Cannabidiol in Anxiety and Sleep: A Large Case Series
Cannabidiol (CBD) is one of many cannabinoid compounds found in cannabis. It does not appear to alter consciousness or trigger a “high.” A recent surge in scientific publications has found preclinical and clinical evidence documenting value for CBD in some neuropsychiatric disorders, including epilepsy, anxiety, and schizophrenia. Evidence points toward a calming effect for CBD in the central nervous system. Interest in CBD as a treatment of a wide range of disorders has exploded, yet few clinical studies of CBD exist in the psychiatric literature.
To determine whether CBD helps improve sleep and/or anxiety in a clinical population.
A large retrospective case series at a psychiatric clinic involving clinical application of CBD for anxiety and sleep complaints as an adjunct to usual treatment. The retrospective chart review included monthly documentation of anxiety and sleep quality in 103 adult patients.
Main Outcome Measures
Sleep and anxiety scores, using validated instruments, at baseline and after CBD treatment.
The final sample consisted of 72 adults presenting with primary concerns of anxiety (n = 47) or poor sleep (n = 25). Anxiety scores decreased within the first month in 57 patients (79.2%) and remained decreased during the study duration. Sleep scores improved within the first month in 48 patients (66.7%) but fluctuated over time. In this chart review, CBD was well tolerated in all but 3 patients.
Cannabidiol may hold benefit for anxiety-related disorders. Controlled clinical studies are needed.
The Cannabis plant has been cultivated and used for its medicinal and industrial benefits dating back to ancient times. Cannabis sativa and Cannabis indica are the 2 main species.1 The Cannabis plant contains more than 80 different chemicals known as cannabinoids. The most abundant cannabinoid, tetrahydrocannabinol (THC), is well known for its psychoactive properties, whereas cannabidiol (CBD) is the second-most abundant and is nonpsychoactive. Different strains of the plant are grown containing varying amounts of THC and CBD. Hemp plants are grown for their fibers and high levels of CBD that can be extracted to make oil, but marijuana plants grown for recreational use have higher concentrations of THC compared with CBD.2 Industrial hemp must contain less than 0.3% THC to be considered legal, and it is from this plant that CBD oil is extracted.3
Many different cultures have used the Cannabis plant to treat a plethora of ailments. Practitioners in ancient China targeted malaria, menstrual symptoms, gout, and constipation. During medieval times, cannabis was used for pain, epilepsy, nausea, and vomiting, and in Western medicine it was commonly used as an analgesic.4,5 In the US, physicians prescribed Cannabis sativa for a multitude of illnesses until restrictions were put in place in the 1930s and then finally stopped using it in 1970 when the federal government listed marijuana as a Schedule I substance, claiming it an illegal substance with no medical value. California was the first state to go against the federal ban and legalize medical marijuana in 1996.6 As of June 2018, 9 states and Washington, DC, have legalized recreational marijuana, and 30 states and Washington, DC, allow for use of medical marijuana.7 The purpose of the present study is to describe the effects of CBD on anxiety and sleep among patients in a clinic presenting with anxiety or sleep as a primary concern.
CBD has demonstrated preliminary efficacy for a range of physical and mental health care problems. In the decade before 2012, there were only 9 published studies on the use of cannabinoids for medicinal treatment of pain; since then, 30 articles have been published on this topic, according to a PubMed search conducted in December 2017. Most notable was a study conducted at the University of California, San Diego’s Center for Medicinal Cannabis Research that showed cannabis cigarettes reduced pain by 34% to 40% compared with placebo (17% to 20% decrease in pain).8 In particular, CBD appears to hold benefits for a wide range of neurologic disorders, including decreasing major seizures. A recent large, well-controlled study of pediatric epilepsy documented a beneficial effect of CBD in reducing seizure frequency by more than 50%.9 In addition to endorphin release, the “runner’s high” experience after exercise has been shown to be induced in part by anandamide acting on CB1 receptors, eliciting anxiolytic effects on the body.10 The activity of CBD at 5-HT1A receptors may drive its neuroprotective, antidepressive, and anxiolytic benefits, although the mechanism of action by which CBD decreases anxiety is still unclear.11 CBD was shown to be helpful for decreasing anxiety through a simulated public speaking test at doses of 300 mg to 600 mg in single-dose studies.12–14 Other studies suggest lower doses of 10 mg/kg having a more anxiolytic effect than higher doses of 100 mg/kg in rats.15 A crossover study comparing CBD with nitrazepam found that high-dose CBD at 160 mg increased the duration of sleep.16 Another crossover study showed that plasma cortisol levels decreased more significantly when given oral CBD, 300 to 600 mg, but these patients experienced a sedative effect.17 The higher doses of CBD that studies suggest are therapeutic for anxiety, insomnia, and epilepsy may also increase mental sedation.16 Administration of CBD via different routes and long-term use of 10 mg/d to 400 mg/d did not create a toxic effect on patients. Doses up to 1500 mg/d have been well tolerated in the literature.18 Most of the research done has been in animal models and has shown potential benefit, but clinical data from randomized controlled experiments remain limited.
