Can CBD Oil Make You Feel Depressed

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Cannabis sativa, also known as marijuana or marihuana, is a recreational plant that contains many 8 chemicals that are constantly being studied by scientists around the world. One of these substances is 9 cannabidiol (CBD), which has gained widespread popularity on the internet as a cure for mental 10 health problems, leading many people to use CBD to self-treat depression and anxiety. This article 11 presents an exploratory cohort study (n = 90) of a group of people aged 16-69 using CBD to self-heal 12 depression symptoms. The survey included basic sociodemographic questionnaire and validated 13 Hospital Depression and Anxiety Scale.and was distributed via the Internet. The results were 14 statistically analyzed. High school degree was the most commonly held education (46%), large city 15 was the most popular place of living (33%) and majority of the respondents have a full-time job 16 (53%). Only 19% of the respondents consult their doctor or pharmacists about taking CBD. On the 17 group of psychiatric patients, only 49% of respondents tell their psychiatrist about using the 18 compound. Psychiatrists should be aware of CBD use in their patients during their daily practice, as 19 CBD use can be found within people from all walks of life, and due to public interest, there is a need 20 for education and research on the efficacy and safety of CBD use for mental disorders. Cannabis is an illegal drug which can affect your mental health. Find out about the effects cannabis can have on your mental health, and how to get support. I started taking CBD oil then hemp oil because I had heard many accounts of its anxiety and pain-reducing benefits. After a couple of months of increased anxiety I made the connection between the hemp oil pill and my depressed mood. When I stopped taking the hemp oil I felt an immediate improvement in my emotional well-being. My story is not typical, but I wanted to tell it to help others who may have had a similar experience.

Cannabidiol (CBD) in the Self-Treatment of Depression-Exploratory Study and a New Phenomenon of Concern for Psychiatrists

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.

Introduction

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 com-pounds. 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 research (5).

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 described mainly 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. Self-care 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 self-medication 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 self-treat 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.

Materials and Methods

The study was designed by psychiatrists from the Department of Psychiatry at the Medical University of Silesia in Katowice and was conducted according to the guide-lines of the Declaration of Helsinki and Good Clinical Practice. It included 23 questions in Polish in the areas of: general sociodemographic parameters, general psychiatric interview of patients, questions related to CBD intake: frequency, dosage and form of consumption, improvement of wellbeing after CBD intake and additionally included the Hospital Anxiety and Depression Scale (HADS) questionnaire. The HADS is one of the most widely used self-assessment questionnaires for screening anxiety/depression symptoms and focuses mainly on the cognitive and psychological aspects. It is used in both the general medical population and the healthy population. The HADS consists of a total of 14 items on 2 separate subscales: Anxiety (HADS-A) and Depression (HADS-D), and the total score ranges from 0 to 42 points. Currently, the categorization system includes several groups: 0–7, normal; 8–10, mild; 11–15, moderate; over 16, severe (15). The survey was uploaded to the Internet via Google Forms, Google’s original online survey tool. The form consisted of 5 separate pages-consent to the study, questions about demographic data, questions about previous psychiatric treatment, questions about CBD use, and the HADS questionnaire. Data were collected via Facebook from August 27, 2021 to September 16, 2021. We asked administrators of depression, mental illness, and CBD use groups and websites to help us collect data, and they actively provided a link to the form on their websites, therefore we could not estimate the amount of people who received the link to the survey. Incomplete questionnaires were rejected. To ensure complete anonymity, as marihuana is still generally a taboo subject, no personal or contact information was collected, including email addresses or IP addresses that would identify respondents. For that reason, we had to avoid sampling methods that would be normally used in such study. We had to avoid using data collection enhancement methods, as they would require us to use more complex technical methods that would not allow data anonymization. Participation in the survey was voluntary, respondents were informed of the purpose of the survey and were required to answer in the affirmative to the first question “I use CBD oil to improve symptoms of depression and agree to participate in this anonymous study (or as a minor, I have the consent of my legal guardian to participate),” otherwise they were not given access to the questionnaire. Ninety seven responses were collected, of which 7 subjects, after reading the manual, did not agree to submit their anonymous responses to analysis.

The collected data were analyzed using STATISTICA 13.0 software (StatSoft, Kraków, Poland). Qualitative variables were tested using the chi-square test. The Shapiro-Wilk test was used to check whether quantitative variables conformed to the normal distribution. The test revealed that not all variables conformed to the normal distribution. In case of non-normal distribution, Mann-Whitney U test was used to compare two independent groups, while Kruskal-Wallis test was used to compare multiple independent samples. Spearman’s rank order correlation test was used to test the relationship between the variables. Statistical significance was assumed at p < 0.05.

