Mental health and CBD: what is the latest information

Drug Topics® is joined by Dr. Alex Capano, Chief Science Officer at Ananda professional, to discuss what CBD is used for mental health, where research should go, and how to ensure patients are getting effective CBD products.

Pharmacological Topics®: Hello and welcome to Over the Counter, a podcast by Drug arguments. In this episode produced in collaboration with Ananda Professional, we are joined by Dr. Alex Capano, who is Chief Science Officer of Ananda Professional, to discuss what CBD is for in mental health, where research should go, and how to ensure patients are getting effective CBD products. What is the role of CBD in mental health?

Alessio Capano: The most common reason people use CBD across the board and particularly in mental health is for anxiety, but that’s not the only role it plays. It is certainly a treatment option, or an adjunct to treatment, for people with PTSD. We see that it specifically reduces the nightmares associated with PTSD. It can also be used for people who have social phobia disorders. So not your generalized anxiety disorders, but really just social phobia. So we’re actually seeing some really interesting work and data on things like ADHD, Alzheimer’s, and other psychiatric conditions.

Drug Topics: What are some conditions CBD is commonly used with?

Capano: Most commonly it is certainly anxiety. For a variety of reasons, it works and anxiety is quite common too, unfortunately. We have a good amount of data, evaluating the safety and efficacy of CBD in anxiety. So this is the most common reason.

Drug Topics: Are there some conditions under which CBD is not suitable for use?

Capano: Interestingly, I don’t think CBD is great for major depressive disorder, where anxiety isn’t a component of it. If there is a depressive problem and anxiety is a component, which happens often, CBD can definitely help with anxiety. But the depression itself, I’m not really obligated by the data. I actually think there are other plant-based medicines or options, and even psychedelics, that are much more promising in treating depression than CBD. It’s not like it’s dangerous. I just don’t see compelling effectiveness like other options. It won’t really replace an SSRI for many people, unless they’re just using it for anxiety, which is atypical.

CBD is not a problem in this case, I want to be clear on this, but some CBD products contain low levels of THC. I think it’s important to remember that THC shouldn’t be used, without a real reason and weighing the pros and cons, in anyone whose frontal lobe isn’t fully developed, because it can slow down frontal lobe maturation, so really between 21 and 25. So you won’t do anything to your frontal lobe because it is what it is. Hence, I warn the use of THC in younger patients. Additionally, if someone has a predisposition, family history, or even a personal history of psychosis, schizophrenia, or bipolar disorder, THC can actually aggravate it and increase the likelihood of it coming back or turning on with the predisposition. So, again, CBD isn’t a problem for that. It doesn’t work the same way in the brain, but if you’re in that field, you’ll definitely want to get a CBD product that doesn’t contain THC.

Drug Topics: So, as you said, many people use CBD for anxiety. What is known about why it is so effective in relieving anxiety?

Capano: Well, if we look at the studies, there are a handful, and more coming out, of studies that look primarily at anxiety and overall see an improvement in anxiety, both in the acute phase, in social phobia, for example, but also long-term, after a month or a couple of months of use, or even just a couple of weeks. We also see a lot of studies where anxiety may not be the main outcome they’re measuring, maybe it’s pain or sleep or something else, but they’re also measuring anxiety. And then we see that secondary outcome where anxiety has a statistically significant improvement. There are indeed dozens of studies that measure anxiety as a secondary outcome. If you are wondering how it works, the truth is that I don’t think we have fully understood all the mechanics of CBD yet. I know we don’t. And I don’t know if we will really do it in my life.

Two ways it helps with anxiety that we know are that it activates and increases the activity of the serotonin 5-HT1A receptor, which is associated with anxiety, even nausea. So this is one of the ways and then another way to improve anxiety is to increase one of our endogenous cannabinoids, hence the ones we produce in our brain on our own. It is a neurotransmitter known as anandamide. And anandamide gets its name from the word ‘ananda’ in Sanskrit and many languages, which means bliss, because this neurotransmitter makes us feel really good. It is associated with an improvement in mood and a decrease in anxiety responses. We don’t produce much of it and then our body eats it very quickly and it goes away. So CBD, that enzyme that devours anandamide, basically inhibits it. So, by inhibiting the enzyme that eats anandamide, it prolongs its half-life and gives you more of your bliss neurotransmitter, circulating in your body, giving you that feeling of bliss. These are the mechanisms that I feel very confident about. I’m sure we’ll find out more over time.

Drug Topics: How can pharmacists ensure that customers are using CBD products safely?

