CBD and Mental Health - Could Cannabidiol be an Effective Treatment for Mental Health Problems?
Can Cannabidiol (CBD) be an Effective Treatment for Mental Health Problems? I get this question several times a day, here's what I learnt.
Relax and Keep Calm
Many people who use CBD oil, or cannabidiol as it is otherwise known, report that it helps them relax. I agree with this, but since using CBD, I’ve also noticed a considerable reduction in my anxiety levels. I’ve spoken about this to other CBD users and lots of them feel the same.
But is there actually any scientific proof that CBD is beneficial for our mental health? Although more clinical studies are needed, the research to date suggests that CBD could do more than just help us chill out and studies are underway into its effectiveness in treating a number of mental health conditions.
Firstly, What is CBD?
CBD is one of over a hundred phytocannabinoids (cannabinoids) derived from the Cannabis sativa plant. People around the world have been using cannabis for thousands of years to treat numerous ailments. But because the plant has psychoactive properties, people have also used it recreationally, to get “high.”
Around a century ago, various governments - for reasons I won’t go into now - began to demonise cannabis use. As a result of this, cannabis was banned in the UK in 1928, although doctors were still permitted to prescribe it for medical reasons. But as the “war against drugs” gained momentum, so too did recreational drug use. And an increase in cannabis use during the “hippy” movement in the 1960s arguably led to it being classified as a Class B drug in 1971. This meant that anyone in possession of, or using cannabis, could be prosecuted and even doctors were no longer allowed to prescribe it. (1)
But what you need to know is that CBD doesn’t get you high. Another, more well-known cannabinoid, tetrahydrocannabinol (THC), is responsible for the cannabis plant’s psychoactive effects. This is why CBD was legalised here in the UK in 2016. THC is still illegal, although it is licensed in some countries to treat Multiple Sclerosis (MS) and chemotherapy symptoms. (2)
CBD: an Active Compound?
Scientists actually isolated CBD from the cannabis plant back in the 1940s. Then, around twenty years later, the compound’s chemical structure was identified, which led to scientists carrying out more studies into its possible effects.
When studies established that CBD didn’t appear to exhibit expected cannabis-like actions (such as getting the user high), it was initially deemed a non-active compound. But then researchers began to notice that the different cannabis extracts they were using in the studies displayed varying levels of activity that weren’t dependent on the amount of THC they contained. This led a group of Brazilian scientists to test the hypothesis that CBD wasn’t inactive and could influence the effects of THC.
Ultimately, they came to the conclusion that CBD was indeed an active compound with the ability to exert various pharmacological actions.
CBD & THC
A number of animal studies conducted found that, depending on the ratio and dose, CBD appeared to both block and increase the effectiveness of certain effects of THC. Subsequent human studies backed this up: combining CBD with THC appeared to mitigate the symptoms of anxiety and psychosis triggered by high doses of THC taken on its own.The addition of CBD also increased THC’s effectiveness in relieving neuropathic pain. These findings led to the development of the drug Sativex - a combination of THC and CBD - for the treatment of MS-related pain and spasticity. (3)
CBD, THC and the Endocannabinoid System
Scientists have since determined that the reason THC and CBD exert different effects on us is down to the varying ways in which they interact with our body’s endocannabinoid system (ECS). Our ECS is a complex network of transmitters (endocannabinoids), cannabinoid receptors and enzymes. Its main function is to help regulate many physiological processes within our body, so we can stay healthy. Because it wasn’t identified until the 1990s, research into the many functions of this signalling system is still in its infancy, but it’s thought to influence the following:
- Appetite and metabolism
- Immune response
- Motor control
- Stress and mood
- Cardiovascular system function
- Liver function
- Skin and nerve function
- Bone remodelling and growth
- Muscle formation
- Learning and memory
- Sleep and circadian rhythm
CBD and its potential health benefits
The ways in which CBD Health Benefits and THC - along with some of the cannabis plant’s other lesser known cannabinoids - interact with the ECS, can positively influence a number of the above processes. Because of this, scientists now believe they have the potential to help treat a range of conditions, including:
- Chronic pain
- Multiple Sclerosis
- Type-1 Diabetes
- Anxiety and Depression
- Menopause symptoms
- Alzheimer’s Disease
- Respiratory disease
- Cancer and chemotherapy-related symptoms
- Neurological disorders
- Autoimmune diseases
- Skin diseases (4), (5)
The cannabis plant’s bad rep is preventing availability
Because the whole cannabis plant was illegal for such a long time, scientists are still playing catch up trying to figure out whether cannabinoids really are an effective treatment for these conditions. It also doesn’t help that there still exists negative “drugs are bad” associations.
