Greg Thorkelson, MD with Ryan Reagan, PhD(c), LPC

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If you follow health and wellness news you are aware of CBD as a popular remedy for a variety of ailments.  Even if you do not follow this area, you are likely to have encountered promotional material or advertisements celebrating its benefits.  For those less familiar, CBD is short for cannabidiol one of the compounds found in hemp. Cannabis sativa is the name of the plant from which both marijuana and CBD are derived.  However, unlike marijuana CBD contains no psychoactive substances. As a result, there is no high associated with CBD.  

You might be wondering then, what exactly is it doing to the brain?  The science on this is emerging but does show some promise.  Scientists have been able to observe changes on brain scans that suggest a calming effect in the regions of the brain associated with anxiety and depression.  This is interesting, because the more popular compound—THC is associated with increases in anxiety and psychotic symptoms when administered at high levels.  THC is the compound that produces the “high” associated with marijuana.  Because CBD did not produce such noticeable effects it received a lot less attention.

In the study where high doses of THC were administered, CBD was subsequently administered and shown to reduce the anxiety symptoms, suggesting that CBD might have a buffering effect when interacting with THC.  It is worth noting here that marijuana is a very complex drug, estimated to contain over hundreds of chemical compounds.  Levels of THC and CBD can vary amongst different strains.  Individuals also may respond differently; some find that marijuana increases anxiety while others find it sedating. This is not suggesting that CBD avoids this problem entirely.  Research has shown that a segment of people being treated with CBD reported worsening of anxiety symptoms.

One of the reasons that it is challenging to get accurate information on CBD is that there is a bit of a “wild west” scenario.  Our blog on mental health aims to provide up-to-date information and clarity when and where it may be lacking. While CBD supplements are legal, the market is new and not regulated by the FDA in the way that other drugs are.  In these situations, there is often a lag in time between quality research and what you may hear anecdotally.  This industry has seen considerable growth in recent years. With that type of growth, it can be challenging to pin down what we know from the “miracle cure-all” phenomenon that never survive the hype.  

How Does CBD Work on the Brain?

CBD is believed to have an impact on serotonin a neurotransmitter in the brain. Low levels of serotonin are implicated in depression and anxiety disorders.  Many of the popular antidepressants like Zoloft, Paxil, Prozac are in a class of medications called SSRI’s. These medications work to boos the level of serotonin in the brain. CBD molecules bond at the same receptor site as serotonin, making it more available.  It also appears to have activity in the parts of the brain associated with memory formation, which is implicated in anxiety disorders.  This makes sense since anxiety disorders tend to be associated with unpleasant memories.

CBD influences the body’s endocannabinoid system (ECS).  This system is involved in regulation of almost everything we do, including sleep, mood, perception, and immune responses.  CBD binds to one of the receptors within this system thereby supplementing its work.  Depression is commonly accompanied by sleep disturbance, and certain anxiety disorders (PTSD) may involve nightmares and flashbacks.  It is also believed that CBD may have an impact on GABA, a compound in the brain associated with the sleep and relaxation functions.

What Does the Research Say?

The research that has been done on CBD to date does show some promising results.  Again, because of the widespread distribution and marketing of CBD products it achieved its status as a popular remedy for nearly any ailment.  The most frequently cited are chronic pain, depression, and anxiety.  On one hand this is not surprising.  Anxiety is the most common mental health complaint, with an estimated 20% of Americans reporting some type of anxiety disorder.  In other words, you are highly likely to encounter someone who reports that CBD has helped with the treatment of anxiety.  

They may be on to something.  There is a growing body of research that suggests that CBD may be helpful in managing the symptoms of PTSD, Social Anxiety, Obsessive-Compulsive Disorder, Panic Disorder, and Generalized Anxiety Disorder.  You will find this citing among many of the articles that you search on CBD.  Keep in mind that this is a growing body of research.  This particular piece analyzed existing literature and drew the conclusion that there was support for its efficacy.

So, what does this actually mean?  It mans that there is support that CBD may be helpful for common anxiety disorders, but more research is necessary to establish specifics.  One of the challenges in psychological and psychiatric research is that there is a component that is always subjective.  The language of “depression” is commonly used to describe transient feelings of hopelessness and sadness.  This is different from suffering from an episode of Major Depression.  This is also true for anxiety.  There is a difference between feeling stressed and “high-strung” and suffering from actual Obsessive-Compulsive Disorder.  