Capano: Well, choose transparent, quality-guaranteed CBD products. So you know they’re using what you want them to use, which is CBD, and that’s the right dose of CBD. That there are no contaminants or really high doses of THC that shouldn’t be in hemp products, because that wouldn’t be legal and could actually exacerbate many different psychiatric conditions. After doing due diligence to put a good product in your store and recommend it, really guiding patients on dosage. Start low, go slow. I feel like I always say that and it’s an industry standard, but it’s really best practice. You want to see how you respond to this. I advise people to try it in the evening, at home, a couple of hours before bed for the first time just to see: are they really sensitive? do they get drowsy from it? Because if so, then they don’t want to take it in the morning on their way to work. Then dosing times, titrating slowly until you really find that sweet spot because this is a bell-shaped dose response curve. More is not always better. This is truly personalized medicine. Although the therapeutic range is not that wide. So it really doesn’t take long to titrate to that optimal dose.

And then consider other medications people are taking. CBD is metabolized via CYP450 enzymes. So are over 50% of prescription and non-prescription drugs. People often worry about drug interactions. I understand. The reality is that drug interactions with CBD don’t occur, to the point where everything we’ve seen in the data, up to very, very high doses. Super therapeutic doses that don’t really reflect real-world use outside the control of severe pediatric seizures and again are pretty benign. Evaluate other medications, talk to patients about possible signs of interaction, but trust that the doses that almost everyone is taking for an over-the-counter product are 10 to 100 times less than what we see as a dose that actually causes any interaction significant with other drugs that are metabolised via CYP450.

The only drug that is always a problem is blood thinners. If you have someone taking blood thinners and using CBD, again, that’s fine. You still have that really nice leeway, it seems like it’s the only class where there is a lower threshold for interaction, but that threshold is seen at 10 milligrams per kilogram of body weight, for that patient. I don’t know anyone who is taking 10 milligrams per kilogram of CBD, that’s really very high. Once again reassure yourself, but tell them “this is not the week or the 2 weeks, so as not to check your INR, your PT, however you are measuring the effectiveness of your anticoagulant”. If you see a change, go back and adjust your dose. It doesn’t mean it’s a contraindication. You just want to watch it and adapt it if necessary. Blood thinners may need to be reduced over time.

Drug Topics: What questions about using CBD in mental health care do you think should be a research priority?

Capano: 2 really fascinating things came to mind. One is that I think we should start considering, and are starting to start, CBD as a prevention. Not just treatment, but actually preventive medicine for neurodegenerative diseases such as Alzheimer’s and other forms of dementia. There is some pretty compelling evidence out there in animals, and many researchers are looking at it in humans right now. Can this actually not only treat the symptoms associated with Alzheimer’s dementia, but can it actually prevent or slow the process in the first place? I think it’s really important. Alzheimer’s is on the rise globally. We want to live well and live well longer. It’s not just about lifespan, because we are living longer than ever. It’s really about health. Someone told me recently and I thought it was a great way to say it. I think preventative medicine keeps our brains as healthy as our bodies.

Also, similar to neurodegenerative disorders is post concussion syndrome or chronic traumatic encephalopathy (CTE). This is really common. Even high school athletes who play soccer, play soccer, get these repeated concussions, even if they are mild concussions. One study showed that 99 out of 100 football players, not even all professionals, had signs of CTE or post concussion syndrome in their brains. There is also evidence that having CBD on board reduces the negative impacts of such injuries, both acute and chronic. I think this is something that is really scary. We see and hear more and more. I think, looking at prevention, if someone is an athlete or is at risk for repeated head injuries or impacts, they are using something to preserve their brain health in the long term.

Drug Topics: And what did research on CBD in the mental health space discover that you found surprising?

Capano: I think the research on pediatric psychology surprised me. I hope it continues to be a priority for people who have started watching it. There are research groups and institutions that evaluate CBD as an option for people, mainly children, with ADHD and see that it is much better tolerated and actually effective, or at least as effective as many of the commonly used stimulants. They are finding the same results in autism spectrum disorder. ADHD, an autism spectrum disorder, one might argue, is more or less the same spectrum. I was surprised, and pleasantly surprised, by the promising results in the data using CBD in the pediatric population for those very common ailments. I am pleasantly surprised. I hope to see even more, but I think in pediatrics we need better options that make our children feel like themselves and able to thrive. I think we will see here that CBD is a viable therapeutic alternative.

Drug arguments: And as always, thanks for listening, and we hope to see you next time, at the counter.

Leave a Comment

Your email address will not be published. Required fields are marked *