Cannabidiol in Anxiety and Sleep: A Large Case Series

Shannon, Scott; Lewis, Nicole; Lee, Heather; Hughes, Shannon

doi:10.7812/tpp/18-041

Cited by 335 publications

(227 citation statements)

References 18 publications

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“…Numerous preclinical trials 9,10 and neuro-imaging studies 8 have demonstrated the anxiolytic effects of CBD. A recently published case-series in psychiatric patients found a benefit of CBD for anxiety and sleep, 16 which is in agreement with the above findings.…”

Section: Comparison With Existing Literaturesupporting

confidence: 88%

Cannabidiol prescription in clinical practice: an audit on the first 400 patients in New Zealand

Gulbransen¹,

Arroll

2020

BJGP Open

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BackgroundCannabidiol (CBD) is the non-euphoriant component of cannabis. In 2017, the New Zealand Misuse of Drugs Regulations (1977) were amended, allowing doctors to prescribe CBD. Therapeutic benefit and tolerability of CBD remains unclear.AimTo review the changes in self-reported quality of life measurements, drug tolerability, and dose-dependent relationships in patients prescribed CBD oil for various conditions at a single institution.Design & settingAn audit including all patients (n = 400) presenting to Cannabis Care, New Zealand, between 7 December 2017 and 7 December 2018 seeking CBD prescriptionsMethodIndications for CBD use were recorded at baseline. Outcomes included EuroQol quality of life measures at baseline and after 3 weeks of use, patient-reported satisfaction, incidence of side effects, and patient-titrated dosage levels of CBD.ResultsFour hundred patients were assessed for CBD and 397 received a prescription. Follow-up was completed on 253 patients (63.3%). Patients reported a mean increase of 13.6 points (P<0.001) on the EQ-VAS scale describing overall quality of health. Patients with non-cancer pain and mental-health symptoms achieved improvements to patient-reported pain and depression and anxiety symptoms (P<0.05). There were no major adverse effects. Positive side effects included improved sleep and appetite. No associations were found between CBD dose and patient-reported benefit.ConclusionThere may be analgesic and anxiolytic benefits of CBD in patients with non-cancer chronic pain and mental health conditions such as anxiety. CBD is well tolerated, making it safe to trial for non-cancer chronic pain, mental health, neurological, and cancer symptoms.

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Section: Comparison With Existing Literaturesupporting

confidence: 88%

Cannabidiol prescription in clinical practice: an audit on the first 400 patients in New Zealand

Gulbransen¹,

Arroll

2020

BJGP Open

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“…In a 10-year-old patient, 5 months of treatment with CBD oil (25 mg) and liquid CBD (6-12 mg) in a sublingual spray as needed was associated with less anxiety and better sleep quality, with no adverse effects (Shannon & Opila-Lehman, 2016). These results were replicated for anxiety in a recently published chart review of 72 adult patients with insomnia and anxiety (Shannon et al, 2019). Most patients in this group were given 25 mg CBD/day, while a few patients were given 50 or 75 mg/day, and one patient with schizoaffective disorder and trauma was given up to 175 mg/day.…”

Section: Other Disordersmentioning

confidence: 75%

“…One case report on the use of CBD by two patients with bipolar disorder showed limited to no improvement with doses of 600-1200 mg for bipolar mania in one of the patients (Shannon et al, 2019). The second patient (OCEBM, 2019).…”

Section: Other Disordersmentioning

confidence: 99%

“…Level 1 evidence is for systematic review of RCTs or individual RCT of narrow confidence interval, Level 2 for cohort studies or systematic review of cohort studies, Level 3 for case-control studies or systematic review of case-control studies, and Level 4 for case-series for studies focused on therapy, prevention, etiology and harm (OCEBM, 2019) was prescribed CBD 600 mg (5-9 days) and olanzapine (10-15 mg), followed by CBD 900-1200 mg (20-33 days), and showed improvement on the Brief Psychiatric Rating Scale (37% reduction) and Young Mania Rating Scale (33% reduction) with CBD and olanzapine, but no additional improvement with CBD monotherapy (Shannon et al, 2019). This effect was consistent with results from animal studies that modeled acute mania with dextroamphetamine (Shannon et al, 2019). The lack of effectiveness can be attributed to the shorter duration of treatment in both cases.…”

Section: Other Disordersmentioning

confidence: 99%

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The therapeutic role of Cannabidiol in mental health: a systematic review

