Overview: CBD in Neuropsychiatry

By Mark Filidei, DO
Director of Integrative/Functional Medicine at Amen Clinics

In the past year or so, I’ve been fielding so many questions from my patients about using CBD for psychiatric symptoms and other health issues. You may be getting these same questions. In this article, I provide an overview of CBD in neuropsychiatry. To begin, let’s take with a closer look at the endocannabinoid system and how it works.

Endocannabinoid System Basics

The endocannabinoid (eCB) system is involved in modulating a wide range of processes and functions throughout the body, including cognition, pain, mood, fertility, bone metabolism, and immune function.

Experts are still exploring the intricacies of how the system works, but basically, eCBs—also called endogenous cannabinoids—are molecules produced in the human body that are similar to cannabinoids. There are 2 key eCBs in the body—anandamide (AEA) and 2-arachidonoylglyerol (2AG).

In order to activate the system, AEA and A2G bind to endocannabinoid receptors located throughout the body. These cannabinoid receptors are similar to the body’s opioid receptors and nicotinic receptors, which also bind to natural substances. Experts have identified 2 types of eCB receptors—CB1 receptors in the central nervous system (brain, lungs, muscles, GI tract, reproductive organs, immune system, liver, bone marrow, and pancreas) and CB2 receptors in the peripheral nervous system (spleen, bones, skin, immune system, liver, bone marrow, and pancreas).

After eCBs have performed their function, they are degraded by the enzyme fatty acid amide hydrolase (FAAH).

eCBs and Psychiatric Health

Emerging research is showing that the eCB system plays an important role in certain areas of the brain and in various aspects of mental health. For example, CB1 is highly expressed in the brain’s limbic system (involved in setting emotional tone), basal ganglia (involved in setting the body’s anxiety level), and cerebellum (involved in thought processing).

Research shows the eCB system plays an important role in stress-related psychiatric disorders, including post-traumatic stress disorder (PTSD), generalized anxiety, and major depressive disorder. The evidence suggests it is involved in gating and buffering the stress response, dampening anxiety, and regulating mood. This appears to be due to action within the amygdala (the brain’s fear center) and the prefrontal cortex (involved in regulating inhibition of the stress response). Specifically, CBD’s mechanisms of action include the agonism of certain calming serotonin receptors and the inhibition of others.

Cannabinoids for Psychosis and Schizophrenia

A 2018 study in the American Journal of Psychiatry found that CBD has beneficial effects for people with schizophrenia and the researchers concluded that CBD “may represent a new class of treatment for the disorder.” Other research has found that CBD significantly alleviates psychotic symptoms in people with schizophrenia.

CBD and Depression

A growing body of research shows that CBD has antidepressant properties. A 2019 study found that CBD interacts with multiple neurotransmitter systems, including the serotonergic, glutamatergic, and endocannabinoid systems. Plus, it induces cellular and molecular changes in regions of the brain related to depression.

CBD and Anxiety

Current evidence, including a 2015 review of existing research in Neurotherapeutics, strongly supports CBD as a treatment for generalized anxiety disorder, panic disorder, social anxiety disorder, obsessive compulsive disorder, and PTSD.

CBD and Neuroprotection

Among the evidence on CBD and neuroprotection, a 2016 study found that CBD attenuates brain damage associated with neurodegenerative and/or ischemic conditions. In addition, the researchers noted that CBD affects synaptic plasticity and facilitates neurogenesis.

CBD vs. Psychiatric Medications

When it comes to treating mental health disorders, medications often come with a host of unpleasant and potentially unhealthy side effects. CBD, however, is associated with a wide range of additional health benefits, such as reducing sugar levels, decreasing inflammation, and reducing arterial blockages.

If you’re considering recommending CBD to the people you serve, it’s important to be aware of the most up-to-date research and the latest legal status of CBD products in your state. It’s also critical to keep in mind that since it has only recently been legalized in some states, we don’t have a lot of information yet about its long-term effects on brain health. As always, make the most informed decision for your patients.

About the Author: Mark Filidei, DO, Amen Clinics Orange County, CA

Dr. Mark Filidei is an Internal Medicine physician and is the Director of Integrative/Functional Medicine for Amen Clinics. Functional Medicine incorporates the latest developments in systems biology, genetics, and a deep understanding of human physiology to address complex medical and mental health issues. Dr. Filidei’s approach is to find the root cause of a person’s health problems including metabolic, genetic, and environmental factors, and to treat those problems in as natural a way as possible by using targeted nutritional supplements, correcting hormone and metabolic imbalances, improving lifestyle and diet, and detecting and treating toxin exposure and infections like mold and Lyme disease.