Mental Health Awareness

Millions of Americans are living with mental health conditions, deeply impacting day-to-day living. Treatment options may vary from person to person just as mental illnesses may look different from person to person. Many resources exist to assist in one’s path to healing and to improve our overall well-being, however in the medical community, there is a growing need to improve knowledge on potential drug dependencies to those who suffer from mental health conditions and find alternatives with improved efficacy and safety. 

Decades of anecdotal data has led researchers to better understand how the cannabis plant may improve one’s quality of life. In recent years growing evidence suggests the endocannabinoid system (ECS) plays an essential role in the pathophysiology of mental illnesses. Here we will discuss what research is available to support the potential benefits of cannabinoids from the cannabis plant, namely cannabidiol (CBD), delta-9-tetrahydrocannabinol (THC), and cannabigerol (CBG), for the following mental health conditions:

• Generalized Anxiety Disorder
• Substance Abuse Disorder
• Depression
• PTSD
• Eating Disorder

Generalized Anxiety Disorder

Anxiety disorders are among the most common reasons for seeking cannabis-based therapy options. Despite available, effective pharmaceutical options for the treatment of Generalized Anxiety Disorder (GAD), many patients end up having treatment-resistant anxiety due to side effects and tolerance to medications. Therefore there is a need to seek alternative options for those who are not responding or benefiting from the available pharmacotherapies. In 2022 a case series using data collected from the UK Medical Cannabis Registry was published, focusing on those in the registry with GAD. Findings showed statistically significant improvements, suggesting cannabis therapies may lead to improved health-related quality of life. 

Those living with GAD understand that the anxiety is uncontrollable, often they wake up with ongoing general worrying. This is often referred to as the non-medical term of “Morning Anxiety” and relates to the cortisol awakening response (CAR). 

Cortisol is known as our “stress hormone” and increases in the second half of the night and then steadily into morning. The night awakening is suggested to not coincide with actual experiences, where CAR is speculated to serve a specific function of preparing individuals for the upcoming demands of the day. Research has stated that “it is likely that individuals with an excessive number of duties and tasks already engage in the process of coping with these duties as soon as they wake up in the morning”. For healthy individuals, this may be useful for thinking about how to manage their day. However, one with an underlying anxiety disorder may find it to be paralyzing. 

While research on CBD and cortisol is its infancy, there have been several clinical trials and one partially controlled trial looking at CBD for stress. All showed that CBD was effective in significantly reducing the stress response and comparable to pharmaceuticals where included. 

Substance Use Disorder

Research into the effects of CBD on addictive drug memory processing is still in its infancy, however there is a growing body of literature looking into the effects of CBD on the regulation of the reinforcing, motivation, and withdrawal-related effects of various drugs of abuse such as alcohol, opioids, nicotine, and psychostimulants. The known safety profile of CBD and its lack of reinforcing effects have increased the number of studies suggesting CBD as a potential therapeutic intervention for substance abuse disorders (SUD). 

A literature review published in 2021 included several findings that would suggest that CBD reduced the consumption, motivation or relapse of alcohol, opioids, and psychostimulants, as well as the withdrawal-related signs of morphine and cocaine.

Depression

Endocannabinoids and CB1 receptors are widely distributed in the brain areas that are often related to mood disorders and their expression is regulated by antidepressants. Enhancement of endocannabinoid activity at various receptor sites appears to exert antidepressant-like effects. The 5-HT1A receptor is a serotonin receptor that is located in presynaptic and postsynaptic regions. Activating these receptors have been involved in the mechanism of action of anti-anxiety, antidepressant, and antipsychotic medications. 

Data indicate that repeated administration of CBD may produce an effect that is consistent with results from studies testing traditional antidepressant medications. These are known to be clinically relevant findings as CBD is known to benefit while exhibiting few side effects, supporting the initiation of clinical trials testing the efficacy of CBD-based compounds for the treatment of mood disorders. 

The serotonergic mechanism of CBD is distinct from commonly used antidepressant medications in that it does not appear to produce symptoms of withdrawal. CBD has also been shown to synergize with other serotonergic medications. Data suggests that CBD could facilitate the antidepressant effect induced by these antidepressant drugs, therefore allowing selective serotonin reuptake inhibitors (SSRIs) to be administered at lower doses, resulting in fewer side effects. 

