CBD and anxiety in older adults
55 year-old Louise* from Calgary, Alberta, was diagnosed with anxiety and depression over fifteen years ago. For years, she took medications prescribed by her doctor to help control her symptoms.
“My depression [medications] had to be tweaked a few times before we found a good combination, and I was prescribed a different medication for the anxiety,” she explains.
“I educated myself and felt that CBD was something I needed to try. I had to wean myself off the medications and onto the CBD oil very gradually. I started with a low-THC, high-CBD oil, and I felt like I had a new spring in my step,” she explains. “It has been very helpful.”
Louise works in the construction management industry. “I am currently looking for a new position, so I only take CBD in case I need to do a drug and alcohol test for work.” Since drug tests detect THC, Louise prefers to skip it to avoid any problems.
Otherwise, the treatment has worked well for her, and she’s been able to taper herself off her old medications.
Prevalence of anxiety in older adults
According to a 2009 report from Harvard Medical School, generalized anxiety disorder is one of the most common mental illnesses affecting older adults (60+). While anxiety is often treated with a combination of medication and cognitive therapy, traditional drug treatments “may not be the best choice for older patients because they are more prone to side effects,” says the report.
Karen Newell, registered practical nurse and director of patient care at Natural Care, echoes the Harvard report’s sentiment.
“Anxiety in older adults can be difficult to treat because they are more prone to side effects from benzodiazepine medications. These side effects can include rebound anxiety, as well as insomnia and a higher risk of falls due to loss of coordination.”
Can CBD help with anxiety?
Recent evidence suggests that CBD, or cannabidiol, a non-intoxicating compound found in the cannabis plant, may be able to treat a number of anxiety disorders. A 2015 review states:
“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.”
In a 2011 study , researchers administered either CBD or a placebo to participants with social anxiety disorder. Participants were then asked to give a presentation in front of a group, and rate their anxiety after. In another session, the participants were given the opposite: the CBD, if they had initially received the placebo, or the placebo, if they had received the CBD. The subjects rated themselves as less anxious when they had taken CBD than when they had taken the placebo.
Newell believes CBD is a good option for older adults suffering from anxiety.
“It’s a great alternative to traditional anti-anxiety medications – with fewer side-effects – and the evidence is there that it provides positive results and may improve quality of life for older patients and their families.”
CBD and medications – do they mix?
In addition to using CBD to help with her anxiety, Louise also takes medication for a thyroid condition. “The CBD has not seemed to affect [my thyroid medication] at all. I’m planning on getting blood work done soon which will let me know if anything has changed.”
Although she believes the CBD and her medication are compatible, it’s important to know that CBD can affect the way certain medications are metabolized.
Newell stresses the importance of working with a physician when considering CBD treatment.
“Drug interactions are an important concern, especially because older patients tend to take more medications. Ideally, patients would undertake a treatment plan with the help of their healthcare provider, and discontinue their other medications when using CBD.”
A very large number of medications are processed in the liver by cytochrome P450 enzymes. While there are upwards of 50 different cytochrome P450 enzymes, just six of them are responsible for metabolizing up to 90 per cent of medications.
CBD deactivates some of these major enzymes, making them less effective at processing medications. This means CBD can affect how medications are processed. This effect is dose-dependent, meaning it’s more pronounced at higher doses. If you are interested in trying CBD, it’s important to talk to your doctor about any interactions it may have with your other medications.
CBD Safety For Seniors
Almost one in five Americans over 50 now uses some kind of CBD product, according to a recent Gallup poll. And they are doing so undeterred by the total lack of FDA oversight or guidelines. But to what extent is CBD use a public health concern for seniors? And what do older adults need to consider when they start using CBD?
Fake product alert
Hemp-derived CBD oil is now poised to overtake olive oil in the category of most counterfeited plant extract on the planet, making authenticity a prime concern for older consumers. Random samplings of CBD products consistently detect misrepresentation between their labels and their contents. In some cases, the nominal cannabinoid is entirely absent, in others, more nefarious substances have been found.
One of the many organic, third-party lab-tested CBD products on the market.
Hence, until the FDA gets its regulatory house in order, responsibility for finding a safe product lies with the consumer. According to the Brightfield Group, seniors tend to prefer ingesting CBD in oils, vape cartridges and edibles, which entails a lot of label-reading for seniors. When evaluating a CBD product, make sure it uses CBD from organic hemp, preferably grown in the United States, and that it is third-party lab tested to verify the CBD content and rule out the presence of contaminants.
Once you get it, how do you use it?
While CBD products have never been easier to access in the US, actually getting the desired results from them can be more complicated.
I spoke with Dr. Danial Schecter, an Ontario-based family physician who is the co-founder of a network of cannabis-based medicine clinics that have served over 60,000 patients in Canada, and who recently became Director of Global Medical Services at Canopy Growth Corporate, about the guidance he suggests for seniors interested in using CBD.