Results

We collected 90 correctly completed questionnaires from the respondents. The study comprised a group of males and females of comparable size who did not differ significantly in age, education and type of occupation. One person reported being non-binary and was excluded from the statistical analysis. The youngest respondent was 16 years old and the oldest was 69 years old. 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%). Majority of the respondents claim that they either trust or probably trust the psychiatrists. The detailed characteristics of the study population are shown in Table 1. There is no difference in trust in psychiatrists between the groups. Respondents’ place of residence differs between gender groups, but the significance level is borderline, which could be tested if a larger sample of respondents were used.

Table 1. Sample characteristics.

Majority of the respondents were or still are treated by a psychiatrist (55%) and started using CBD for depressed mood (69%). The most commonly consumed other psychoactive substance was caffeine (47%). Only 19% of respondents consulted a doctor or pharmacists about taking CBD, and most respondents (59%) consume CBD daily. Majority of the respondents (57%) are currently under the supervision of a psychiatrist and a little over half (51%) do not tell their psychiatrists about their use of CBD. Majority of respondents said they felt better after CBD treatment (86%). The detailed characteristics of CBD use for self-treatment of mental disorders are shown in Table 2.

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Table 2. CBD consumption characteristics.

Women were more likely to be diagnosed or treated by a psychiatrist compared to men (χ 2 =; 6.19 p = 0.01; chi-square test). Among the psychiatric disorders treated, men were significantly more likely to be diagnosed with anxiety disorders (χ 2 = 4.87; p = 0.027; chi-square test). No significant difference was found between genders for the other disorders. Women were significantly more likely than men to take CBD due to insomnia (χ 2 = 5.07; p = 0.024) and energy depletion (χ 2 = 3.72; p = 0.05 (borderline); chi-square test). Men were significantly more likely than women to use THC (χ 2 = 5; p = 0.025) and alcohol (χ 2 = 7.06; p = 0.008 chi-square test).

Men were significantly more likely than women to learn about CBD from the Internet, while women learned from friends and family (χ 2 = 8.61; p = 0.04 chi-square test). Respondents most frequently purchased CBD from online stores, while the most common form of CBD consumption was CBD oil, which was significantly more frequently consumed by women (χ 2 = 7.12; p = 0.03 chi-square test).

Majority of the respondents (53%) claim that CBD made them feel overall better and 88% of the respondents would more likely take CBD than a prescription drug from a psychiatrist. Table 3 shows detailed psychiatric outcome analysis for respondents using CBD.

Table 3. Assessment of CBD effects on mental health of respondents.

Out of respondents who are or were treated by a psychiatrist, the most commonly drugs prescribed were selective serotonin reuptake inhibitors (16%). Table 4 shows which prescription medications were or are being taken by respondents. Greater improvement in wellbeing was reported by younger respondents (r = −0.22; p < 0.02; Spearman's rank-order correlation). There was no correlation between reported improvement in wellbeing after CBD use and: (1) frequency of CBD use, (2) amount of CBD dose taken, or (3) form of CBD use.

Table 4. Psychiatric medications taken by respondents.

Under the HADS Anxiety subscale, 69% of respondents qualified for the group that exceeded the norm criteria (score > 7 points), while in the case of the HADS sub-scale, 47% exceeded this cut-off point.

93% of the respondents did not observe any negative effects of CBD consumption. Two respondents reported the occurrence of anxiety disorders during therapy, while 1 respondent reported the following symptoms: depressed mood, addiction, diarrhea, xerostomia.

Only 17% of respondents reported that they were currently taking psychotropic drugs. This group is too small to perform a statistical analysis using the above statistical tests. 49% of respondents admit to having taken the above drugs in their lifetime. Individuals who admit to taking psychotropic drugs in the past are significantly more likely to trust psychiatrists (p < 0.0001; Mann Whitney U test).

Discussion

The path to the use of CBD in psychiatry is partially clear, as CBD has been approved by the U.S. Food and Drug Administration as a drug for the treatment of drug-resistant epilepsy, suggesting that the compound has a satisfactory long-term safety profile for this neurological condition (16). Data on the benefits of CBD in reducing the severity of depressive symptoms and anxiety are limited but promising. Some studies show that CBD is useful in treating depression, anxiety, sleep disorders and even problematic cannabis use, as well as in reducing the positive symptoms of schizophrenia, with little to no side effects such as diarrhea, which decreased over time (17, 18). Clinical studies are also encouraged by the authors of publications summarizing the achievements of science in the field of CBD use in psychiatry. They point out that studies in larger groups of people are necessary not only to determine the safety and usefulness of the substances in psychiatric treatment, but also to determine the efficacy of the treatment in the context of differences in symptoms of gender disorders, since most clinical trials have been conducted mainly in men (19, 20). There is still too many question marks to not monitor people who use CBD on their own. The situation in which patients decide to self-medicate their symptoms with a drug for which there is, for the time being, limited evidence of efficacy and safety is potentially dangerous because, apart from the side effects, such actions may worsen their mental state through the natural progression of depressive disorders, especially since some respondents choose to take more than CBD, including THC or hallucinogens, which may not be neutral among respondents.

