CBD for Anxiety and OCD

Does CBD Work for OCD?  

• A study published in 2015 stated that CBD’s anti-compulsive properties may help alleviate the symptoms of OCD(1). The study also outlined CBD’s promise in treating anxiety disorders, which are also associated with OCD.

• Another study in 2017 highlighted CBD’s ability to help reduce the compulsions caused by OCD(2). The authors of the study believe that CBD’s anxiety-reducing and antipsychotic properties provide therapeutic benefits to OCD patients. 

• Although significant research has been done on CBD’s effects on OCD symptoms, more studies need to be conducted on CBD as an alternative OCD therapy. 

• Before adding  to one’s medication regimen, an OCD patient must consult with a doctor first.

Why People Are Taking CBD for OCD

The main medications used in the treatment of obsessive-compulsive disorder (OCD) are selective serotonin reuptake inhibitors (SSRIs)(3). 

According to the United States Food and Drug Administration (US FDA), patients are allowed to use the following SSRIs to treat OCD(4):

• Clomipramine (Anafranil) 

• Fluoxetine (Prozac)

• Fluvoxamine 

• Paroxetine (Paxil or Pexeva) 

• Sertraline (Zoloft) 

These SSRIs are also used to treat depression. However, OCD patients take these drugs at higher doses and for more extended periods compared with those of depression patients(5).

Despite the use of these medications, remission of the disorder is uncommon(6).

According to Harvard Health Publishing, patients with depression might take two to six weeks to respond to SSRIs. Meanwhile, OCD patients take 10 to 12 weeks to respond to these medications(7).

SSRIs also have side effects, including restlessness, gastrointestinal distress, sexual dysfunction, weight gain, and insomnia(8).

For these reasons, OCD patients might have started exploring alternative treatments, such as cannabidiol (CBD).

According to a 2019 study, there may be a link between the endocannabinoid system (ECS) and the treatment of OCD symptoms(9).

The ECS helps regulate several functions, like mood, appetite, immune responses, sleep, stress, mood, and memory(10). It has two primary receptors: the cannabinoid receptor 1 (CB1 receptor) and the cannabinoid receptor 2 (CB2 receptor).

In the 2019 study, the researchers suggested that CB1 receptors can be found in high densities in brain regions that are believed to be associated with OCD symptoms(11). 

These regions in the brain include the prefrontal cortex, hippocampus, basal ganglia, and amygdala(12). 

The researchers of the 2019 study also cited preclinical studies done on rodents. According to the researchers, these studies suggested that cannabinoid signaling might have positive effects on OCD-relevant functions(13). 

Examples of these functions relevant to OCD include fear extinction and the balance between goal-directed strategies and the habitual actions of OCD patients.

CBD is one of the primary cannabinoids that is derived from the Cannabis sativa plant and believed to have several neurological benefits(14). 

Tetrahydrocannabinol (THC) is the other phytocannabinoid that is predominantly present in the marijuana plant. It is psychoactive, unlike CBD.

CBD is not the same as medical marijuana. However, like CBD, marijuana may also have therapeutic effects on OCD.   

A study in 2020 revealed that the OCD symptoms and anxiety levels of OCD patients significantly reduced when they were administered CBD and THC(15).

However, the test subjects who were given THC reported increased blood pressure, heart rate, and intoxication compared with OCD patients who received placebo and CBD concentrations.

Research published in the journal Neurochemical Research suggested that CBD’s interaction with 5-HT1A receptors could inhibit the reuptake of serotonin in the brain. This inhibition meant more serotonin would be made available to the body(16). 

This inhibition is similar to the mechanism of action of SSRIs(17). 

Serotonin is a neurotransmitter and a chemical in the brain responsible for several functions, like memory, sleep, depression, and anxiety management(18).

A study in 2012 that was published in the journal Translational Psychiatry stated that CBD might trigger the ECS to create more endogenous cannabinoids, including anandamide(19). 

The body produces endogenous cannabinoids. Anandamide, meanwhile, is a transmitter responsible for pain, cognition, and mood functions.

