Pharmacological properties of cannabidiol in the treatment of psychiatric disorders: a critical overview

Abstract

This Section of Epidemiology and Psychiatric Sciences appears in each issue of the Journal to stress the relevance of epidemiology for behavioral neurosciences, reporting the results of studies that explore the use of an epidemiological approach to provide a better understanding of the neural basis of major psychiatric disorders and, in turn, the utilisation of the behavioural neurosciences for promoting innovative epidemiological research.The ultimate aim is to help the translation of most relevant research findings into every-day clinical practice. These contributions are written in house by the journal's editorial team or commissioned by the Section Editor (no more than 1000 words, short unstructured abstract, 4 key-words, one Cannabidiol (CBD) represents a new promising drug due to a wide spectrum of pharmacological actions. In order to relate CBD clinical efficacy to its pharmacological mechanisms of action, we performed a bibliographic search on PUBMED about all clinical studies investigating the use of CBD as a treatment of psychiatric symptoms. Findings to date suggest that (a) CBD may exert antipsychotic effects in schizophrenia mainly through facilitation of endocannabinoid signalling and cannabinoid receptor type 1 antagonism; (b) CBD administration may exhibit acute anxiolytic effects in patients with generalised social anxiety disorder through modification of cerebral blood flow in specific brain sites and serotonin 1A receptor agonism; (c) CBD may reduce withdrawal symptoms and cannabis/tobacco dependence through modulation of endocannabinoid, serotoninergic and glutamatergic systems; (d) the preclinical pro-cognitive effects of CBD still lack significant results in psychiatric disorders. In conclusion, current evidences suggest that CBD has the ability to reduce psychotic, anxiety and withdrawal symptoms by means of several hypothesised pharmacological properties. However, further studies should include larger randomised controlled samples and investigate the impact of CBD on biological measures in order to correlate CBD's clinical effects to potential modifications of neurotransmitters signalling and structural and functional cerebral changes.

Clinical uses of cannabis and cannabinoids in the United States

“…Additionally, a 2018 neuroimaging study examining patients at high risk of psychosis showed that CBD normalized fMRI signatures in regions associated with psychosis [52]. Other preclinical work has suggested several mechanisms through which CBD may exert anti-psychotic properties, including antagonism of CB1 receptors, modulation of dopamine signaling, and decreasing neuroinflammation [53,54]. Follow-up RCTs examining the effectiveness of CBD in psychotic disorders has shown mixed results [54].…”

“…Other preclinical work has suggested several mechanisms through which CBD may exert anti-psychotic properties, including antagonism of CB1 receptors, modulation of dopamine signaling, and decreasing neuroinflammation [53,54]. Follow-up RCTs examining the effectiveness of CBD in psychotic disorders has shown mixed results [54]. A 2012 double-blind RCT reported that CBD was as effective as amisulpride, an antipsychotic commonly used to treat schizophrenia, in treating both positive and negative symptoms of schizophrenia and had fewer associated side effects, including extrapyramidal symptoms, hyperprolactinemia, and weight gain [55].…”

“…However, a 2018 RCT comparing CBD to placebo did not show any significant change in positive or cognitive symptoms [57]. A review of available studies suggests that the opposing effects seen in these studies could be related to dosing of CBD (timing and quantity) as well as the stage of schizophrenia being studied [54]. Therefore, while preliminary evidence has suggested a possible role for CBD as an antipsychotic, the specifics of how-and in whom-the drug should be used are still unclear.…”

A Review of Human Studies Assessing Cannabidiol's (CBD) Therapeutic Actions and Potential

“…2 In vitro, animal, and human studies suggest mechanisms of action for CBD directly or tangentially related to the endocannabinoid system, as delineated in Table 1. [2][3][4][5][6][7][8][9][10] There has been an incredible amount of media coverage on the health benefits of CBD, with CBD products heralded as medical breakthroughs or even miracles for all types of diseases. 11,12 Medical professionals may be interested in CBD as a new therapy for patients with limited traditional options or are asked about CBD products by patients, family, and acquaintances for a host of ailments.…”

The Effect of Cannabidiol on Psychosis-like Behaviour Induced by Methamphetamine and MK-801 in Mice: A Negative Report

“…Treatment options are limited and a better understanding of the brain mechanisms involved might lead to novel treatments. Although THC in particular has been implicated in the development of psychosis or schizophrenia [6,7], several recent reviews have suggested that CBD may be beneficial in a number of psychiatric disorders including psychosis [8][9][10]. However, there is substantial variability in experimental power, methodology, dosing and experimental protocols used, and the mechanism of any antipsychotic-like effect of CBD remains unclear.…”