Although CBD and THC are now licensed to treat a limited number of conditions (Sativex and Epidiolex to treat MS-related spasticity and epilepsy respectively), the eligibility criteria remains incredibly strict. Since the licenses were granted in 2018, only a tiny minority have been able to access either medication on the NHS. Unfortunately, nine months after the law change, only twenty patients had managed to get an NHS prescription for what’s now referred to as “medical cannabis.” (6)
Even in the private sector, less than a hundred prescriptions for medical cannabis were issued in 2019 - at a cost of at least £1000 each month! As highlighted in the mainstream media, this exorbitant price tag has driven parents with children suffering from severe epilepsy to source medical cannabis from abroad.
In fact, while it’s estimated that 1.4 million people in the UK use medical cannabis, the majority are still forced to source it illegally. This has led to calls for widespread clinical trials involving medical cannabis to further understanding and encourage mainstream acceptance and availability. (7)
Drug Science and Project Twenty21
To help address this issue, the non-profit research group Drug Science launched its Twenty21 initiative in 2019. Backed by the Royal College of Psychiatrists and with the support of cannabis companies, academic researchers and the United Patients Alliance, Project Twenty21 offers hope to those who are currently forced to break the law when accessing the medication they or their children rely on. (8)
Drug Science was founded by David Nutt, a former British Government chief drug advisor sacked in 2009 for voicing his belief that alcohol is more harmful than certain illegal drugs. Backed by an artillery of scientific evidence, Drug Science is on a mission to reform outdated, politically motivated drug policies - so that more people can reap the benefits from cannabis-based medications. (9)
With this in mind, Project Twenty21 will supply 20,000 British patients suffering from a variety of conditions - including PTSD and addiction - with subsidised medical cannabis, in an effort to gauge its effectiveness. It’s hoped that gathering a database of evidence of its efficacy will help pave the way for medical cannabis to be prescribed on the NHS, so many more people can legally access it in the future. (10)
Mental Health Problems
The term “mental health problems” encompasses a wide range of issues and conditions, from worries about every day life to serious, long-term illnesses. Unfortunately, many people believe that having mental health problems implies a certain weakness of character. Not only is this perception wrong, it’s also damaging because it prevents people accessing the help they need. Reversing this belief is important because with early support, most people suffering from a mental health condition can overcome or learn to manage their mental health problems. (11)
The impact of COVID-19 on mental health
Mental health is just as important as physical health yet it’s often stigmatised and sidelined. This is why the theme for this year’s World Mental Health Day, “mental health for all,” an urgent call for more investment and greater access for everyone, everywhere, is so significant. This is especially relevant right now because, according to a World Health Organisation survey, the COVID-19 pandemic has seen many mental health services around the world come to a complete standstill, at a time when people need them the most. (12)
In the UK specifically, the number of adults experiencing some form of depression has almost doubled during the coronavirus pandemic, rising from one in ten (9.7%) in the months leading up to its start, to one in five (19.2%) by June 2020. (13)
But even before COVID-19, there had already been an undeniable increase in people suffering from mental health problems. Between 1993-2014, there was a 20% increase in the amount of men and women with common mental health problems, with 1 in 6 people experiencing common mental health problems such as anxiety or depression in any given week. (14)
According to the National Institute for Health and Care Excellence (NICE), common mental health problems are:
- Generalised Anxiety Disorder (GAD)
- Panic Disorder
- Obsessive Compulsive Disorder (OCD)
- Post-Traumatic Stress Disorder (PTSD) (15)
Mental Health Statistics
Diagnoses of mental health conditions based on those over 16 living in private housing in England (report, mind.org)
- 8 in 100 - Mixed Anxiety and Depression
- 6 in 10 - Generalised Anxiety Disorder (GAD)
- 3 in 100 - Depression
- 2 in 100 - Phobias
- 1 in 100 - Obsessive Compulsive Disorder (OCD)
- Fewer than 1 in 100 - Panic Disorder
- Diagnoses that may change in their lifetime:
- 3 in 100 - Antisocial Personality Disorder (ASPD)
- 2 in 100 - Borderline Personality Disorder (BPD)
- Fewer than 1 in 100 - Psychotic Disorders (including schizophrenia)
(In reality the numbers are probably higher as they exclude those in hospital, prison, or homeless/rough sleeping).
