362 -Cannabidiol (CBD) and Mental Health
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Cannabidiol: Mental Health Uses and Cautions

The CEU/OPD/CPD course can be found at https://allceus.com/member/cart/index/product/id/982/c/ for clinicians in the US and at https://australia.allceus.com/member/cart/index/product/id/516/c/ for clinicians in Australia.

Intro to CBD
~ THC is the psychoactive component of cannabis
~ THC has antispasmodic, analgesic, anti-tremor, anti-inflammatory, appetite stimulating and anti-emetic properties
~ High levels of THC is commonly used for its sleep-inducing effects
~ THC mimics the effects of anandamide and 2-AG (endogenous cannabinoid) which modulates sleeping and eating habits, the perception of pain
~ GABA neurons contain CBD receptors which are activated upon useof THC (and maybe CBD) https://www.royalqueenseeds.com/blog-the-link-between-marijuana-and-dopamine-n823

https://www.ncbi.nlm.nih.gov/pubmed/22625422
CBD cont…
~ CBD is the major nonpsychoactive component of Cannabis sativa.
~ According to a 2013 study published in the British Journal of Clinical Pharmacology, CBD benefits include acting as an anti-inflammatory, anticonvulsant, antioxidant, antiemetic, anxiolytic, neuroprotective, immunomodulatory and antipsychotic effects
~ A biphasic drug has different effects on the body at different blood concentration levels.
~ Ex. Alcohol acts as a stimulant until BAC levels reach 0.05%. After this point it causes sedation and depression
~ At a low concentration CBD increases wakefulness, alertness and other elevating responses.
~ At higher levels CBD has a sedating effect

CBD cont…
~ 36% of respondents reported that CBD treats their medical condition(s) “very well by itself,” while only 4.3% reported “not very well.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6043845/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604171/

The Cannabinoid Receptors
~ CBD and THC both bind to the CB 1 & 2 receptors, they interact with them different ways
~ CB1 and CB2 are both responsible for regulating neuro-hormones which are involved in memory, mood, sensations of pain and appetite regulation
~ CB1
~ Found in the CNS and responds to endogenous cannabinoids, as well as THC (agonist) and CBD (mild antagonist).
~ Abundant in areas of the brain concerned with movement, coordination, pain and sensory perception, emotion, memory, cognition, autonomic and endocrine (hormone) functions
The Cannabinoid Receptors
~ CB2
~ Found only in the immune system and not in the CNS, but seems to reduce inflammation and related pain.
~ It responds to endogenous cannabinoids, as well as CBD, THC
Alcohol and CBD

~ The CB1 receptor is a significant player in the reinforcing and motivating attributes of alcohol. Combining alcohol and CBD results in significantly lower blood levels of alcohol.
~ CBD reduces the reinforcement, motivation and relapse for alcohol.
~ CBD attenuates alcohol-induced liver steatosis, metabolic dysregulation, inflammation and neutrophil-mediated injury.
~ Cannabinoids have an effect on nearly all enzymes responsible for metabolizing alcohol.
~ Cannabinoid antagonists also mitigate alcohol withdrawal symptoms.
~ CB1 receptor agonists (THC) encourage alcohol consumption, while CB1 receptor antagonists (CBD) decrease it.

Benefits of CBD
~ According to the National Institute of Health, manipulating the endocannabinoid system by introducing external cannabinoids like CBD could be useful in treating a variety of medical ailments, including:
How CBD Impacts Mood
~ CBD can help people recover from Clostridium difficile toxin A toxicity and restore the intestinal barrier* https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5721977/
~ CBD reduces chronic pain https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503660/
~ CBD binds with estrogen receptors https://www.ncbi.nlm.nih.gov/pubmed/6296360
~ Impacts insulin levels via cannabinoid receptors in the pancreas http://www.cbdforbenefits.com/top-3-ways-cbd-oil-balances-estrogen-levels/
~ 160mg-600mg of cannabidiol may play a therapeutic role in sleep regulation, increase in sleep time and reduced awakenings (Monti, 1977; Chagas et al., 2014b, Zuardi et al., 1993, Carlini and Cunha, 1981).
~ The endocannabinoid system plays a significant role in regulation of the HPA-Axis and reduces cortisol production https://www.ncbi.nlm.nih.gov/pubmed/30036537, https://www.ncbi.nlm.nih.gov/pubmed/18426497