The survey involved people of different ages (both minors and retirees), with different levels of education, and living in both rural and urban communities, which means that the use of CBD for self-treatment of depression is not limited to certain social groups. This information may be useful in further planning of scientific and educational activities in this area.

When analyzing the above responses, it should first be noted that only 19% of respondents consulted their doctor or pharmacist about taking CBD. At the same time, in the group of psychiatric patients, only 49% of respondents informed their psychiatrist about the use of CBD during psychiatric treatment. This situation is potentially dangerous because when patients buy CBD outside the pharmacy, this sale escapes the control of the pharmaceutical regulatory authority, which may encourage the accidental ingestion of other substances than intended, because when sales are outside the control of pharmaceutical regulators, consumers need to trust the honesty of the sellers. The situation of physicians and pharmacists being informed by the patient of the use of a psychoactive substance that is not an approved drug for the condition being treated is also extremely difficult. Categorical prohibition is unlikely to be effective, but it will limit the patient’s honesty at subsequent visits, and acceptance of this state of affairs means that the patient accepts responsibility-at least in part – for the possible adverse effects of taking a psychoactive substance. The situation of physicians and pharmacists will not improve until they have accurate knowledge of the effects of CBD in various clinical situations and of interactions with the most common psychotropic drugs. There is an urgent need to complete this knowledge.

An important element in the mystery of the CBD phenomenon is the chemical composition of the oil itself or the dried fruit you buy. You should keep in mind that in addition to CBD and other cannabinoids, there are substances from other chemical groups, such as terpenoids, flavonoids, and alkaloids. It is possible that these substances may have an impact on the patient’s wellbeing (21). It is important to know this because a possible complex antidepressant effect of Cannabis sativa- derived substances cannot be excluded. Research suggests that CB1 and CB2 receptors are associated with depression and bipolar disorder, and a single nucleotide polymorphism in the CB1 receptor has been observed in patients with treatment-resistant depression (22). CBD is an agonist of the 5HT-1A receptor, which in combination with its action on cannabinoid receptors may lead to a new unique effect (5).

As mentioned in the introduction, the media is eagerly interested in the topic of using CBD to treat depression, and society is picking up on the topic in social media. In public discourse, healthcare professionals should stick to facts. There is not enough data to conclusively confirm or rule out the claim that CBD is useful in treating mental illness. Given the social aspect of CBD use, further research by interdisciplinary teams made up of psychiatrists and pharmacists seems well warranted.

The responses collected shed light on another aspect. When planning further research on the use of CBD to improve symptoms of depressive disorders, it is important to pay attention to validated instruments that help in the diagnosis of depression. The responses to the question about reasons for starting CBD use may suggest that although we asked about self-treatment of depression, and this was clearly explained in the survey instructions and in the first question, some of the public may not fully understand the nature of this disorder. Patients could be suffering from major depressive disorder or mixed depression-anxiety disorder, and since it makes a difference in terms of the proper medical solutions offered byphysicians, it may not make a difference to patients. They might just call both disorders “depression,” whereas according to our HADS-A and HADS-D results, anxiety is actually more prevalent in our study group. Differentiating the causes of depressive disorders on the basis of the currently used International Statistical Classification of Diseases and Related Health Problems will make it possible to reduce methodological errors, contribute to a more rapid resolution of scientific problems and avoid inaccuracy in providing data to other scientists.

Study Limitations

This study is probably the only study to examine the extent of self-treatment of depression with CBD, but it is not free of limitations. The data was collected during COVID-19 pandemic, which could have an impact on the respondents wellbeing in terms of depressive and anxiety symptoms. Due to anonymity of the study, the study was anonymous and was not prospective, therefore, we could not explain if CBD actually helps people who use the substance. The survey was conducted over the Internet, which limits the ability to rule out respondent error in completing the survey and prevents intentional bias from being ruled out. A small group of respondents does not allow for indepth statistical analysis and it is not necessarily representative for the population; furthermore, the selection of the group depends on activity on the Internet. However, the exploratory nature of this study provides solid justification for further research and analysis in this area.

Conclusions

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 for self-treatment of depression due to depressed mood. Due to public interest, there is a need for education and research on the efficacy and safety of CBD use for mental disorders.

Data Availability Statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics Statement

Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. Written informed consent from the participants’ legal guardian/next of kin was not required to participate in this study in accordance with the national legislation and the institutional requirements.