Although the causes of mental health problems can be both varied and complicated, certain groups are more likely to be affected:
LGBTIQ+ people - are between 2-3 times as likely than heterosexual people to report mental health problems.
Black or Black British people - in any given week 23%, compared with 17% white British people, will experience common mental health problems.
Young Women, age 16-24 - in any given week 26%, compared with 17% of adults in general, will report having a common mental health problem, and the numbers are rising.
People who are homeless, have contact with the criminal justice system, or are engaged in substance misuse - in any given year, 40% will have a mental health problem.
The higher figures in these groups are linked with social inequality and disadvantage, discrimination and social exclusion, traumatic experiences and physical health. (16)
According to reports in England and Wales, around only 1 in 8 adults with mental health problems are receiving any form of treatment, with psychiatric medication being the most common. The reasons for this are varied. Some people are unable to recognise that they or those close to them are suffering from mental health problems and even if they do, they may not know how to access treatment. The stigma associated with mental health problems can prevent people seeking help, especially with regard to psychotic disorders and substance abuse. Certain ethnic or social groups are also much less likely to seek treatment. (17)
Treating Mental Health Problems
There are various ways to treat mental health problems, including Psychotherapy, Counselling, Cognitive and behavioural therapy. Some people need inpatient hospital or residential treatment.
Many people take prescription medications to treat mental health problems, but these often cause difficult side-effects, such as mood swings, weight-gain, sleeplessness and sexual dysfunction. Some can also cause more serious long-term health problems. This is why scientists are exploring whether CBD which, according to the WHO, is generally safe and well-tolerated, could be beneficial for certain mental health conditions.
Could CBD Treat Mental Health Problems and Illnesses?
To date, the research looks promising and suggests that taking CBD could help with mental health without many of the adverse effects associated with conventional medications. Read on to find out more.
Research has shown that CBD interacts with our ECS and has neuroprotective, anxiolytic (anti-anxiety), anti-depressant, anti-stress, antipsychotic and anti-inflammatory properties, indicating its potential to help treat a range of mental health problems and illnesses.
A 2015 review of previous studies suggests that CBD could be an effective short-term treatment for social anxiety disorder, generalised anxiety disorder, panic disorder and post-traumatic stress disorder. (18)
There’s definitely a need for more research into just how effective CBD is at treating mental health problems, but hopefully the findings of Project Twenty21 will kickstart more widespread clinical trials.
CBD and receptor activity
Our ECS has two known types of cannabinoid receptors: CB1 and CB2 receptors. Mainly located in the brain, CB1 receptors regulate neurotransmitter release in a way that halts excessive neuronal activity, thereby calming us down and reducing anxiety. These receptors also play a part in pain reduction and inflammation, the regulation of movement, posture control, sensory perception, memory and cognitive function.