Finally, the most notable benefit of cannabis as a form of treatment is safety. There have been no reports of lethal overdose with either of the cannabinoids and, outside of concerns over abuse, major complications are very limited.19 Current research indicates that cannabis has a low overall risk with short-term use, but more research is needed to clarify possible long-term risks and harms.
Given the promising biochemical, physiologic, and preclinical data on CBD, a remarkable lack of randomized clinical trials and other formal clinical studies exist in the psychiatric arena. The present study describes a series of patients using CBD for treatment of anxiety or sleep disturbances in a clinical practice setting. Given the paucity of data in this area, clinical observations can be quite useful to advance the knowledge base and to offer questions for further investigation. This study aimed to determine whether CBD is helpful for improving sleep and/or anxiety in a clinical population. Given the novel nature of this treatment, our study also focused on tolerability and safety concerns. As a part of the evolving legal status of cannabis, our investigation also looked at patient acceptance.
Design and Procedures
A retrospective chart review was conducted of adult psychiatric patients treated with CBD for anxiety or sleep as an adjunct to treatment as usual at a large psychiatric outpatient clinic. Any current psychiatric patient with a diagnosis by a mental health professional (psychiatrist, psychiatric nurse practitioner, or physician assistant) of a sleep or anxiety disorder was considered. Diagnosis was made by clinical evaluation followed by baseline psychologic measures. These measures were repeated monthly. Comorbid psychiatric illnesses were not a basis for exclusion. Accordingly, other psychiatric medications were administered as per routine patient care. Selection for the case series was contingent on informed consent to be treated with CBD for 1 of these 2 disorders and at least 1 month of active treatment with CBD. Patients treated with CBD were provided with psychiatric care and medications as usual. Most patients continued to receive their psychiatric medications. The patient population mirrored the clinic population at large with the exception that it was younger.
Nearly all patients were given CBD 25 mg/d in capsule form. If anxiety complaints predominated, the dosing was every morning, after breakfast. If sleep complaints predominated, the dosing was every evening, after dinner. A handful of patients were given CBD 50 mg/d or 75 mg/d. One patient with a trauma history and schizoaffective disorder received a CBD dosage that was gradually increased to 175 mg/d.
Often CBD was employed as a method to avoid or to reduce psychiatric medications. The CBD selection and dosing reflected the individual practitioner’s clinical preference. Informed consent was obtained for each patient who was treated and considered for this study. Monthly visits included clinical evaluation and documentation of patients’ anxiety and sleep status using validated measures. CBD was added to care, dropped from care, or refused as per individual patient and practitioner preference. The Western Institutional Review Board, Puyallup, WA, approved this retrospective chart review.
Setting and Sample
Wholeness Center is a large mental health clinic in Fort Collins, CO, that focuses on integrative medicine and psychiatry. Practitioners from a range of disciplines (psychiatry, naturopathy, acupuncture, neurofeedback, yoga, etc) work together in a collaborative and cross-disciplinary environment. CBD had been widely incorporated into clinical care at Wholeness Center a few years before this study, on the basis of existing research and patient experience.