Author Contributions

GW: conceptualization, project administration, and visualization. GW and MS: methodology and software. GW and RP: validation and writing—review and editing. GW, IS, and MS: formal analysis, investigation, and writing—original draft preparation. GW and IS: resources. MS: data curation. PG and RP: supervision. All authors contributed to the article and approved the submitted version.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Acknowledgments

The authors would like to thank Kombinat Konopny, HempNation, Dr. Konopny Siedlce, and Depresja, Stany Lekowe, Ataki Paniki, Fobie. Grupa integracyjna. Facebook group for making their networking channels available so the authors could collect the data.

References

1. Borowska M, Czarnywojtek A, Sawicka-Gutaj N, Woliński K, Płazińska MT, Mikołajczak P, et al. The effects of can-nabinoids on the endocrine system. Endokrynol Pol. (2018) 69:705–19. doi: 10.5603/EP.a2018.0072

2. Campos AC, Fogaça MV, Sonego AB, Guimarães FS. Cannabidiol, neuroprotection and neuropsychiatric disorders. Pharmacol Res. (2016) 112:119–27. doi: 10.1016/j.phrs.2016.01.033

3. Millar SA, Stone NL, Yates AS, O’Sullivan SE. A systematic review on the pharmacokinetics of cannabidiol in humans. Front Pharmacol. (2018) 9:1365. doi: 10.3389/fphar.2018.01365

4. Aviram J, Samuelly-Leichtag G. Efficacy of cannabis-based medicines for pain management: a systematic review and meta-analysis of randomized controlled trials. Pain Physician. (2017) 20:755–96. doi: 10.36076/ppj.20.5.E755

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5. Russo EB, Burnett A, Hall B, Parker KK. Agonistic properties of Cannabidiol at 5-HT1a receptors. Neurochem Res. (2005) 30:1037–43. doi: 10.1007/s11064-005-6978-1

6. McFadden BR, Malone T. Homegrown perceptions about the medical use and potential abuse of CBD and THC. Addict Behav. (2021) 115:106799. doi: 10.1016/j.addbeh.2020.106799

7. Huestis MA, Solimini R, Pichini S, Pacifici R, Carlier J, Busardò FP. Cannabidiol adverse effects and toxicity. Curr Neuro-pharmacol. (2019) 17:974–89. doi: 10.2174/1570159X17666190603171901

8. Iffland K, Grotenhermen F. An update on safety and side effects of cannabidiol: a review of clinical data and relevant animal studies. Cannabis Cannabinoid Res. (2017) 2:139–54. doi: 10.1089/can.2016.0034

9. Wieckiewicz G, Stokłosa I, Piegza M, Gorczyca P, Pudlo R. Lysergic acid diethylamide, psilocybin and dimethyltryptamine in depression treatment: a systematic review. Pharmaceuticals. (2021) 14:793. doi: 10.3390/ph14080793

10. CBD Oil Benefits by New York Times. Available online at: https://www.nytimes.com/2019/10/16/style/self-care/cbd-oil-benefits.html (accessed September 16, 2021).

11. CBD Oil Benefits by Forbes. Available online at: https://www.forbes.com/health/body/cbd-oil-benefits/ (accessed September 16, 2021).

12. Fugh-Berman A. Herb-drug interactions. Lancet. (2000) 355:134–8. doi: 10.1016/S0140-6736(99)06457-0

13. Sarrafpour S, Urits I, Powell J, Nguyen D, Callan J, Orhurhu V, et al. Considerations and implications of cannabidiol use during pregnancy. Curr Pain Headache Rep. (2020) 24:38. doi: 10.1007/s11916-020-00872-w

14. Best, CBD Shops. Available online at: https://straininsider.com/best-cbd-online-shops-europe/ (accessed November 22, 2021).

15. Wieckiewicz M, Danel D, Pondel M, Smardz J, Martynowicz H, Wieczorek T, et al. Identification of risk groups for mental disorders, headache and oral behaviors in adults during the COVID-19 pandemic. Sci Rep. (2021) 11:17586. doi: 10.1038/s41598-021-90566-z

16. Silvestro S, Mammana S, Cavalli E, Bramanti P, Mazzon E. Use of cannabidiol in the treatment of epilepsy: efficacy and security in clinical trials. Molecules. (2019) 24:1459. doi: 10.3390/molecules24081459

17. Shannon S, Lewis N, Lee H, Hughes S. Cannabidiol in anxiety and sleep: a large case series. Perm J. (2019) 23:18–041. doi: 10.7812/TPP/18-041

18. Solowij N, Broyd SJ, Beale C, Prick JA, Greenwood LM, van Hell H, et al. Therapeutic effects of prolonged cannabidiol treatment on psychological symptoms and cognitive function in regular cannabis users: a pragmatic open-label clinical trial. Cannabis Cannabinoid Res. (2018) 3:21–34. doi: 10.1089/can.2017.0043

