Cannabidiol monotherapy for treatment-resistant schizophrenia. Journal of Psychopharmacology (Oxford, England), 20(5), 683–686. https://doi.org/10.1177/026988110606096