The sampling frame consisted of 103 adult patients who were consecutively treated with CBD at our psychiatric outpatient clinic. Eighty-two (79.6%) of the 103 adult patients had a documented anxiety or sleep disorder diagnosis. Patients with sole or primary diagnoses of schizophrenia, posttraumatic stress disorder, and agitated depression were excluded. Ten patients were further excluded because they had only 1 documented visit, with no follow-up assessment. The final sample consisted of 72 adult patients presenting with primary concerns of anxiety (65.3%; n = 47) or poor sleep (34.7%; n = 25) and who had at least 1 follow-up visit after CBD was prescribed.
Main Outcome Measures
Sleep and anxiety were the targets of this descriptive report. Sleep concerns were tracked at monthly visits using the Pittsburg Sleep Quality Index. Anxiety levels were monitored at monthly visits using the Hamilton Anxiety Rating Scale. Both scales are nonproprietary. The Hamilton Anxiety Rating Scale is a widely used and validated anxiety measure with 14 individual questions. It was first used in 1959 and covers a wide range of anxiety-related concerns. The score ranges from 0 to 56. A score under 17 indicates mild anxiety, and a score above 25 indicates severe anxiety. The Pittsburg Sleep Quality Index is a self-report measure that assesses the quality of sleep during a 1-month period. It consists of 19 items that have been found to be reliable and valid in the assessment of a range of sleep-related problems. Each item is rated 0 to 3 and yields a total score from 0 to 21. A higher number indicates more sleep-related concerns. A score of 5 or greater indicates a “poor sleeper.”
Side effects and tolerability of CBD treatment were assessed through spontaneous patient self-reports and were documented in case records. Any other spontaneous comments or complaints of patients were also documented in case records and included in this analysis.
Deidentified patient data were evaluated using descriptive statistics and plotted graphically for visual analysis and interpretation of trends.
The average age for patients with anxiety was 34 years (range = 18–70 years) and age 36.5 years for patients with sleep disorders (range = 18–72 years). Most patients with an anxiety diagnosis were men (59.6%, 28/47), whereas more sleep-disordered patients were women (64.0%, 16/25). All 72 patients completed sleep and anxiety assessments at the onset of CBD treatment and at the first monthly follow-up. By the second monthly follow-up, 41 patients (56.9%) remained on CBD treatment and completed assessments; 27 patients (37.5%) remained on CBD treatment at the third monthly assessment.
Table 1 provides means and standard deviations for sleep and anxiety scores at baseline and during the follow-up period for adults taking CBD. Figure 1 graphically displays the trend in anxiety and sleep scores over the study period. On average, anxiety and sleep improved for most patients, and these improvements were sustained over time. At the first monthly assessment after the start of CBD treatment, 79.2% (57/72) and 66.7% (48/72) of all patients experienced an improvement in anxiety and sleep, respectively; 15.3% (11/72) and 25.0% (18/72) experienced worsening symptoms in anxiety and sleep, respectively. Two months after the start of CBD treatment, 78.1% (32/41) and 56.1% (23/41) of patients reported improvement in anxiety and sleep, respectively, compared with the prior monthly visit; again, 19.5% (8/41) and 26.8% (11/41), respectively, reported worsening problems as compared with the prior month.
CBD Oil: 9 Science-Backed Benefits
Dr. Bindiya Gandhi is an integrative medicine physician with expertise in functional and holistic medicine based in Atlanta, Georgia.
Commissions we earn from partner links on this page do not affect our opinions or evaluations. Our editorial content is based on thorough research and guidance from the Forbes Health Advisory Board.
Cannabidiol, or CBD, is a chemical compound found in the cannabis sativa plant. When applied topically or consumed through smoke inhalation or edible consumption, CBD interacts with neuroreceptors in your endocannabinoid system, which sends signals between your cells to help regulate your movement, mood, homeostasis and immune system.
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CBD is often extracted from the cannabis sativa plant in oil form and mixed with an inert carrier oil like hemp seed oil for consumption. In fact, of the 60% of U.S. adults who report having used CBD before, 55% of them use CBD oils and tinctures specifically, according to a recent Forbes Health survey of 2,000 U.S. adults conducted by OnePoll.
CBD research is growing, too. Here are nine ways studies suggest CBD oil could benefit your health.