19. García-Gutiérrez MS, Navarrete F, Gasparyan A, Austrich-Olivares A, Sala F, Manzanares J. Cannabidiol: a potential new alternative for the treatment of anxiety, depression, and psychotic disorders. Biomolecules. (2020) 10:1575. doi: 10.3390/biom10111575

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22. Valverde O, Torrens M. CB1 receptor-deficient mice as a model for depression. Neuroscience. (2012) 204:193–206. doi: 10.1016/j.neuroscience.2011.09.031

Keywords: cannabidiol, cannabis, marihuana, depression, self-treatment

Citation: Wieckiewicz G, Stokłosa I, Stokłosa M, Gorczyca P and Pudlo R (2022) Cannabidiol (CBD) in the Self-Treatment of Depression-Exploratory Study and a New Phenomenon of Concern for Psychiatrists. Front. Psychiatry 13:837946. doi: 10.3389/fpsyt.2022.837946

Received: 17 December 2021; Accepted: 24 February 2022;
Published: 22 March 2022.

Patrik Roser, University of Duisburg-Essen, Germany

Andrea Mastinu, University of Brescia, Italy
Raphael Mechoulam, Hebrew University of Jerusalem, Israel
David Gurrea Salas, Psychiatric Services Aargau, Switzerland

Copyright © 2022 Wieckiewicz, Stokłosa, Stokłosa, Gorczyca and Pudlo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Cannabis and mental health

Cannabis is an illegal drug which can affect your mental health. This page is about the effects that cannabis can have on your mental health. And how to get help and support. You may also find this page if you care for someone who uses cannabis.

If you would like more advice or information you can contact our Advice and Information Service by clicking here .

  • Overview
  • About
  • How does it work?
  • How can it make me feel?
  • Cannabis & mental health
  • Psychosis & schizophrenia
  • Is cannabis addictive?
  • Get help
  • Confidentiality
  • Useful Contacts

Overview

  • Cannabis is known by different names such as marijuana and weed.
  • Cannabis is a drug that can make you feel happy or relaxed. And anxious or paranoid.
  • THC is the main chemical in cannabis which can change your mood and behaviour.
  • Skunk is the most common name for stronger types of cannabis which has more THC.
  • Research has found a link between cannabis and developing psychosis or schizophrenia.
  • Psychosis is when you experience or believe things that other people don’t.
  • Schizophrenia is the name of a mental illness. If you have schizophrenia, you can have psychosis and other symptoms.
  • If cannabis is affecting your health or how you feel, you can see your GP.

Need more advice?

What is cannabis?

Cannabis is an illegal drug made from the cannabis plant. You can smoke or eat cannabis. You can smoke it on its own or mix it with tobacco to make a ‘joint’ or ‘spliff’. It can also be cooked in food or brewed in tea.

People use cannabis for different reasons. Sometimes they use it to relieve mental or physical symptoms. This is called self-medication. This may make you feel better in the short term. But in the longer term it can increase problems or create new ones.

Cannabis is the most widely used illegal drug in Britain. Young people are more likely to use it than older people.

Cannabis can be called marijuana, dope, draw, ganja, grass, hash, herb, pot, and weed, and other things.
Stronger types of cannabis can be called skunk, super-skunk, Northern Lights, Early Girl and Jack Herer.

You can find more information about cannabis, on the FRANK website. You can find the details of the website in the Useful Contacts section of this page. The website tells you what cannabis looks like, how it is used and the law on cannabis.

How does cannabis work?

Cannabis will go into your bloodstream when smoked. It will quickly be carried to your brain and stick to your receptors. This will affect your mood and behaviour.

Cannabis contains lots of different chemicals known as cannabinoids. Some examples are cannabidiol (CBD) and tetrahydrocannabinol (THC). THC is the main active ingredient in the cannabis plant. The more THC there is in cannabis, the greater the effect will be.

Skunk is a stronger variety of cannabis. It contains higher levels of THC. Evidence suggests that the effects of skunk are faster and stronger than milder cannabis.

CBD can lessen the unwanted psychoactive effects of THC such as hallucinations and paranoia. It can also reduce anxiety. This means that the effects of THC will be lower if there is more CBD in the plant.

How can cannabis make me feel?

The effects of cannabis can be pleasant or unpleasant. Most symptoms will usually last for a few hours. But there can be unpleasant long term symptoms. Especially if you used cannabis regularly over a long period of time. The risks can also be worse if are young and smoke strong cannabis, like skunk.

What are the pleasant effects of cannabis?

Cannabis can make you feel happy, relaxed, talkative or laugh more than usual.You may find that colours and music are brighter and sharper. Pleasant effects are known as a ‘high.’