CBD and Neurotransmitters
~ The activation of adenosine receptors by CBD
~ Produces anti-anxiety and anti-inflammatory effects of cannabidiol.
~ Release of dopamine and glutamate, two neurotransmitters that play major roles inside the body.
~ Dopamine is involved in cognition, motor control, motivation and reward mechanisms
~ Glutamate is one of the main excitatory neurotransmitters, being involved in memory, learning and cognition.
~ Higher concentrations of CBD have been shown to activate the 5-HT1A serotonin receptor, impacting pain, sleep and mood

CBD and Neurotransmitters
~ Using marijuana or CBD while on antidepressants or antipsychotics can be potentially dangerous, as it can intensify any or all of the effects, making a patient's condition even worse. (This is also very similar with sedatives and alcohol)
~ https://www.ncbi.nlm.nih.gov/pubmed/22716160
~ https://www.ncbi.nlm.nih.gov/pubmed/22729452
~ Overview of CBD Safety: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5569602/

CBD and Parkinson’s Disease
~ PD is associated with impairment of motor control after the loss of 60-80% of dopamine-producing neurons
~ The endocannabinoid system plays a major role in Parkinson’s Disease.
~ CBD boosts dopamine levels in preclinical studies…but
~ Long-term, heavy marijuana usage could reduce dopamine levels
~ Digestive imbalance (sick gut) may play a role in the advancement of PD & the severity of symptoms.
~ Cannabinoids have neuroprotectant, anti-oxidant and anti-inflammatory properties which can be beneficial for managing PD.
Drugs that Interact with CBD
~ Any drug metabolized by CYP450 enzymes could potentially interact with cannabidiol. According to the Indiana University Department of Medicine, drugs known to use the CYP450 system include:

Increasing Natural Cannabinoids
~ In order to produce the proper amount of endogenous cannabinoids, the body requires a sufficient amount of Omega-3 fatty acids the pre cursor to endogenous cannabinoids
~ Hemp seeds and hemp oil
~ Chia seeds
~ Walnuts
~ Fatty fish
~ Eggs (pasture-fed or omega-3 enriched only)
~ Cacao powder contains three compounds that are structurally very similar to endocannabinoids and inhibit the breakdown of endocannabinoids. (70-90% dark chocolate) di Tomaso, Emmanuelle. “Brain cannabinoids in chocolate.” Nature 382 (1996): 677-678.

Increasing Natural Cannabinoids
~ Beta-caryophyllene is found in black pepper, lemon balm, hops, cloves, cannabis, oregano, cinnamon and stimulates the CB2 receptor (immune/anti-inflammatory)
~ Echinacea also contains CB2 agonists according to Dustin Sulak, DO
~ Kava may stimulate the CB1 receptor
~ Black and Green tea prevents the breakdown of endocannabinoids, and stimulate cannabinoid receptors. Thors L, Burston JJ, Alter BJ, McKinney MK, Cravatt BF, et al. (2010) Biochanin A, a naturally occurring inhibitor of fatty acid amide hydrolase. British Journal of Pharmacology 160: 549–560.
~ Lactobacillus acidophilus activates CBT recpetors
~ Studies show that DIM reduces inflammation by binding to CB2 receptors
~ Curcumin (found in turmeric) raises endocannabinoid. Hassanzadeh P, Hassanzadeh A (2012) The CB1 receptor-mediated endocannabinoid signaling and NGF: the novel targets of curcumin. Neurochemical Research 37: 1112–1120.
~ https://www.optimallivingdynamics.com/blog/how-to-stimulate-and-support-your-endocannabinoid-system

CBD Oil Dosing
~ The FDA has not created a Recommended Daily Intake (RDI) for CBD, which means CBD does not have an official serving size nor is it formally regulated.
~ CBD impacts are affected by body weight, body fat percentage, and other hormonal and physiological processes.
~ With that being said, a good rule of thumb is 1–6MG of CBD for every 10 pounds of body weight to start. https://medium.com/cbd-origin/whats-the-best-cbd-dosage-81ec4f95503b
~ Cannabidiol comes in
~ Oil
~ Tincture
~ Vape
~ Capsules
~ Topicals
~ Suppositories
Summary
~ Cannabidiol is the non-euphoric cannabinoid.
~ THC is the cannabinoid which produces the euphoric effects.
~ The endocannabinoid system is highly connected with
~ Sleep
~ Inflammation
~ Mood (serotonin, dopamine, glutamate)
~ Sex hormones (esp. estrogen)
~ Muscle coordination
~ Significant research has shown the benefits of cannabidiol for everything from anxiety to inflammation and psychosis.
~ It is important to note that CBD and THC can interact with most medications so medical supervision is strongly advised.
~ Natural methods to enhance the ECS include omega-3s, curcumin, black and green tea, black pepper, cinnamon, kava and echinacea

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