1. Offset Anxiety and Depression
CBD’s ability to calm is perhaps its most popular effect and the reason its use is so widespread. A 2017 study in the Brazilian Journal of Psychiatry tested the anxiety levels of 57 men in a simulated public speaking test. Some received a placebo while others received either 150 milligrams, 300 milligrams or 600 milligrams of CBD before their speeches. Those who received 300 milligrams of CBD experienced significantly reduced anxiety during the test compared to those who received the placebo. Interestingly, participants who received either 150 or 600 milligrams of CBD experienced more anxiety during the test than the 300 milligrams group.
Meanwhile, at least one study in mice revealed CBD had effects similar to the antidepressant imipramine. Human trials are needed, though, to confirm whether CBD can induce this same antidepressant reaction in our bodies.
2. Treat Select Epilepsy Syndromes
In some instances, CBD can be used to treat epileptic seizures.
In 2018, the Food and Drug Administration (FDA) approved the use of CBD under the brand name Epidiolex to treat seizures resulting from Lennox-Gastaut syndrome and Dravet syndrome—two rare forms of epilepsy—in patients at least 2 years old.
Three well-vetted studies provide the basis of support for the FDA’s decision. In these trials, 516 patients with Lennox-Gastaut syndrome or Dravet syndrome received either Epidiolex or a placebo. Epidiolex, when taken along with other prescribed medications, decreased the frequency of participants’ seizures compared to the placebo.
3. Reduce PTSD Symptoms
In a small 2018 study in the Journal of Alternative and Complementary Medicine, 11 people with post-traumatic stress disorder (PTSD) received CBD along with routine psychiatric care for eight weeks in an outpatient psychiatric clinic. Ten of the 11 experienced a decrease in their PTSD symptoms. CBD was generally well tolerated, the researchers write.
Margaret Rajnic, a doctor of nursing practice experienced in medical cannabis and CBD, emphasizes the importance of using therapy in tandem with any type of cannabis or CBD for PTSD. “There is an amount of therapy that is needed for PTSD,” she says. “But CBD will give you that little bit of decreased anxiety.”
Four other human trials from 2012 to 2016 suggest CBD reduces PTSD symptoms, although some include THC, or tetrahydrocannabinol, the main mind-altering element in cannabis. When THC and CBD work together, they create what’s called an “entourage effect,” complementing each other’s benefits and potency. For example, taking the same dose of THC and CBD together tempers the “high” from THC, while just a little THC paired with more CBD enhances the effects of the CBD.
4. Treat Opioid Addiction
Some studies—both preclinical animal and human clinical trials—suggest CBD could be used to help treat people who are dependent on opioids.
In one such study, researchers administered CBD to people with heroin use disorder. Over the course of a week, CBD significantly reduced heroin users’ cue-induced cravings, withdrawal anxiety, resting heart rate and salivary cortisol levels. No serious adverse effects were found.
Other studies find CBD helpful in reducing various psychiatric and medical symptoms like anxiety, insomnia and pain in patients with substance use disorders, indicating that CBD may be an effective treatment for opioid addiction. However, further studies are necessary.
5. Alleviate ALS Symptoms
Amyotrophic lateral sclerosis (ALS) is a disease that causes nerve cells in the brain and spinal cord to deteriorate, resulting in loss of muscle control that worsens over time. It’s not yet understood exactly why ALS occurs, although it can be hereditary in some cases. There’s no known cure, and there are only two FDA-approved medications to help treat ALS symptoms.
Research suggests people with ALS can benefit from the entourage effect created by the combination of THC and CBD, similar to people with PTSD. In a 2019 study, patients received a combination of THC and CBD in varying doses depending on their needs and preferences. Those with mild, moderate or severe spasticity (muscle tightness and stiffness) due to ALS reported high levels of satisfaction with the treatment, and those with moderate to severe spasticity reported higher satisfaction rates than those with mild spasticity.
6. Relieve Unmanageable Pain
In 2005, Canada approved the use of Sativex, an oromucosal (absorbed in the lining of the mouth) spray with equal proportions of THC and CBD, for the treatment of multiple sclerosis-related central neuropathic pain. In 2007, Canada approved the medicine’s use again for cancer pain that proved unresponsive to other medications.