What are the unpleasant effects of cannabis?

Cannabis can cause hallucinations, changes in mood, amnesia, depersonalisation, paranoia, delusion and disorientation. You might find it harder to concentrate or remember things. You may find that you can’t sleep well and you feel depressed. You may also feel hungry or like time is slowing down.

You might have lower motivation. And cannabis can affect how you sense things. You may see, hear or feel things differently. This is known as hallucinating. Hallucinations can be a sign of psychosis.

Psychosis can be a symptom of mental illness, including schizophrenia, schizoaffective disorder and bipolar disorder. These can be called ‘psychotic illnesses.’

You can use the links below to find out more about:

Or call our General Enquries team on 0121 522 7007 and ask them to send you a copy of our factsheet.

Can cannabis affect my mental health?

Regular cannabis use is linked to an increased risk of anxiety and depression. But most research seems to have a focus on the link between psychosis and cannabis.

Using cannabis can increase the risk of later developing psychotic illness, including schizophrenia. There is a lot of reliable evidence to show a link between the use of stronger cannabis and psychotic illnesses, including schizophrenia. But the link is not fully understood.

Cannabis may be one of the causes of developing a mental illness, but it isn’t be the only cause for many people. Not everyone who uses cannabis will develop psychosis or schizophrenia. And not everyone who has psychosis or schizophrenia has used cannabis. But you are more likely to develop a psychotic illness if you smoke cannabis. And are ‘genetically vulnerable’ to mental health problems.

‘Genetically vulnerable’ means that you are naturally more likely to develop a mental health problem. For example, if people in your family have a mental illness, you may be more likely to develop a mental health problem. if someone in your family has depression or schizophrenia, you are at higher risk of getting these illness when you use cannabis.

Cannabis can have the following effects.

  • Long term use can have a small but permanent effect on how well you think and concentrate.
  • Smoking cannabis can cause a serious relapse if you have a psychotic illness.
  • Regular cannabis use can lead to an increased risk of later developing mental illness. Especially if you use cannabis when you are young.

For more information, see our ‘Does mental illness run in families’ section Or call our General Enquiries team on 0121 522 7007 and ask them to send you a copy of our factsheet.

What is the difference between psychosis and schizophrenia?

Psychosis and schizophrenia aren’t the same illness.

Psychosis is the name given to symptoms or experiences, which include hallucinations and delusions. Hallucinations make someone experience things differently to other people. This might be seeing things or hearing voices. Delusions are when people have unusual beliefs that other people don’t have.

Schizophrenia is a mental illness that affects how someone thinks or feels. Symptoms of schizophrenia include hallucinations and delusions. But often it will have other symptoms like feeling flat or emotionless, or withdrawing from other people.

Use the links below to find out more about:

Or call our General Enquiries team on 0121 522 7007 and ask them to send you a copy of our factsheet

Is cannabis addictive?

Cannabis can be addictive.

About 1 in 10 regular cannabis users become dependent on it. Your risk of getting addicted is higher if you start using it in your teens or use it every day.

You can develop a tolerance to cannabis if you use it regularly. This means you need more to get the same effect.

If you become addicted, you may feel withdrawal symptoms when you don’t use cannabis. For example, you might:

  • be irritable,
  • have cravings,
  • have sleep problems,
  • be restless, and
  • have mood swings.

You might smoke cannabis with tobacco. If you do you may become addicted to nicotine. This means you are at risk of getting diseases such as cancer and heart disease. So, if you stop using nicotine or cut down you could experience nicotine withdrawal too.

You can get information on stopping smoking tobacco by clicking the following link: www.nhs.uk/live-well/quit-smoking/take-steps-now-to-stop-smoking/

How can I get help if cannabis is affecting my health?

Can I see my GP?

Speak to your GP if cannabis use is affecting your physical or mental health. Be honest with your GP about your cannabis use and symptoms. Your GP may not offer you the right support if they don’t know the full picture.

  • offer you treatment at the practice, or
  • refer you to your local drug service.

You can find local drug treatment support by clicking on the following link: www.talktofrank.com/get-help/find-support-near-you

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What can my local drug service do?

The service can offer counselling, support groups and advice. They can help you to:

  • reduce your cannabis use,
  • stop using cannabis,
  • reduce the affect that cannabis has on your life, and
  • support you to not start using again.

The service may be provided through the NHS or through charity. You may be able to self-refer to this type of service. If you can’t self-refer speak to your GP or health professional.

Should I be referred to a specialist mental health service?

Your GP should refer you to a specialist mental health service if they think you have psychosis.32 The service could be the Community Mental Health Team or an Early Intervention Psychosis service. Both psychosis and schizophrenia can be treated using antipsychotic medication and talking treatments.