The gold-standard of treatment for mental illness is still psychotherapy and/or medication.  Some disorders can be effectively treated with either and often both are done if there is significant impairment to daily functioning.  For those that are reluctant to take medications, or those that find the side-effects too distressing, CBD may be an option.  This should not be read that CBD does not have its own side-effects to consider, that will be covered below.  What we can say is that CBD might be helpful in relieving some of the distress associated with mild and lingering symptoms of these disorders.

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The research on depression is less supported.  However, anxiety disorders are associated with an increased risk of depression.  Having an anxiety disorder is an exhausting experience.  Chronic stress affects the body and the constant efforts to manage symptoms often lead to fatigue.  Many individuals that suffer from an anxiety disorder report bouts of rumination that easily transition to depression and despair.  Chronic pain also raises the risk of depression.  This can form a nasty cycle with anxiety and pain driving depressive symptoms.  Since CBD shows some evidence of helping to alleviate both pain and anxiety, it could be that it is helping to slow down this cyclical motion.

If you recall, the endocannabinoid system (ECS) is implicated in the maintenance of a wide variety of bodily functions.  It would not be surprising that CBD would find this space as a popular remedy for such a wide variety of ailments.  The FDA has approved use of medications for the treatment of epilepsy, and there is ongoing research to determine whether it is effective in treating spastic pain associated with multiple sclerosis.  It is also being explored for its potential to ease the side effects of chemotherapy.

One of the promising areas of treatment is its potential use to treat substance use disorders (SUD).  There is preliminary research that supports that CBD was helpful in easing the craving associated with drug cues.  Individuals with substance use disorders will often speak of triggers to relapse—the need to avoid “people, places, and things.”  CBD may be helping to take the edge off of the intensity associated with this symptom.  

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How Is CBD Taken?

CBD is sold in a variety of forms, including oils, tinctures, and supplements.  There are also methods for vaporizing and inhaling CBD.  Health Central recommends the use of oils or tinctures and “dry herb vaping.”  The latter method involves heating the flowers of CBD, avoiding the byproducts that come with smoking combustible material.  Tinctures use an alcohol-based solution that is taken orally under the tongue (sublingually).  This is believed to be the best route to getting the compound widely distributed.  The downside to supplements is that much of the compound can be destroyed in the gut.  

How Do I Obtain CBD?

This is also an area that is developing.  CBD is widely available on the internet and retail outlets that can differ from state to state.  There are some physicians with expertise in this area.  The Association of Cannabis Specialists and the Society of Cannabis Clinicians are two notable organizations.  One thing that is highly important is to discuss the use of CBD with any physician treating you.  There is sometimes an impression that products that are identified as “natural” or sold without prescription are somehow safer.  This is not true.  Many substances have interactions with other medications and substances including food.  The body is complex.  

Are There Side Effects and Concerns I Should Know About?

There are some side-effects to consider with CBD.  The most common side effects include changes in appetite, diarrhea, dizziness, drowsiness, changes in mood, and low blood pressure.  As with many medications, there can be interactions with alcohol or other sedating substances.  It is also not clear yet what the proper dosage is for effective treatment.  In one study there were different effects at 300, 600, and 900mg, with evidence that heat rate increased at the highest dose.  There was also note of increased liver enzymes, which may be an indicator of liver damage.  The effects of long-term use of CBD is not known at this time.  

Finally, one of the other concerns is that since the FDA does not regulate CBD products there can be wide variation in terms of quality.  In one study published in 2017 in the Journal of the American Medical Association it was found that 70% of CBD products sold online were mislabeled.  Furthermore, some of these contained THC the chemical found in marijuana.  While marijuana has been legalized in many states for the treatment of medical conditions, it is not necessarily supported in all areas including employment.  

Many employers routinely test for substance use either at the time of hire or thereafter, and compounds that were erroneously assumed not to contain THC could test positive on urinalysis.  This is incredibly important to consider for individuals who may be on other Medically Assisted Therapies (MAT) for substance use disorders.  It is recommended that anyone considering the purchase of CBD supplements to look for “third-party” verification as a quality measure.  This indicates that a third party has independently analyzed the product for what it is said to contain.

To summarize, there is a growing body of research to support some of the hype associated with CBD as a supplement to treat a wide variety of common ailments.  CBD is not a cure but may be an option in managing symptoms of anxiety and quite possibly mild depression.  It may be a good option for those who cannot tolerate medications, or simply do not want to take them.  It is not clear what the long-term impacts of CBD are since the research in this area is still emerging.  While issues of dosing and efficacy are worked out in the research it can be said that CBD appears to be relatively safe with minimal concerns.  As with any medication, discuss with your physician prior to using.

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