Although CBD appears not to bind to either CB1 or CB2 receptors, it does however increase the availability of the ECS’s own endocannabinoids, which can in turn activate these receptors. For example, because it interferes with the breakdown of the endocannabinoid anandamide (named after the Sanskrit word for “bliss”and thought by some to be responsible for the phenomenon “runner’s high”), it could contribute to a more positive mood.
CBD also interacts with other receptors with anxiolytic, anti-depressant and neuroprotective results. It’s thought to help activate 5-HT1A receptors (serotonin, or “happiness” receptors) and is involved in the modulation of opioid receptors (which trigger brain reward systems). (19)
CBD and hippocampal volume
The hippocampus is a region in the brain associated with memory and the interpretation of environmental contexts. In animal studies, treatment with CBD has been shown both to increase production and prevent a reduction of neurons in the hippocampus region, therefore possibly leading to an increase in hippocampal volume. It’s thought this could help those diagnosed with schizophrenia and mood disorders such as PTSD, because in such patients less hippocampal volume has been detected. (20)
Always Exercise Caution
Please always check with your doctor before taking CBD for any mental health conditions, especially if you are already taking any other medications. Also, only purchase high-grade, third-party lab tested products so you know the exact quality and cannabinoid content of what you’re taking.
Anxiety is our physiological and emotional response to stress. When we feel threatened, our brain triggers a process known as the fight or flight response, an innate survival instinct passed down through generations which enabled our ancestors to react swiftly to avoid imminent death either by confronting danger or fleeing to a place of safety. This response activates our body’s alarm system and a surge of the stress hormones adrenaline and cortisol are released, causing a racing heart, shortness of breath, trembling, flutters in the stomach, nausea and sweating. We feel nervous and can exhibit hyper vigilant and avoidant behaviours.
The problem is that although most of us are lucky enough not to face the same acute danger on a daily basis our ancestors did, this response can nevertheless be triggered by comparatively harmless situations such as sitting exams, job interviews and public speaking. In certain ways, this anxiety is productive as it helps us prepare for and cope with stressful situations. But some of us may continue to feel anxious after the event. We may feel anxious much of the time and this anxiety may seem disproportionate to the circumstances. This is what is called an anxiety disorder and it can be very debilitating, affecting our ability to function on a daily basis, interfering with our social life, relationships, school and work. This type of persistent anxiety can also throw our body out of balance and lead to the onset of various health problems, such as heart disease and inflammatory conditions. (21)
There are various ways to deal with anxiety, such as relaxation techniques, mindfulness, meditation, yoga, walking and other forms of exercise. A GP may write a referral for CBT or they may prescribe medication. However, waiting lists can be very long and medications often cause various side effects.
How can CBD help?
Although more research is needed, the studies undertaken thus far suggest that CBD could help with anxiety.
36 patients undertook the Simulated Public Speaking Test (SPST). In this test, which is used to measure social anxiety disorder (SAD), participants’ heart rate, blood pressure and skin conductance (physiological measures of anxiety) are recorded while they speak in front of a video camera for a few minutes (known to be an anxiety-provoking test).
In this double-blind, placebo-controlled procedure, CBD was found to lessen the anxiety levels experienced by the participants undergoing the test. Patients with SAD who were treated with CBD exhibited fewer symptoms of anxiety than the placebo group and no more than the group without SAD. Other real life studies have been conducted, but more research is needed into the optimum beneficial CBD dose, (22) although in animal studies, lower doses have proved more effective. (23)
We all feel sad or depressed sometimes. It’s a normal reaction to loss or some of life’s many challenges. However, if you feel intense sadness that persists, along with a lack of interest in life, feelings of helplessness, hopelessness and worthlessness, it could mean that you’re suffering from clinical depression.
Symptoms of depression include:
- Feeling depressed most of the time, especially in the morning.
- Feeling tired/lacking in energy most days.
- Feeling worthless or guilty most days.
- Finding it hard to focus, remember things or make decisions.