Find out more about:

Or call our General Enquiries team on 0121 522 7007 and ask them to send you a copy of our factsheet.

Can I be excluded from services?

You shouldn’t be excluded from:

• mental health care because of cannabis misuse, and
• a substance misuse service because of psychosis.

Can I see a therapist?

A therapist may be able to help you to understand the reason why you use drugs.

There are lots of different types of therapy. Cognitive Behavioural Therapy (CBT) is suggested as a treatment if:

  • you misuse drugs, and
  • have a common mental health problem such as depression or anxiety.

Or call our General Enquiries teams on 0121 522 7007 and ask them to send you a copy of our factsheet.

Can I get further support?

• Speak to a specialist drug service such as Frank.
• Join a support group such as Marijuana Anonymous UK.

Details of Frank and Marijuana Anonymous UK can be found at the end of the factsheet in the ‘Useful contacts’ section.

Find out more about:

Or call our General Enquiries team on 0121 522 7007 and ask them to send you a copy of our factsheet.

What about confidentiality?

You might be worried about telling your GP or other health professionals that you are using cannabis. But health professionals must stick to confidentiality laws. This means that they usually won’t be able to tell other people or services about what you have told them. Unless you agree.

They can only tell other people about what you have said if:

  • there is a risk of serious harm to you or to others,
  • there is a risk of a serious crime,
  • you are mentally incapable of making your own decision, or
  • the NHS share your information under ‘implied consent’.

For example, you might tell your doctor that you are planning to hurt yourself. Your doctor could decide to share this information with or healthcare or social care professionals. They should only do this to protect you and make sure you’re safe.

Find out more about:

Or call our General Enquiries team on 0121 522 7007 and ask them to send you a copy of our factsheet.

Useful Contacts

FRANK
Gives confidential advice to anyone concerned about using cannabis or other drugs.

Telephone helpline: 0300 123 6600. Open 24 hours a day
SMS: 82111 Email: through website
Live chat: through website. Open 2pm – 6pm everyday.
Website: www.talktofrank.com

Marijuana Anonymous
They are run by people who have experience of cannabis use. They offer a 12-step recovery programme for people who want to quit cannabis use and are free to use.

DrugScope
Gives online information on a wide range of drug related topics. They do not have a helpline.

Narcotics Anonymous
They run online meetings and face to face meetings all over the country for people who want to stop using drugs. They offer sponsorship.

Telephone helpline: 0300 999 1212. Open 10am – 12 midnight.
Website: www.ukna.org

Adfam
A national charity for families and friends of drug users. It offers support groups and confidential support and information.

Telephone admin: 020 3817 9410
Address: 2nd Floor, 120 Cromer Street, London, WC1H 8BS
Email: [email protected]
Website: www.adfam.org.uk

Release
They give free non-judgmental, specialist advice and information to the public and professionals on issues related to drug use and drug laws.

Telephone helpline: 020 7324 2989
Address: 61 Mansell Street, London E1 8AN
Email: [email protected]
Website: www.release.org.uk

Addaction
A charity that supports people to make positive behavioural change. Such as a problem with alcohol, drugs, or mental health and wellbeing. They give support for families too. They have different services in different parts of the country.

Telephone admin: 020 7251 5860
Address: Part Lower Ground Floor, Gate House, 1-3 St. John’s Square, London, England, EC1M 4DH
Email: [email protected]
Website: www.addaction.org.uk

Change Grow Live (CGL)
A charity that supports people to make positive behavioural change. Such as a problem with alcohol, drugs, or mental health and wellbeing. They give support for families too. They have different services in different parts of the country.

Webchat: via website
Website: www.changegrowlive.org/

Turning Point
Works with people affected by drug and alcohol misuse, mental health problems and learning disabilities.

Address: Standon House, 21 Mansell Street, London, E1 8AA
Email: through the website
Website: www.turning-point.co.uk

DNN Help
You can get free rehabilitation treatment through your local drug team. But you can pay for private treatment if you want to. This is an online treatment finder for private rehabilitation services.

CBD Oil Made Me Feel Worse

I mentioned in a recent blog post that I had been struggling with a case of the Mondays, except it stretched out over eight Mondays, and every other day of the week. I was in an extended funk. It turns out that CBD oil may have caused this cloud that was hanging over me. But let’s back up.

CBD oil has been growing in popularity. Its proponents claim that is offers near-miraculous results of decreased anxiety, reduced inflammation, relief of body aches and pains; some even go as far as to make outrageous claims that it can prevent cancer (I’m wary of any too-good-to-be-true claims in pill form).

According to Healthline, “CBD oil is made by extracting CBD from the cannabis plant, then diluting it with a carrier oil like coconut or hemp seed oil.” It doesn’t contain the THC from the plant that makes you high. It is purported to have the benefits of marijuana without the psychoactive properties or legality issues. (I am a personal trainer, not a lawyer. I’m not qualified to give legal advice, please consult your local law.)