Meanwhile, continued studies in the U.S. indicate CBD is effective in treating chronic, non-cancer pain. In one 2020 study, researchers administered CBD topically to a group of patients with symptomatic peripheral neuropathy (a result of brain nerve and spinal cord nerve damage) while another group with the same condition received a placebo. Results showed a significant reduction in intense, sharp pains and cold, itchy sensations in those who used the topical CBD compared to those who used the placebo. No participants reported adverse side effects.
When introduced topically, CBD oil doesn’t affect the systemic issue as it might if it were introduced directly into the bloodstream. Instead, topical CBD is more localized and treats pain in a certain area. Since it’s more direct, it may have a more pronounced effect.
7. Ease Diabetic Complications
For starters, tests on human cells found that CBD helps reduce the effects of high glucose levels on other cells in the body, which typically precedes the development of diabetes and various complications. Researchers concluded that with further studies, CBD could have significant benefits when used in patients with diabetes, diabetic complications and plaque buildup in artery walls.
In another small study, 13 patients with type 2 diabetes who weren’t on insulin treatment were given both CBD and a placebo (in lieu of insulin). Researchers found CBD decreased their levels of resistin (which causes resistance to insulin, the protein that regulates sugar levels) and increased their levels of glucose-dependent insulinotropic peptide (a hormone that ensures a sufficient release of insulin from digested food) compared to their baselines before they started the test. These results suggest CBD could be a natural treatment for diabetes by helping the body regulate insulin-related hormone levels.
8. Protect Against Neurological Disease
Preclinical and clinical studies show that CBD has antioxidant and anti-inflammatory properties. Researchers deduce these characteristics can provide significant neuroprotection, or protection against numerous pathological disorders.
Several preclinical studies suggest CBD can produce beneficial effects against Parkinson’s disease, Alzheimer’s disease and multiple sclerosis. Huntington’s disease and cerebral ischemia were also tested, although significant positive results were not recorded. Further clinical studies are needed to confirm CBD’s benefits when used as a treatment for these disorders.
9. Inhibit Arthritis Symptoms
Arthritis involves the deterioration of the tissues in and around your joints. There are several types of arthritis, and symptoms include pain, stiffness and loss of motion. Arthritis treatment usually targets pain relief and improved joint function.
A 2006 study found that Sativex—a CBD-based botanical drug approved in the United Kingdom in 2010—promoted statistically significant improvements in quality of sleep, pain during movement and pain at rest in patients with rheumatoid arthritis when compared to a placebo. It was the first controlled trial of Sativex as a treatment for rheumatoid arthritis, involving 58 patients. CBD was found to have a pain-relieving effect, as well as an ability to suppress disease activity.
In 2018, in a study of more localized treatment, researchers administered a synthetic CBD gel in either 250-milligram or 500-milligram doses daily or a placebo to patients with knee pain due to osteoarthritis. Patients also stopped taking any other anti-inflammatory medications or painkillers, with the exception of acetaminophen, before and during the study period.
The results were interesting, although not entirely conclusive. On one hand, those treated with CBD did not experience much change in pain when compared with placebo patients. On the other hand, there were statistically significant differences between the group receiving the 250-milligram dose and the placebo group when measuring the average weekly improvement of their worst pain levels and their WOMAC (Western Ontario and McMaster Universities Arthritis Index) physical function rating. Additionally, men seemed to benefit from CBD more significantly than women in this test.
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What Are the Benefits of CBD?
More than 60 percent of CBD users were taking it for anxiety, according to a survey of 5,000 people. Does it help?
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By Dawn MacKeen
The CBD industry is flourishing, conservatively projected to hit $16 billion in the United States by 2025. Already, the plant extract is being added to cheeseburgers, toothpicks and breath sprays. More than 60 percent of CBD users have taken it for anxiety, according to a survey of 5,000 people, conducted by the Brightfield Group, a cannabis market research firm. Chronic pain, insomnia and depression follow behind. Kim Kardashian West, for example, turned to the product when “freaking out” over the birth of her fourth baby. The professional golfer Bubba Watson drifts off to sleep with it. And Martha Stewart’s French bulldog partakes, too.
What is CBD?
Cannabidiol, or CBD, is the lesser-known child of the cannabis sativa plant; its more famous sibling, tetrahydrocannabinol, or THC, is the active ingredient in pot that catapults users’ “high.” With roots in Central Asia, the plant is believed to have been first used medicinally — or for rituals — around 750 B.C., though there are other estimates too.