The study showed that the test subjects exposed to CBD had higher anandamide levels.

A 2019 study stated that increased anandamide levels guard the body against stress and reduce signs of anxiety and fear(20).

A 2015 study published in Neurotherapeutics, the journal of the American Society for Experimental Neurotherapeutics, suggested that CBD might help treat several disorders, such as generalized anxiety disorder, social anxiety disorder, and OCD(21). 

The study also outlined CBD’s anti-compulsive properties, which might help in the treatment of OCD symptoms. 

Another study conducted in 2017 revealed that CBD had several therapeutic actions, including anxiety-reducing and antipsychotic activities(22). The study also highlighted CBD’s ability to lessen the compulsions caused by OCD and other psychiatric conditions.

How CBD Oil Works to Alleviate Symptoms of OCD

The National Institute of Mental Health (NIMH) describes OCD as a chronic condition. Patients who are diagnosed with the disorder have uncontrollable, recurring thoughts (obsessions) and behaviors (compulsions) that they are urged to repeat frequently(23). 

NIMH defines obsessions as repeated urges or unwanted thoughts that may cause anxiety. Obsessive symptoms include(24):

• Fear of contamination or germs

• Forbidden thoughts that involve sex, religion, or harm

• Aggressive thoughts towards oneself or others

• Urge to have things in perfect order (e.g., symmetrical)

Meanwhile, compulsions are the repetitive behaviors that OCD patients feel the urge to do in response to their obsessive thoughts. These compulsive behaviors include(25):

• Excessive cleaning or handwashing

• Arranging things in a particular way

• Repeatedly checking on things (e.g., repeatedly checking if the door has been locked or the oven has been turned off)

• Compulsive counting

NIMH also says that OCD patients may develop other mental disorders. These conditions include depression, anxiety, and body dysmorphic disorder (the mistaken belief that a part of one’s body is abnormal)(26). 

According to NIMH, OCD patients can also develop a tic disorder. This condition is characterized by sudden, brief, and repetitive movements, like eye blinking, facial grimacing, head or shoulder jerking, and shoulder shrugging. 

Tics can also be vocal. Examples of vocal tics are repetitive throat-clearing, grunting, or sniffing sounds.

NIMH says that symptoms may ease over time, or they may worsen. NIMH also reports that OCD patients are likely to use substances, like alcohol or drugs, to calm themselves down. 

NIMH recommends that people with OCD avoid the triggers of their obsessions.

According to Mayo Clinic, the causes of OCD have not been entirely determined. However, there have been theories as to why people develop OCD. These theories include(27):

• Biology – OCD may be caused by changes in the natural chemistry or brain function of an individual.

• Genetics – Developing OCD may be genetic, but the specific genes that are affected have yet to be identified.

• Learned obsessions and behaviors – Obsessions and compulsions may have been learned from family members or gradually learned over time.

Several factors may also contribute to an individual’s likelihood of developing OCD. These include(28):

• Family history – Chances of developing OCD are higher when one has relatives with the disorder. 

• Stressful life events – Traumatic experiences may trigger intrusive thoughts, rituals, and emotional distress, which are all characteristic of OCD.

• Other mental health disorders – Include anxiety disorders, depression, and substance abuse among others.

CBD’s suggested therapeutic benefits might be helpful in the alleviation of symptoms of OCD.

CBD for Anxiety

According to a study published in the World Journal of Psychiatry, adults and children with OCD reveal that their obsessions cause them severe distress and anxiety(29).

Researchers of a 2014 study have found that CBD might demonstrate anti-anxiety and antidepressant effects in animal models(30). 

The authors revealed that these therapeutic benefits might be associated with CBD’s interaction with the 5-HT1A receptors. 

Another study conducted in 2019 has found that CBD might help in the treatment of neuropsychiatric disorders, such as anxiety, epilepsy, and schizophrenia(31). 

The researchers have also discovered CBD’s calming effects on the central nervous system. 