I was intrigued by the idea that non-THC CBD oil could help with inflammation and pain, mainly because I had been dealing with elbow pain that wasn’t letting up despite treatment and physical therapy.

I listen to a lot of health and fitness podcasts, and a recurring theme seemed to be the benefits of CBD oil. The Joe Rogan Experience podcast, Mind Pump, Ben Greenfield Fitness and many more reported positive outcomes from CBD and hemp oil. There were podcasts, blogs, some Facebook friends, and even a real-life friend raving about the benefits.

I may have never tried it except for a CBD store opened up in my small neighborhood.

I didn’t notice any immediate reduction in pain. The lady at the store said to increase my dose. I doubled it. I felt the same. Maybe I’m a non-responder. I felt an increase in anxiety, but I attributed it to the fact that in December my diet had gotten off track. I was eating at restaurants more than usual, eating sugar, and drinking wine — a winning combination for feeling for like crap.

I deal with low-level anxiety that is kept at bay with exercise and proper nutrition.

I decided to stop taking the expensive oil until I got my diet back to normal because I am a firm believer that there is no such thing as a magic pill. If I’m eating poorly, no pill or oil is going to fix me —However, if I am eating well, sleeping, hydrating, exercising, and starting from a place of health, maybe CBD oil would enhance (not replace) my efforts to reduce pain.

supplements to take daily.

I cleaned up my act in January and decided to switch to a hemp oil pill from a trusted supplement company. The problem with supplements is they are unregulated. Who knows what was in the CBD oil that was not “working” for me. It could have had less active ingredients than it claimed or other components not listed on the bottle.

So I switched to a reputable company that I knew and trusted, where I buy most of my supplements (fish oil, protein powders, creatine, etc.). My diet was back on track, I was exercising regularly, but I didn’t notice any discernible improvements in pain. It was a habit to take the hemp oil pill every day — it didn’t seem to be “working” for my pain but it was expensive, so I figured I would at least finish the bottle before I wrote it off as ineffective.

My heightened anxiety from December had subsided a bit, but through December and most of January I was feeling increasingly down. I had a cloud over my head. The activities that usually brought me joy, like blogging and training, felt overwhelming. I was unmotivated and uninspired, I wasn’t handling stress well, often felt defeated, and my workouts were sluggish.

I was feeling depressed from my usual mood and life outlook. What was wrong with me? I attributed feeling a little off in December due to my lifestyle choices, but in January I was back to normal with no improvement in my mood.

Then I thought it must be the colder weather, earlier sunset, and increased stress at my marketing job, but I knew deep down that this wasn’t me — Life circumstances haven’t changed, but I suddenly felt like life was hard.

I woke up one Saturday towards the end of January and decided on a whim not to take my hemp oil pill. I certainly didn’t associate the pill with my mood at that point, I just decided not to take it.

By the end of the day, I started to feel better already. By Sunday the cloud had completely blown away. I was feeling like myself again, and I felt hope. I felt motivated. For the first time in weeks, I started brainstorming ways to increase my business, rather than feeling like I should shut it down.

I almost couldn’t believe that it may have been the hemp oil pill that made me feel depressed. Maybe it was a coincidence. Perhaps I’d wake up the next day feeling like crap again. But no. I felt like myself again — day after day.

I started researching (aka Google) if CBD oil could increase depression and anxiety like I had been experiencing, and in a sea of articles touting its anxiety-reducing benefits, I found one single article that said a tiny percentage of people on a Reddit thread reported an increase in anxiety.

After taking the hemp oil I didn’t experience pain relief, and I felt emotionally worse.

I am not writing this to say that hemp oil is wrong or you shouldn’t take it. I am clearly an outlier. It does appear to be useful for most people. It’s just an important reminder that there is no single solution, whether it be a specific diet, exercise plan, or supplement, that is effective for 100% of the population. Our bodies are different and may not respond in the same way as in our friends, co-workers, or Joe Rogan.

In the end I am disappointed that it didn’t work for me. This post is not intended to discourage anyone from trying CBD oil. I am writing this article because when I searched for cases of people that had a negative CBD experience, I couldn’t find anything except for that single article citing a Reddit thread. I hope that if you decide to try CBD or hemp oil that it works miracles for you, but if you experience an increase in anxiety or depression like I did, that you’ll make the connection sooner so that you don’t suffer needlessly.

This was my experience and it may be different than yours. I can’t recommend that you take or don’t take any supplement. As always, please contact qualified medical professionals when making decisions about your health.

Strange, right? Was your experience different than mine? I’d love to hear about it. Anyone out there feel like I did after taking CBD or hemp oil?

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