CBD for Anxiety and Sleep in a Real World Setting

An intriguing study from the United States has found that low dose CBD decreased anxiety in mental health patients with an anxiety diagnosis.  It seemed to help sleep as well, but less so.

shutterstock_710293651Much existing cannabis research has been in Israel and Europe.  Restrictive Federal laws in the U.S. have prevented widespread study of the potential uses of cannabinoids.  Some clinician/researchers at a holistic mental health clinic in Colorado recently published a retrospective case study of patients with anxiety and sleep disturbance who had been prescribed CBD as part of their treatment.  The setting is a little unusual.  The authors described it this way:

Wholeness Center is a large mental health clinic in Fort Collins, CO, that focuses on integrative medicine and psychiatry. Practitioners from a range of disciplines (psychiatry, naturopathy, acupuncture, neurofeedback, yoga, etc) work together in a collaborative and cross-disciplinary environment. CBD had been widely incorporated into clinical care at Wholeness Center a few years before this study, on the basis of existing research and patient experience.

While the setting is unusual, there aren’t too many places where you could study the use of CBD in multiple patients.  The authors reviewed the cases of 103 patients who had been administered CBD over the previous year. 82 of the patients had a documented anxiety or sleep disorder.

According to the authors:

These results demonstrated a more sustained response to anxiety than for sleep over time. Patient records displayed a larger decrease in anxiety scores than in sleep scores. The sleep scores demonstrated mild improvement. The anxiety scores decreased within the first month and then remained decreased during the study duration.

Doses in the study were relatively low, ranging from 25mg per day to 175mg per day of CBD taken orally. Sleep quality was measured using the Pittsburg Sleep Quality Index and anxiety was measured using the Hamilton Anxiety Rating Scale. Some patients reported drowsiness during the first 2 weeks of treatment and this side-effect diminished over time.

The authors caution appropriately that these results might be due to placebo.  Future studies will need to compare low dose CBD to placebos in double-blinded studies.  This study is an interesting first step that confirms many of the anecdotal reports of CBD’s effectiveness for anxiety.

Reference: Shannon S, Lewis N, Lee H, Hughes S. Cannabidiol in anxiety and sleep: A large case series. Perm J 2019;23:18-041. DOI: https://doi.org/10.7812/TPP/18-041

Qi and The Endocannabinoid System

I’m having trouble wrapping my head around the endocannabinoid system (ECS).  This is apparently one of the body’s more complex systems – on the level of the digestive system, the nervous system, and the immune system.  It is believed to play a major role in maintaining homeostasis (balance) in the mind and body.  Where would I start writing about the digestive system (for example)?  How could I do it justice in this format? To get a sense of the complexity of the ECS see this 2012 “overview.”

shutterstock_623123291.jpgEndo stands is short for “endogenous”, which means originating within the body. Cannabinoids are the substances that activate the ECS.  We are more familiar with phytocannabinoids (plant-derived cannabinoids) such as THC and CBD.  After Israeli scientist Raphael Mechoulam and his associates discovered THC in 1963 (and later CBD) they began to search for how these substances worked. In 1991 they discovered that THC binds to certain sites in the brain and nervous system and they called these “CB1 receptors.” In 1992 the team found the natural substance that binds to this receptor and named it “anandamide.”  The team found another receptor, mostly in the gut and the immune system, and named it CB2.  They discovered the endocannabinoid 2-arachidonoylglycerol (2-AG) as a substance that naturally binds to the CB2 receptor (also binding to a lesser extent to the CB1 receptor).

So if the phytocannabinoid THC binds to the CB1 receptor, does the phytocannabinoid CBD bind to the CB2 receptor?  It would be great if it were that simple, but it is not. CBD does not bond directly to either CB1 or CB2 receptors but it appears to increase the level of natural cannabinoids (endocannabinoids). It is also a “negative allosteric modulator” to the CB1 receptor, actually reducing THC’s ability to bind with CB1.  This may be one reason that CBD seems to mellow THC’s high and decrease paranoia.  CBD also acts on chemicals like serotonin.  CBD’s ability to relieve pain is likely due to a different mechanism entirely.  It is the result of activating transient receptor potential vanilloid type 1 (TRPV1) receptors.

