3. It seems like CBD is now being used in lots of products (shampoos, cosmetics, oils, bath salts, etc.). Does it really help when it is part of a product?
5. Is there current research in the US for CBD? Are other countries using CBD?
4. Does CBD based medication really help with anxiety and depression and has it been scientifically proven to help with anxiety and depression?
2. Is CBD (and CBD products) safe to use?
Purified CBD extract (GW Pharmaceuticals) was approved by the FDA in 2018 as a treatment for 2 rare forms of epilepsy – Dravet syndrome and Lennox-Gastaut syndrome – as a Schedule 5 compound. The brand name is Epidiolex.
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.
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.”
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
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.
Cannabidiol may hold benefit for anxiety-related disorders. Controlled clinical studies are needed.
Parker, L. A., Kwiatokowska, M., and Mechoulam, R. (2006). Delta-9-tetrahydrocannabinol and cannabidiol, but not ondansetron, interfere with conditioned retching reactions elicited by a lithium-paired context in Suncus murinus: an animal model of anticipatory nausea and vomiting. Physiol. Behav. 87, 66–71. doi: 10.1016/j.physbeh.2005.08.045
Di Nardo, P. A., Brown, T. A., and Barlow, D. H. (1994). Anxiety disorders interview schedule for DSM-IV (ADIS-IV). Albany, NY: Graywind, 1–195.
Blessing, E. M., Steenkamp, M. M., Manzanares, J., and Marmar, C. R. (2015). Cannabidiol as a potential treatment for anxiety disorders. Neurotherapeutics 12, 825–836. doi: 10.1007/s13311-015-0387-1
At the commencement of the study, 40 teenagers with SAD participated, and 20 of them were assigned to the CBD group and the other 20 to the placebo group. This sample size was determined because the current study had been approved by the ethics committee on the condition that, as a pilot study, no more than 20 teenagers take CBD oil. Of the 40 participants, three in the CBD group declined daily treatment with CBD oil during the study because they disliked the smell and the taste of the oil.
The results of the measurements with FNE of the level of the symptoms that were associated with SAD are shown in Figure 1. When the collected data were analyzed by a 2 (period of measurements: preintervention versus postintervention, MEASUREMENT) × 2 (participant group: the CBD group versus the Placebo group, PARTICIPANT) repeated-measures ANOVA (analysis of variance), the main effect was statistically significant for MEASUREMENT (F1,35 = 10.35, p = 0.003, η p 2 = 0.0228) but not for PARTICIPANT (F1,35 = 2.69, p = 0.11, η p 2 = 0.071). The interaction between these factors was significant (F1,35 = 44.81, p < 0.001, η p 2 = 0.561). The mean FNE score (SD) of the CBD group was 24.4 (2.7) in the preintervention measurement and 19.1 (2.1) in the postintervention measurement and that of the placebo group was 23.5 (2.1) in the preintervention measurement and 23.3 (2.9) in the postintervention measurement.
Developmentally, SAD is likely to not only begin in adolescence (mid to late teens) but can also occur earlier in childhood (Somers et al., 2006). A significant number of adults report that they have had problems with social anxiety for their entire lives or as long as they can remember (Brown et al., 2001; Masataka, 2003). A large-scale study of individuals presenting at an anxiety clinic found a mean age of onset of 15.7 years, a number that was younger than the onset of other anxiety disorders (Merikangas et al., 2011).
Liebowitz, M. R. (1987). Social phobia. Mod. Probl. Pharm. Psychiatry 22, 141–173.