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Danial Schecter (DS) I’ll start with a few basics: CBD is a molecule derived from the cannabis plant. It is what we call non-euphoric-inducing, in that it doesn’t cause you to feel high, but it is still what we call psychoactive, meaning that it has an effect on the neurotransmitters and the chemistry of your brain, just like an antidepressant or a sleep aid would have.
Abbie Rosner (AR): How do you approach CBD dosage for seniors?
DS: When we’re talking about CBD, in terms of dosing it in particular, we know that doses of CBD are very safe, that there has been no documented overdose of CBD, that it does not cause euphoria and that it is safe to be used in quite high quantities. We have studies where it’s been used in as low as 5-10 mgs per day, and studies that are using it in as high as 1500 mgs a day.
The supposed effects of CBD are that it has anti-inflammatory, antidepressant and anxiolytic (anti-anxiety) properties – but we still don’t really know exactly how it works. Yet there have been studies done in humans, for example, where subjects were given 600 mg of CBD in a single dose or a placebo, and then had them do a simulated public speaking exercise. And those who had the CBD had a significantly easier time, with less anxiety.
But, in clinical practice, we never give doses like that. It’s just not affordable. What I see in my clinical practice is that the majority of people will respond to somewhere between 40 and 100 mgs of CBD/day.
AR: If a 70 year old woman came into your clinic, would you recommend that she take 40 mg of CBD?
DS: No. What I would say is, we don’t know what your dose is going to be. Everyone’s endocannabinoid tone is different, their metabolism is different, you’re on a certain number of medications that will potentially affect the metabolism of CBD and the only way to know if it is going to work and what the dosage is, is by taking a standardized approach, starting low and going slow.
AR: And what would the starting dose be?
DS: In a healthy adults a starting dose would usually be 5 mg of CBD, but in people who are elderly, who are potentially on a number of medications, and who are very sensitive to side-effects of medications, we like to cut that dose in half, and start at 2.5 mgs of CBD. The 40-100 mgs a day of CBD a day that I mentioned previously, that’s usually for people who are using it for pain or for anxiety and wellbeing.
AR: Pain and anxiety are two of the main issues that older adults are facing – so the picture that I’m getting is that, if an older adult comes in and says, I have pain and I’d like to start with CBD – you’d start low but you might theoretically get up to 40-100 mgs of CBD to actually address the effects.
DS: Exactly – so what we usually do is, we encourage people to start at a very low dose – 2.5 mgs – and then increase in 2.5 mg increments – depending on how aggressive they want to be – over anywhere between 2 days and one week. And then wait to see if they feel any kind of response.
Usually, the psychological symptoms will take longer to actually improve or respond to CBD than the physical symptoms. So we would often recommend a slower titration for anxiety or depression, and for the physical symptoms that have a quicker response, we could recommend a quicker titration.
AR: What do you recommend for seniors who want to supplement or replace their medications with CBD?
DS: Whenever we want to start a new medication, one of the very basic principles is that we should really not be playing around with another medication. So you only want to introduce or remove one medication at a time.
If you’ve been on a sleep aid for many years, and you want to stop taking it and use CBD, I would not recommend that you all of a sudden stop taking the sleep aid and start taking CBD, because your insomnia will get worse. Under the guidance of your physician, you would want to taper in the CBD until you reach a stable dose.
AR: Is CBD alone a potent medication?
DS: It can be. But it’s probable that the best benefits – at least what I see in clinical practice – is when we can use a combination of both THC and CBD.
There is idea that exists that THC is bad and CBD is good, when in actuality, both of these molecules have a very important place in clinical practice. And while THC has received a bad rap, because it is associated with getting high, in actuality, it has more immediate benefits than CBD. With THC there’s a huge misconception that people just use it to get high. But in doses that do not cause you to get high, it can be very beneficial for things such as sleep, pain, nausea, appetite stimulation and muscle spasms.
AR: That’s all fine and well in Canada. But in most of the United States, older adults need to get a medical marijuana card to access those products –with all the bureaucracy that entails. And now they can access CBD in almost any drugstore – and that’s what they’re doing!
DS: For someone who wants to access CBD on the open market, that’s absolutely fine – but ideally, they would be doing so under the supervision of their main treating physician.
AR: In your practice, are you seeing older adults who are asking for CBD products?
DS: That’s actually what we’re seeing the most of these days. In Canada, where cannabis has been legalized for recreational use, the greatest increase in our patient population at the clinics are the Baby Boomers and the parents of Baby Boomers who are coming in all the time asking to try that CBD oil.
But the other thing is that, even when they want CBD, once we start examining them, getting their history and understanding what it is they are looking for, we find that very often they would benefit from a low dose of THC in addition to CBD. Here in Canada, you can very easily say, I know you’ve heard about CBD, but you could benefit even more from something with a little THC.
AR: And there’s the beauty of full legalization – that you don’t have to jump through so many hoops to get a little THC in your medicine.