The Pros and Cons of CBD Oil for OCD

The Pros

• Animal studies, human studies, and clinical trials have suggested CBD’s promise in treating OCD symptoms.

• A study published in the journal Cannabis and Cannabinoid Research states that CBD has an excellent safety profile(38). Hence, it may be safely used in the treatment of OCD.

• The World Health Organization reveals that there has been no reported case of CBD addiction in humans(39). Hence, it is not a substance that is highly likely to be abused.

• If federal and state laws allow CBD use in an area, a prescription is not required when purchasing CBD products.

The Cons

• Further research and clinical studies are needed to determine if CBD is an effective treatment for OCD. 

• CBD has minimal side effects, such as weight or appetite changes, tiredness, and diarrhea(40).

• The US FDA has approved the use of CBD only in the treatment of epilepsy(41). For this reason, a standard CBD dosage for treating OCD has yet to be developed.

• There might be drug interactions between CBD and SSRIs. Liver enzymes, called cytochrome P450, metabolize SSRIs. CBD might inhibit CYP450 enzymes and reduce the efficacy of SSRIs in the treatment of OCD(42). 

How to Choose the Right CBD for Anxiety and OCD

OCD patients who want to explore CBD as a treatment for their disorder may choose from three types. These include full-spectrum CBD oil, broad-spectrum, and CBD isolates.

Among the three, full-spectrum CBD oil is believed to be more effective because of the entourage effect. This mechanism involves the synergy of all the active ingredients of the cannabis plant to give maximum therapeutic effect to users.

The ingredients of a full-spectrum CBD oil include less than 0.30% THC, flavonoids, terpenes, fatty acids, and essential oils.

OCD patients should note that THC may have mild psychoactive effects on some individuals. Some drug tests can also detect THC.

For patients who want to avoid these risks, a broad-spectrum CBD oil is more recommended. It has all the components of a full-spectrum oil, except for THC.

Some patients may be allergic to the ingredients of full-spectrum and broad-spectrum CBD oils. There is an option that makes use of pure cannabidiol. This oil is known as a CBD isolate.

Some CBD oil products are sometimes labeled as ‘CBD hemp oil’ or ‘CBD hemp extract.’

CBD comes from the flowers, leaves, and stalks of a hemp plant. Meanwhile, hemp seed oil, which is extracted from hemp seeds, does not contain CBD.

Before patients use CBD oil, they should make sure their CBD product is of high quality. Here are some guidelines before making a purchase, especially online:

1. Check if the state where the CBD products are going to be bought allows the use of CBD and other medical cannabis-related products.

2. Research on the CBD manufacturer’s legitimacy. Make sure the products to be purchased are non-GMO and derived from certified organic hemp. 

3. Look up the CBD brand and its products online. Check the reviews and see if the store is authorized by the government to sell CBD. More credible brands have money-back guarantee policies to assure customer satisfaction. 

4. Determine the extraction process used in a CBD oil product. CO2 extraction is a safe process(49). Natural carrier oils that are used in the extraction methods of CBD include MCT oil (medium-chain triglycerides from coconut oil), hemp seed oil, and extra-virgin olive oil.

5. Request access to a product’s batch testing reports. To certify the quality and potency of the ingredients of their CBD products, manufacturers allow third-party laboratories to analyze these. There has been a prevalence of mislabeled CBD products being sold online. In 2018, researchers found that a significant number of CBD products contained less CBD than what was declared in the label(50). The authors also found that 43% of the product samples tested had more CBD than what was on the label, while 21% had THC amounts that were enough to get children high. 

6. Before buying a CBD product for OCD treatment, patients should consult with a doctor first.

CBD Dosage for OCD

Due to the US FDA’s lack of approval, a standard CBD dosage chart for OCD patients has not yet been developed. When taking CBD oil for OCD, patients should go low and slow. 

OCD patients are advised to start with a low dosage of CBD. If there are no side effects, the dosage may be increased gradually until therapeutic effects are observed.