Cannabidiol and THC are just two of the plant’s more than 100 cannabinoids. THC is psychoactive, and CBD may or may not be, which is a matter of debate. THC can increase anxiety; it is not clear what effect CBD is having, if any, in reducing it. THC can lead to addiction and cravings; CBD is being studied to help those in recovery.
Cannabis containing 0.3 percent or less of THC is hemp. Although last year’s Farm Bill legalized hemp under federal law, it also preserved the Food and Drug Administration’s oversight of products derived from cannabis.
What are the claims?
CBD is advertised as providing relief for anxiety, depression and post-traumatic stress disorder. It is also marketed to promote sleep. Part of CBD’s popularity is that it purports to be “nonpsychoactive,” and that consumers can reap health benefits from the plant without the high (or the midnight pizza munchies).
Just as hemp seedlings are sprouting up across the United States, so is the marketing. From oils and nasal sprays to lollipops and suppositories, it seems no place is too sacred for CBD. “It’s the monster that has taken over the room,” Dr. Brad Ingram, an associate professor of pediatrics at the University of Mississippi Medical Center, said about all the wild uses for CBD now. He is leading a clinical trial into administering CBD to children and teenagers with drug-resistant epilepsy.
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Understand Post-Traumatic Stress Disorder
The invasive symptoms of PTSD can affect combat veterans and civilians alike. Early intervention is critical for managing the condition.
- Removing the Stigma: Misconceptions about how PTSD develops and its symptoms, can prevent people from seeking treatment.
- Psychedelic Drugs: As studies explore the therapeutic value of substances like MDMA, veterans are becoming unlikely advocates for their decriminalization.
- SeekingPeace: Mission Within is a Mexican retreat that uses hallucinogens to treat PTSD. Some female U.S. veterans and veteran spouses have turned to it to heal from trauma.
- Virtual Reality: A treatment using new technology to immerse patients in a simulation of a memory could helpthemovercome trauma.
Does CBD work?
“It’s promising in a lot of different therapeutic avenues because it’s relatively safe,” said James MacKillop, co-director of McMaster University’s Michael G. DeGroote Center for Medicinal Cannabis Research in Hamilton, Ontario.
Last year, the F.D.A. approved Epidiolex, a purified CBD extract, to treat rare seizure disorders in patients 2 years or older after three randomized, double-blind and placebo-controlled clinical trials with 516 patients that showed the drug, taken along with other medications, helped to reduce seizures. These types of studies are the gold standard in medicine, in which participants are divided by chance, and neither the subject nor the investigator knows which group is taking the placebo or the medication.
While there is hope for treating other conditions with the plant extract, Epidiolex remains the only CBD-derived drug approved by the F.D.A. Most of the research on cannabidiol has been in animals, and its current popularity has outpaced science. “We don’t have the 101 course on CBD quite figured out yet,” said Ryan Vandrey, an associate professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine.
Does CBD help anxiety and PTSD?
For students with generalized social anxiety, a four-minute talk, with minimal time to prepare, can be debilitating. Yet a small experiment in the journal Neuropsychopharmacology found that CBD seemed to reduce nervousness and cognitive impairment in patients with social anxiety in a simulated public speaking task.
However, a double-blind study found healthy volunteers administered CBD had little to no change in their emotional reaction to unpleasant images or words, compared to the placebo group. “If it’s a calming drug, it should change their responses to the stimuli,” said Harriet de Wit, co-author of the study and a professor in the University of Chicago’s department of psychiatry and behavioral neuroscience. “But it didn’t.”
Many soldiers return home haunted by war and PTSD and often avoid certain activities, places or people associated with their traumatic events. The Department of Veterans Affairs is funding its first study on CBD, pairing it with psychotherapy.
“Our top therapies attempt to break the association between reminders of the trauma and the fear response,” said Mallory Loflin, an assistant adjunct professor at the University of California, San Diego and the study’s principal investigator. “We think that CBD, at least in animal models, can help that process happen a lot faster.” While large clinical trials are underway, psychologists say there isn’t compelling evidence yet as to whether this is a viable treatment.
Does CBD help sleep and depression?