- Being unable to sleep, or sleeping too much most days.
- Lacking interest or pleasure in many activities nearly every day.
- Frequently thinking about death or suicide.
- Feeling restless.
- Losing or gaining weight.
Because the brain chemicals linked to depression - serotonin and norepinephrine - influence both mood and pain, depression can also manifest itself in physical ways. You may experience joint or back pain, have digestive problems and changes in appetite.
Causes of Depression
Although scientists are yet to figure out the exact causes of depression, it’s thought they could include:
Brain structure - there appear to be physical differences in brain structure in people suffering from depression.
Brain chemistry - if neurotransmitters (chemicals in the brain that influence mood) aren’t functioning how they should, this could cause depression.
Hormones - imbalances or changes in hormone levels can trigger depression.
Genetics - people are more likely to suffer from depression if someone in their family has it. (24)
There are different types of depression and those who suffer from it can often have other mental health problems, such as anxiety, OCD, panic disorder, phobias, substance use disorders and eating disorders.
How can CBD help treating Depression?
Research suggests that the anxiolytic properties of CBD are responsible for it also functioning as an antidepressant. (25)
In animal studies, CBD has shown the potential to treat depression and PTSD through its activation of 5-HTP1A receptors, which reduced stress-related physiological and behavioural responses of rodents. (26)
Often described by doctors as a type of psychosis, Schizophrenia is a severe mental illness which changes the way you think and behave and can impact on your ability to cope with everyday life. Because schizophrenia can develop when you’re a teenager, the symptoms are sometimes mistaken for an adolescent “phase.”
Symptoms of schizophrenia are split into two groups, “positive” and “negative” and can include:
- Disorganised thinking
- Lack of motivation
- Change in sleep patterns
- Less interest in social activities
- Low sex drive
- Poor grooming or hygiene
- Slow movement
People can have episodes of especially severe symptoms (called acute schizophrenia), which are followed by periods of few or no symptoms. (27)
Past research has found negative links between cannabis use and schizophrenia. Apparently, the personality changes that can occur in those who abuse cannabis mimic those brought about by schizophrenia. Furthermore, the onset of schizophrenia has been shown to occur at an earlier age in those with a history of long-term cannabis use. There’s even evidence that cannabis could potentially trigger acute schizophrenic psychosis.
However, it’s also been noted that schizophrenic patients who use cannabis have more insight and experience less abusive or accusatory hallucinations, than those who don’t use it. (28)
How can CBD help treat Schizophrenia?
As already mentioned, CBD has anti-psychotic effects. The optimum dose for anti-psychotic effects tends to be higher than that for anti-anxiety effects. Research shows that CBD’s anti-inflammatory effects possibly facilitate its anti-psychotic effects.
In animal studies, CBD has been found to work in a similar way to clozapine, an atypical antipsychotic medication that is used to treat treatment-resistant schizophrenia. (29) It’s been found to reduce the rate of suicidal behaviour in those with schizophrenia and schizoaffective disorder.
In studies so far, CBD has been shown to be a generally safe and well-tolerated treatment for schizophrenia. (30) When taken with an atypical antipsychotic medication similar to clozapine, CBD appeared to reduce some of its side effects, such as memory deficits and social impairment.
One study in which 42 patients with schizophrenia were given up to 800mg of CBD each day showed a reduction in psychotic symptoms with fewer side effects than treatment with another antipsychotic medication, amisulpride. (31)
Post-Traumatic Stress Disorder (PTSD)
A relatively common, chronic psychiatric condition, PTSD can develop after you experience a traumatic event. A wide range of traumatic experiences can trigger PTSD. These can include any of the following:
- Experiencing domestic abuse/violence
- Experiencing emotional neglect, violence and abuse
- Being the victim of a violent or sexually motivated crime
- Witnessing someone being killed or seriously injured
- Surviving a serious accident or natural disaster
- Having a heart attack or receiving a serious medical diagnosis
- Experiencing war, torture or a terrorist attack
PTSD can cause a myriad of symptoms, both mental and physical, as the sufferer attempts to cope with the aftermath of the traumatic event/s. These can include:
- Panic attacks
- Mood disturbances - irritability, anger, aggression
- Anxiety and depression
- Reckless behaviour
- Disturbed sleep and nightmares
- Fearful and avoidant behaviour
- Lack of concentration
- Substance abuse
- Gut issues
- Reduced immunity (32)
How Can CBD help treat PTSD?