Patients are also advised to keep a journal to record their reactions to the CBD treatment. They may use this journal as a reference upon consultation with their physician.

Before adding CBD to their OCD therapy, patients should always inform their doctor first.

 

Credit: The above article is extracted from https://cbdclinicals.com/cbd-for-ocd/

CBD Clinicals has strict sourcing and reference guidelines and relies exclusively on independent and peer-reviewed studies from medical associations & academic institutions. This is further explained in their editorial process.

1. Blessing, E. M., Steenkamp, M. M., Manzanares, J., & Marmar, C. R. (2015). Cannabidiol as a Potential Treatment for Anxiety Disorders. Neurotherapeutics: the journal of the American Society for Experimental NeuroTherapeutics, 12(4), 825–836. https://doi.org/10.1007/s13311-015-0387-1

2. P. Flaer, M. AlRubaie. Cannabidiol (CBD): An Innovative Pharmacological Treatment for Obsessive-Compulsive Disorder (OCD). Research & Reviews: Journal of Neuroscience. 2017; 7(1): 12–16p.

3. Pittenger, C., & Bloch, M. H. (2014). Pharmacological treatment of obsessive-compulsive disorder. The Psychiatric clinics of North America, 37(3), 375–391. https://doi.org/10.1016/j.psc.2014.05.006

4. Mayo Clinic Staff. (2020 March 11). Diagnosis and Treatment. Retrieved from https://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/symptoms-causes/syc-20354432

5. Pittenger, C. op cit. 

6. Ibid.

7. Publishing, H. H. (2009, April). Treating obsessive-compulsive disorder. Retrieved from https://www.health.harvard.edu/mind-and…/treating-obsessive-compulsive-disorder

8. Ibid.

9. Kayser, R., Snorrason, I., Haney, M., Lee, F., & Simpson, H. (2019 Jun). The Endocannabinoid System: A New Treatment Target for Obsessive-Compulsive Disorder?. Cannabis and Cannabinoid Research. 77-87. https://doi.org/10.1089/can.2018.0049

10. Human Endocannabinoid System. (n.d.). Retrieved from https://www.uclahealth.org/cannabis/human-endocannabinoid-system

11. Kayser, R. op. cit. 

12. Ibid.

13. Ibid.

14. Maroon, J., & Bost, J. (2018). Review of the neurological benefits of phytocannabinoids. Surgical neurology international, 9, 91. https://doi.org/10.4103/sni.sni_45_18

15. Kayser, R. R., Haney, M., Raskin, M., Arout, C., & Simpson, H. B. (2020). Acute effects of cannabinoids on symptoms of obsessive-compulsive disorder: A human laboratory study. Depression and anxiety, 10.1002/da.23032. Advance online publication. https://doi.org/10.1002/da.23032

16. Russo, E.B., Burnett, A., Hall, B. et al. Agonistic Properties of Cannabidiol at 5-HT1a Receptors. Neurochem Res 30, 1037–1043 (2005). https://doi.org/10.1007/s11064-005-6978-1

17. Sangkuhl, K., Klein, T. E., & Altman, R. B. (2009). Selective serotonin reuptake inhibitors pathway. Pharmacogenetics and genomics, 19(11), 907–909. https://doi.org/10.1097/FPC.0b013e32833132cb

18. What Causes OCD. (n.d.). Retrieved from https://www.ocduk.org/ocd/what-causes-ocd/

19. Leweke FM, Piomelli D, Pahlisch F, et al. Cannabidiol enhances anandamide signaling and alleviates psychotic symptoms of schizophrenia. Transl Psychiatry. 2012;2(3):e94. Published 2012 Mar 20. DOI:10.1038/tp.2012.15.

20. Morena M., Aukema, R., […], and Hill M. Upregulation of Anandamide Hydrolysis in the Basolateral Complex of Amygdala Reduces Fear Memory Expression and Indices of Stress and Anxiety. Journal of Neuroscience 13 February 2019, 39 (7) 1275-1292; DOI: https://doi.org/10.1523/JNEUROSCI.2251-18.2018. 

