SAN DIEGO — With cannabidiol, or CBD, becoming increasingly popular, a presenter here at Psych Congress discussed what that can mean for psychiatrists.
CBD is a nonintoxicating, but psychoactive cannabinoid with multiple mechanisms of action that has the potential to lend well to multiple medications in psychiatry, Andrew Penn, MS, NP, associate clinical professor of nursing at University of California, San Francisco, said in his presentation.
CBD is only legal if from industrial hemp or from FDA-approved medicine, according to the presentation. Epidiolex, an oral solution of CBD, is FDA-approved for Dravet syndrome and Lennox-Gastaut syndrome.
The limited research has also shown that CBD may be a complement to some existing psychiatric medicine, may improve sleep, anxiety and PTSD, and possibly have antipsychotic effect. However, it remains unknown how CBD will be used in psychiatric research and practice now that there’s a prescription form of the drug on the market, according to the presentation.
Penn discussed how CBD’s mechanism of action differs from tetrahydrocannabinol (THC). Actually, one of the things that CBD is known for is countering the effects of THC. Penn also highlighted that there are more than 550 phytochemical compounds identified in cannabis and CBD is just one of them.
“The way that it’s been drawn up until this point is that THC is the ‘bad guy’ — THC is the thing that makes you psychotic, develop a dependency problem, become anxious, disrupts your intellectually development (and some of those things are partially true); CBD is kind of portrayed as the ‘ good guy,’” he said. “But really the difference is not black and white. THC isn’t the ‘bad guy’ and CBD isn’t the ‘good guy.’ It’s way more complicated than that — they both are just compounds at this point. So, we have to figure out how to work with them.”
Clinical research related to psychiatric disorders is limited, and most of the information is anecdotal user data.
“We don’t have enough info, so in the absence of information, we have stories. Sometimes stories are helpful, and sometimes they’re misleading. We have a lot of stories and we need more data, but the reality is that we can’t wait for that,” Penn said.
Regardless of the limited research, patients will continue to use CBD, most of the time in much smaller doses than what is seen in the few studies, Penn said. Some advice he offered clinicians was to tell patients not to stop taking their medication and replace it with CBD, and instead consider adding CBD to existing medication and to avoid significant THC doses.
“We need to know a lot more. We need to know how we can use lower doses, will CBD work as a rapidly-acting antidepressant and what happens when we use it for a long period of time? A big question I have is now that we have Epidiolex on the market, are we going to start using it in psychiatry?” he said.
CBD also needs clearer regulations and labeling. It should be determined whether this is a medicine, supplement or food product, which all have different regulatory, labeling and approval processes, according to Penn.
“We’re in this in-between place, we’re not really sure where this is going. CBD is maybe nonintoxicating, but it’s certainly psychoactive, has multiple mechanisms of action and it may turn out to be quite useful in psychiatry, but we need to study this a lot more,” he said. “What I encourage you to do is get curious. Gather information from you patients and if you’re feeling so inclined, put it out in the world and publish it because we need a lot more information for this to be helpful.” – by Savannah Demko
Penn, A. Confused about CBD? A scientific and rational examination of its risks and benefits in psychiatry. Presented at: Psych Congress; Oct. 3-6, 2019; San Diego.
Disclosure: Penn reports no relevant financial disclosures.