Up in the wee hours of the night, stuck watching videos of puppies? CBD may be promising as a sleep aid; one of the side effects of the Epidiolex trials for epilepsy was drowsiness, according to Mr. MacKillop, a co-author of a review on cannabinoids and sleep. “If you are looking for new treatments for sleep, that may be a clue,” he said.
But he cautions that the side effects could have been because of an interaction with other medications the children were taking to control the seizures. So far, there hasn’t been a randomized, placebo-controlled, double-blind trial (the gold standard) on sleep disorders and CBD.
A recent chart review of 72 psychiatric patients treated with CBD found that anxiety improved, but not sleep. “Over all, we did not find that it panned out as a useful treatment for sleep,” said Dr. Scott Shannon, assistant clinical professor of psychiatry at the University of Colorado, Denver and the lead author of the review in The Permanente Journal.
Sleep can be disrupted for many reasons, including depression. Rodents seemed to adapt better to stressful conditions and exhibited less depressive-like behavior after taking CBD, according to a review in Journal of Chemical Neuroanatomy. “Surprisingly, CBD seems to act faster than conventional antidepressants,” wrote one of the authors of a new review, Sâmia Joca, a fellow at the Aarhus Institute of Advanced Studies in Denmark and an associate professor at the University of São Paulo in Brazil, in an email interview. Of course, it’s difficult to detect depression in animals, but the studies that Ms. Joca and her colleagues reviewed suggested that in models of chronic stress exposure, the mice and rats treated with CBD were more resilient.
But without clinical trials in humans, psychologists say CBD’s effect on depression is still a hypothesis, and not an evidence-based treatment.
Is CBD harmful?
“If you take pure CBD, it’s pretty safe,” said Marcel Bonn-Miller, an adjunct assistant professor at the University of Pennsylvania’s Perelman School of Medicine. Side effects in the Epidiolex trial included diarrhea, sleepiness, fatigue, weakness, rash, decreased appetite and elevated liver enzymes. Also, the safe amount to consume in a day, or at all during pregnancy, is still not known.
Recently, the F.D.A. sent a warning letter to Curaleaf Inc. about its “unsubstantiated claims” that the plant extract treats a variety of conditions from pet anxiety and depression to cancer and opioid withdrawal. (In a statement, the company said that some of the products in question had been discontinued and that it was working with the F.D.A.)
Dr. Smita Das, chair of the American Psychiatric Association’s Council on Addiction Psychiatry’s cannabis work group, does not recommend CBD for anxiety, PTSD, sleep or depression. With patients turning to these to unproven products, she is worried that they may delay seeking appropriate mental health care: “I’m dually concerned with how exposure to CBD products can lead somebody into continuing to cannabis products.”
Some CBD products may contain unwanted surprises. Forensic toxicologists at Virginia Commonwealth University examined nine e-liquids advertised as being 100 percent natural CBD extracts. They found one with dextromethorphan, or DXM, used in over-the counter cough medications and considered addictive when abused; and four with a synthetic cannabinoid, sometimes called Spice, that can cause anxiety, psychosis, tachycardia and death, according to a study last year in Forensic Science International.
Earlier research found fewer than a third of 84 products studied contained the amount of CBD on their labels. Some users of CBD have also failed drug tests when the product contained more THC than indicated.
This year, 1,090 people have contacted poison control centers about CBD, according to the American Association of Poison Control Centers. Over a third are estimated to have received medical attention, and 46 were admitted into a critical care unit, possibly because of exposure to other products, or drug interactions. In addition, concern over 318 animals poured into the American Society for the Prevention of Cruelty to Animals’ Animal Poison Control Center.
Is CBD a scam or not?
A few drops of CBD oil in a mocha or smoothie are not likely to do anything, researchers contend. Doctors say another force may also be at play in people feeling good: the placebo effect. That’s when someone believes a drug is working and symptoms seem to improve.
“CBD is not a scam,” said Yasmin Hurd, director of the Addiction Institute of Mount Sinai in New York City who led a double-blind study of 42 recovering heroin addicts and found that CBD reduced both cravings and cue-based anxiety, both of which can cycle people back into using. “It has a potential medicinal value, but when we are putting it into mascara and putting it into tampons, for God’s sake, to me, that’s a scam.”