Khan

Sattar

Mian³

et al. 2020

J Cannabis Res

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Background: The therapeutic application of cannabidiol (CBD) is gaining interest due to expanding evidence for its use. Objective: To summarize the clinical outcomes, study designs and limitations for the use of CBD and nabiximols (whole plant extract from Cannabis sativa L. that has been purified into 1:1 ratio of CBD and delta-9tetrahydrocannabinol) in the treatment of psychiatric disorders. Materials and method: A systematic review was conducted including case reports, case series, open-label trials, non-randomized and randomized controlled trials (RCTs). The search resulted in 23 relevant studies on CBD and nabiximols in the treatment of a wide range of psychiatric disorders. The quality of evidence was judged by using the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence that ranges from Level 1 to Level 5 based on the quality and study design. These levels of evidence help in grading the recommendations, including Grade A (strong), Grade B (moderate), Grade C (weak), and Grade D (weakest). Results: CBD and CBD-containing compounds such as nabiximols were helpful in alleviating psychotic symptoms and cognitive impairment in patients with a variety of conditions, and several studies provided evidence of effectiveness in the treatment of cannabis withdrawal and moderate to severe cannabis use disorder with Grade B recommendation. There is Grade B recommendation supporting the use of CBD for the treatment of schizophrenia, social anxiety disorder and autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD). Grade C recommendation exists for insomnia, anxiety, bipolar disorder, posttraumatic stress disorder, and Tourette syndrome. These recommendations should be considered in the context of limited number of available studies. Conclusion: CBD and CBD-containing compounds such as nabiximols were helpful in alleviating symptoms of cannabis-related disorders, schizophrenia, social anxiety disorder, and comorbidities of ASD, and ADHD with moderate recommendation. However, there is weaker evidence for insomnia, anxiety, bipolar disorder, posttraumatic stress disorder, and Tourette syndrome. The evidence for the use of CBD and CBD-containing compounds for psychiatric disorders needs to be explored in future studies, especially large-scale and welldesigned RCTs.

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“…A trial of oral CBD oil (25 mg) resulted in a decrease in this patient's anxiety, and improvement in the quality and quantity of her sleep. A more substantial retrospective case series of 72 adults given CBD for anxiety and sleep complaints at a psychiatric clinic (as an adjunct to usual treatment) assessed patient data monthly over 12 weeks [70]. Anxiety scores on the Hamilton Anxiety rating Scale (HAMA) decreased within the first month in 79% of the sample and remained low during the study duration.…”

Section: Insomniamentioning

confidence: 99%

Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review

et al. 2020

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Background: Medicinal cannabis has received increased research attention over recent years due to loosening global regulatory changes. Medicinal cannabis has been reported to have potential efficacy in reducing pain, muscle spasticity, chemotherapy-induced nausea and vomiting, and intractable childhood epilepsy. Yet its potential application in the field of psychiatry is lesser known. Methods: The first clinically-focused systematic review on the emerging medical application of cannabis across all major psychiatric disorders was conducted. Current evidence regarding whole plant formulations and plant-derived cannabinoid isolates in mood, anxiety, sleep, psychotic disorders and attention deficit/hyperactivity disorder (ADHD) is discussed; while also detailing clinical prescription considerations (including pharmacogenomics), occupational and public health elements, and future research recommendations. The systematic review of the literature was conducted during 2019, assessing the data from all case studies and clinical trials involving medicinal cannabis or plant-derived isolates for all major psychiatric disorders (neurological conditions and pain were omitted). Results: The present evidence in the emerging field of cannabinoid therapeutics in psychiatry is nascent, and thereby it is currently premature to recommend cannabinoid-based interventions. Isolated positive studies have, however, revealed tentative support for cannabinoids (namely cannabidiol; CBD) for reducing social anxiety; with mixed (mainly positive) evidence for adjunctive use in schizophrenia. Case studies suggest that medicinal cannabis may be beneficial for improving sleep and post-traumatic stress disorder, however evidence is currently weak. Preliminary research findings indicate no benefit for depression from high delta-9 tetrahydrocannabinol (THC) therapeutics, or for CBD in mania. One isolated study indicates some potential efficacy for an oral cannabinoid/ terpene combination in ADHD. Clinical prescriptive consideration involves caution in the use of high-THC formulations (avoidance in youth, and in people with anxiety or psychotic disorders), gradual titration, regular assessment, and caution in cardiovascular and respiratory disorders, pregnancy and breast-feeding. Conclusions: There is currently encouraging, albeit embryonic, evidence for medicinal cannabis in the treatment of a range of psychiatric disorders. Supportive findings are emerging for some key isolates, however, clinicians need to be mindful of a range of prescriptive and occupational safety considerations, especially if initiating higher dose THC formulas.

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Cannabidiol in Anxiety and Sleep: A Large Case Series

Cited by 335 publications

References 18 publications

Cannabidiol prescription in clinical practice: an audit on the first 400 patients in New Zealand

Cannabidiol prescription in clinical practice: an audit on the first 400 patients in New Zealand

The therapeutic role of Cannabidiol in mental health: a systematic review

Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review

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