Got all that?  Me neither.

What I do get is the idea of homeostatis.  Wikipedia defines homeostasis as

“the property of a system in which variables are regulated so that internal conditions remain stable and relatively constant. Examples of homeostasis include the regulation of temperature and the balance between acidity and alkalinity (pH).”

The ECS appears to be responsible for regulating balance in the body.  Dr. Ethan Russo believes that some challenging syndromes, such as migraine headaches and fibromyalgia, are actually due to an endocannabinoid deficiency.  If our body produces too little anandamide and 2-AG (and other endocannabinoids) it may result in painful syndromes such as these. The implication is that cannabinoids may eventually be part of a treatment for migraines and fibromyalgia.

In China migraines and fibromyalgia might be addressed as imbalances in Qi (pronounced “chi”). Qi is the concept of vital energy.  Acupuncture meridians are thought of as channels for Qi in the body.  Qigong and Tai Chi are techniques for improving Qi.

Western Medicine is missing a system of vital energy.  Most systems of medicine around the world recognize the importance of this vital energy for the mind and body. The concepts of yin and yang are important components of Qi, and it is critical that yin and yang are balanced.  In Japan vital energy is called Ki.  In India it is prana.   Some Western medicine doctors understand that “the will to live” is an important component in someone’s battle against a chronic or terminal illness, but that’s about the only time you hear anything approaching this concept in the West.

Is the endocannabinoid system the same as Qi?  Do they at least overlap?  What do you think?



Why do People take CBD?

People take CBD (cannabidiol) for a lot of reasons.  Project CBD has developed a list of conditions and research on the effects of CBD on each condition.  I will not attempt to duplicate this here.  You should check it out at their site.

Some of the more common reasons that people take CBD include:

Seizure Disorders – In the U.S. there is a prescription form of CBD called Epidiolex that is approved to treat seizures that begin in childhood.  Lennox–Gastaut syndrome (LGS) is a complex, rare, and severe form of childhood-onset epilepsy. Dravet syndrome is a rare, catastrophic, lifelong form of epilepsy that begins in the first year of life with frequent and/or prolonged seizures.

Anxiety and PTSDStudies have shown that CBD can reduce anxiety.  Many currently approved medications, such as benzodiazepines, can cause dependence or have other side-effects.  People often take CBD to help with anxiety.

Fibromyalgia, Migraines and Irritable Bowel Syndrome – These disorders are thought by some to be a form of endocannabinoid deficiency.  CBD and other cannabinoids may become important in the treatment of these disorders.

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Photo by Oleksandr Pidvalnyi on Pexels.com

Pain – CBD can reduce both acute and chronic pain.  Scientists are still trying to understand this.  CBD isolate (CBD all by itself) works well in a fairly narrow dose range to treat pain, but full spectrum cannabis extracts seem to work in a wider range.  This finding has been called the “entourage effect.” CBD has anti-inflammatory properties and seems to help arthritis pain.

Psychosis – THC makes some people more paranoid and it is thought to induce psychosis in a small subset of people.  CBD can reverse these symptoms and it has been suggested as a possible treatment for schizophrenia. The early results have been mixed.

Sleep – Cannabinoids have been used to help improve sleep, but CBD’s effect on sleep is complex.  Low doses of CBD often appear to be activating, while somewhat increased doses are more relaxing.  CBD can decrease both anxiety and pain – and these are things that keep us up at night.

Cancer prevention and treatment – this is more controversial, but there is research suggesting that CBD and other cannabinoids inhibit cancer cell growth.

What do you use CBD for?  Does it help?  Please comment below or discuss this on reddit.