Research has found that CBD could be beneficial in the treatment of PTSD because of its anxiolytic properties. (33)
As mentioned earlier, treatment with CBD also potentially contributes to greater hippocamapal volume in the brain, which according to one study is associated with recovery of PTSD. (34)
In a retrospective review of DSM-5 diagnosed PTSD patients on a treatment regime of CBD and routine psychiatric care, a reduction in the severity of PTSD symptoms was noted. However, this study did not include a placebo or control group, dosing was not precise and other psychiatric medications were added, removed or changed at intervals (35)
The stress-coping mechanisms of people with PTSD don’t appear to function properly. Animal studies have shown that CBD can help to regulate these responses, so could be useful in treating PTSD. (36)
People who have Bipolar disorder can experience dramatic changes in mood, behaviour and energy levels, and is often characterised by periods with extreme highs and lows. Of course, it’s normal for us to go from feeling really happy one minute then sad or irritable the next, but with Bipolar disorder, these fluctuations can be far more severe. You may go through periods of feeling very happy and exhibit manic or erratic behaviour, which can followed by prolonged periods of hopelessness. This can have a profoundly negative effect on your daily functioning, relationships and work.
The three principal types of “episodes” are:
- Manic episodes
- Hypomanic episodes
- Major depressive episodes
Each can last anything from a few minutes to a few weeks and can vary between mild and extreme.
Bipolar disorder is thought to be caused by an imbalance in the brain of the neurotransmitters which regulate our mood, for example, serotonin, dopamine, GABA, and glutamate. Genetic inheritance, environmental and social influences are believed to play a part in this imbalance, with the following being some of the known causes of the disorder:
- Post-traumatic stress
- Hormone imbalances
- Neurotransmitter imbalances
- Neurodegenerative disorders
- Excessive mental stress
- Genetic disposition
- Chronic depression
But in many cases the exact cause cannot be fully identified, which contributes to the difficulty finding an effective treatment for this condition.
Treatments for Bipolar disorder include psychiatric therapy to identify any possible triggers and underlying causes such as mental stress or a history of abuse, and pharmaceutical medications to control the symptoms, such as:
- Mood stabilisers
(Any underlying hormonal imbalances should also be identified and treated.)
How can CBD help treat Bipolar Disorder?
Because CBD has been found to help protect the brain from damage and support healthy neurotransmitter function, it’s thought that it could help reduce the severity of bipolar disorder and stabilise mood. (37)
There are various anecdotal reports of patients with bipolar disorder successfully using cannabis to reduce symptoms of mania and depression. Others use it to supplement their lithium so they can reduce how much they need to take or to reduce its negative side effects. Various studies have also shown that CBD is beneficial in the treatment of mood disorders. (38)
A phase II trial comparing the long-term effects of CBD with that of a placebo in patients with a bipolar disorder diagnosis is currently being conducted, so watch this space for updates. (39)
So, is CBD the real deal when it comes to treating mental health conditions?
As shown, investigations into the use of CBD to treat mental health conditions are yielding promising results. However, we still need more research, especially into the long-term benefits of CBD on mental health. So, if you’re currently taking prescription antidepressants, anti-anxiety or anti-psychotic medications to treat a mental health condition, please continue to do so unless your doctor instructs you otherwise.
→ This article is not intended to diagnose, treat, cure or prevent any ailment, illness or disease.
→ For a full report on the recreational use of CBD read WHO's Critical Review Report on CANNABIDIOL (CBD)
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