21. Blessing, E. M. op. cit. 

22. Flaer, P. op. cit. 

23. Obsessive-Compulsive Disorder. (n.d.). Retrieved from https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml

24. Ibid.

25. Ibid.

26. Ibid.

27. Mayo Clinic Staff. (2020 March 11). Symptoms and Causes. Retrieved from https://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/symptoms-causes/syc-20354432

28. Ibid.

29. Lack C. W. (2012). Obsessive-compulsive disorder: Evidence-based treatments and future directions for research. World journal of psychiatry, 2(6), 86–90. https://doi.org/10.5498/wjp.v2.i6.86

30. de Mello Schier, A. R., de Oliveira Ribeiro, N. P., Coutinho, D. S., Machado, S., Arias-Carrión, O., Crippa, J. A., Zuardi, A. W., Nardi, A. E., & Silva, A. C. (2014). Antidepressant-like and anxiolytic-like effects of cannabidiol: a chemical compound of Cannabis sativa. CNS & neurological disorders drug targets, 13(6), 953–960. https://doi.org/10.2174/1871527313666140612114838

31. Shannon, S., Lewis, N., Lee, H., & Hughes, S. (2019). Cannabidiol in Anxiety and Sleep: A Large Case Series. The Permanente Journal, 23, 18–041. https://doi.org/10.7812/TPP/18-041

32. Hagen, K., Solem, S., Opstad, H.B. et al. The role of metacognition and obsessive-compulsive symptoms in psychosis: an analogue study. BMC Psychiatry 17, 233 (2017). https://doi.org/10.1186/s12888-017-1392-1

33. Khan, R., Naveed, S., Mian, N. et al. The therapeutic role of Cannabidiol in mental health: a systematic review. J Cannabis Res 2, 2 (2020). https://doi.org/10.1186/s42238-019-0012-y

34. Aouizerate, B., & Haffen, E. (2019). New Research in Obsessive-Compulsive Disorder and Major Depression. Brain sciences, 9(6), 140. https://doi.org/10.3390/brainsci9060140

35. Crippa, J. A., Guimarães, F. S., Campos, A. C., & Zuardi, A. W. (2018). Translational Investigation of the Therapeutic Potential of Cannabidiol (CBD): Toward a New Age. Frontiers in immunology, 9, 2009. https://doi.org/10.3389/fimmu.2018.02009

36. Linge, R., Jiménez-Sánchez, L., Campa, L., Pilar-Cuéllar, F., Vidal, R., Pazos, A., Adell, A., & Díaz, Á. (2016). Cannabidiol induces rapid-acting antidepressant-like effects and enhances cortical 5-HT/glutamate neurotransmission: role of 5-HT1A receptors. Neuropharmacology, 103, 16–26. https://doi.org/10.1016/j.neuropharm.2015.12.017

37. Liou, S. (2011, June 26). About Glutamate Toxicity. Retrieved from https://hopes.stanford.edu/about-glutamate-toxicity/

38. Iffland, Kerstin, and Franjo Grotenhermen. “An Update on Safety and Side Effects of Cannabidiol: A Review of Clinical Data and Relevant Animal Studies.” Cannabis and cannabinoid research vol. 2,1 139-154. 1 Jun. 2017, doi:10.1089/can.2016.0034

39. “CANNABIDIOL (CBD) Critical Review Report.” World Health Organization, 2018.

40. Iffland, K. op. cit. 

41. What to Know About Products Containing Cannabis and CBD. (n.d.). Retrieved from https://www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis

42. Yamaori S, Ebisawa J, Okushima Y, Yamamoto I, Watanabe K. Potent inhibition of human cytochrome P450 3A isoforms by cannabidiol: role of phenolic hydroxyl groups in the resorcinol moiety. Life Sci. 2011 Apr 11;88(15-16):730-6. doi: 10.1016/j.lfs.2011.02.017. Epub 2011 Feb 26.

Further Resources:

 

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