Cannabidiol (CBD) in the Self-Treatment of Depression-Exploratory Study and a New Phenomenon of Concern for Psychiatrists
Gniewko Wieckiewicz, Iga Stokłosa, Maciej Stokłosa, Piotr Gorczyca and Robert Pudlo
Frontiers in Psychiatry, March 2022 | Volume 13 | Article 837946
doi : 10.3389/fpsyt.2022.837946
Cannabis sativa, whose flowers are also known as marijuana or marihuana, is a recreational plant that contains many chemicals that are constantly being studied by scientists around the world. One of these substances is cannabidiol (CBD), which has gained widespread popularity on the internet as a cure for mental health problems, leading many people to use CBD to self-treat depression and anxiety. This article presents an exploratory cohort study (n = 90) of a group of people aged 16–69 using CBD to self-heal depression symptoms. The survey included basic sociodemographic questionnaire and validated Hospital Depression and Anxiety Scale. And was distributed via the Internet. The results were statistically analyzed. High school degree was the most commonly held education (46%), large city was the most popular place of living (33%) and majority of the respondents have a full-time job (53%). Only 19% of the respondents consult their doctor or pharmacists about taking CBD. On the group of psychiatric patients, only 49% of respondents tell their psychiatrist about using the compound. Psychiatrists should be aware of CBD use in their patients during their daily practice, as CBD use can be found within people from all walks of life, and due to public interest, there is a need for education and research on the efficacy and safety of CBD use for mental disorders.
Keywords : cannabidiol, cannabis, marihuana, depression, self-treatment
Cannabis sativa, commonly known as marijuana or marihuana, is a plant with psychoactive properties used primarily for recreational purposes. However, in recent years, numerous studies have been conducted that have found its beneficial effects in the treatment of many diseases (1).
Marijuana-derived compounds, known for their antioxidant, anti-inflammatory, and antinecrotic properties, are considered promising agents that are increasingly used in research related to Parkinson’s disease, epilepsy, depression, anxiety disorders, and schizophrenia, as well as in the treatment of chronic pain (2–4). The substances contained in marijuana are called cannabinoid compounds. The most potent constituent of cannabis is natural tetrahydrocannabinol (THC), which is responsible for the psychoactive properties of marijuana (1). Among other compounds, one is especially notable–cannabidiol (CBD), a non-psychoactive compound which could be useful in depression treatment, as the studies have demon-strated the activity of CBD as a partial agonist of 5HT1a serotonin receptors, which could be beneficial in the treatment of depression and anxiety by using this substance, but this still requires extensive
CBD appears to be relatively safe substance in preliminary studies, but there are several side effects that should be mentioned. CBD is one of the better tolerated substances compared to THC, mainly due to its lower addictive potential (6). In the available literature, the adverse effects describedmainly refer to studies in animal models and depend on the dose taken and the duration of use. The use of CBD in animals resulted in the development of drug toxicity, increased fetal mortality, liver cell damage, inhibition of spermatogenesis, and hypotension, but it should be mentioned that the doses used in animals were above the recommended amounts for humans (7). The most common side effects reported in studies of cannabinoid use for epilepsy or psychotic disorders were fatigue, diarrhea, and appetite disturbances (8). Other side effects reported after CBD use included vomiting, insomnia, and hepatologic disorders. Nonetheless, in certain conditions CBD could be dangerous, as it is metabolized in the liver with the involvement of CYP3A4, which affects its interactions with many drugs that are also processed with the involvement of this enzyme system (including anti-fungals, clarithromycin, or rifampicin) (7).
The public is very interested in natural methods to treat depression. Scientists are focusing on the study of dimethyltryptamine (DMT), a psychedelic substance found in many plants, and psilocybin, a psychedelic that occurs naturally in mushrooms such as psilocybin cubensis (9). The popularity of CBD in the treatment of depression is as great in society as the popularity of the use of DMT or psilocybin-on October 15, 2021, the Google search engine returns 6,370,000 results for the term “CBD depression treatment,” and information on this topic can be found on such well-known websites as the New York
Times or Forbes (10, 11). Despite the great popularity that the use of CBD for depression enjoys on the Internet, in our opinion, the scientific data on the efficacy and safety of this substance in the treatment of depression remain sparse. It is not difficult to find groups on social media (e.g., Facebook) where experiences are shared about the use of CBD for self-care for mental health and where people (often without medical training) recommend certain products from the Internet along with dosage. Selfcare for mental health has its limits, and that is when patients turn to supplements and products purchased online without the knowledge of their doctor, as this is potentially dangerous. There are documented over-the-counter uses of St. John’s wort in combination with serotonin reuptake inhibitors that resulted
in the development of serotonin syndrome (12). Because we do not know much about CBD, we believe that people who use CBD to self-medicate should be closely monitored. We were unable to find appropriate studies describing this phenomenon in any disease, although previous literature suggests that selfmedication with CBD exists for chronic pain, anxiety, and depression (13). In our opinion, the availability of CBD on the retail market is disproportionate to the number of scientific reports on the efficacy and safety of CBD, because in many European countries such as Austria, Spain, Sweden, Germany or France you can easily buy CBD legally (14). This situation is potentially dangerous from a medical perspective for both patients and medical staff, as people risk potentially treacherous
intoxication by searching social media for unverified data on the ingestion of rather unknown substances. Therefore, as a group of psychiatrists, we decided to investigate the problematic phenomenon of using CBD to self-treat depressive symptoms, as it is important to learn more about the people who choose to do so. We aimed to explore the basic demographic and epidemiological characteristics of people who use CBD to selftreat their depressive disorders and to demonstrate the fact that this phenomenon exists. The study was exploratory in nature, therefore we did not rise any particular research questions.