In a recently published observational study, it was found that medicinal cannabis use was associated with lower self-reported depression. Initiation of medicinal cannabis during the follow-up period was associated with significantly decreased anxiety and depressive symptoms, an effect that was not observed in Controls who had not initiated cannabis use. 

A qualitative analysis published in 2022 paid close attention to the notable quality of life improvements attributed to medicinal cannabis use. The two overarching categories were “enhanced well-being” and “improved daily functioning”. Enhanced well-being includes feelings such as regaining a sense of hope, enjoying family life, and laughing more often. A woman from the study with Lyme Disease was quoted saying, “People such as myself are able to become productive and valued members of society again when we can have the quality of life improved so simply.” 

PTSD

Medications recommended for the treatment of PTSD are currently either SSRIs or serotonin-norepinephrine reuptake inhibitors (SNRIs), which do not specifically target the memory process. This could be why the pharmacological treatment of PTSD has shown to be difficult, with the potential for considerable side effects. However, interventions that directly affect our ECS have shown promise as they can affect both emotional and cognitive aspects. Recent studies have pointed towards the ways in which cannabinoid therapy may help alleviate associated symptoms of PTSD such as anxiety, nightmares, increased alertness, panic attacks, depression, and overwhelming emotions. 

There have been two observations of importance that have led researchers to further explore cannabinoid therapy as a PTSD treatment option. First, patients with PTSD were found to be more likely to consume cannabis as a form of self-medication in an attempt to reduce their symptoms of anxiety and disrupted sleep. Secondly, patients with PTSD were shown through research to have increased levels of cannabinoid receptors while decreased peripheral levels of the endogenous cannabinoid, Anandamide (AEA). This means that those suffering with PTSD may be experiencing an AEA deficiency. 

Due to the modulating effect of CBD on the ECS, and considering the many body processes that the ECS regulates, CBD has seen increased research for potential value in several conditions. Research has stated that the “ECS can provide more efficient and better tolerated alternatives to the standard treatments for PTSD”. The potential of cannabinoid therapy has been repeatedly demonstrated in animal models of traumatic event exposure as well as anecdotally in humans. CBD, in particular, is promising as it has been researched for its effectiveness among generalized anxiety disorders, depression, and traumatic memories while proving to be well tolerated by humans, both in overall safety and possible side effects.

Eating Disorder

There is a lack of effective treatment for eating disorders, such as Anorexia nervosa (AN), bulimia, and binge-eating disorder (BED) however there is extensive evidence that suggests the ECS plays an essential role in our emotional response to eating. 

Both THC and CBG have been looked at for their potential to serve as an appetite stimulant. User anecdotes also suggest that cannabis use will promote appetite. Studies have shown that caloric intake increases among cannabis users when compared with non-users. This leads to the popular belief that cannabis use leads to unintentional weight gain, however many human epidemiological studies show the opposite. As far as appetite is concerned, when provided care and guidance in your approach to dosing, cannabinoids may actually help to promote a healthy weight. 

Recent evidence suggests that exaggerated anxiety and diminished reward or motivation to eat are key roles in triggering AN symptoms. The University of California, San Diego is looking at CBD for its potential to reduce anxiety, and to investigate benefits for adults living with AN. Their study to understand CBD’s role in regulating meal time anxiety is currently active. 

The importance of a dose-outcome relationship

Cannabis is not a one-size fits all approach, and more cannabis does not typically correlate to increased benefit. One-on-one support, taking it slow, and being consistent with your therapy are all key components to finding success. Mental health conditions are incredibly complex and more than one therapy may be necessary to alleviate symptoms. If you seek resources for how to talk to your doctor or data-driven answers to your questions about cannabinoid therapy and symptoms of mental health conditions, the Realm of Caring Care Team is here to assist. 

At Realm of Caring, we are not medical professionals nor clinically trained to advise one through their mental illness. However, we care. We are here to help you find resources. We are also here to support you if you are utilizing cannabinoid therapy to bring symptomatic relief, whether that relief is needed psychologically or physically. Those of us who suffer are well aware, mental health illnesses go far beyond affecting mood, physical symptoms may also be witnessed. 

Reach the care team by calling (719) 347-5400, emailing info@realmofcaring.org, or by scheduling an appointment.

Additional Resources:

• Help for Mental Illnesses
• Looking after you Mental Health
• Find a Therapist who specializes in anxiety, depression, OCD, PTSD, and related disorders.
• A step-by-step guide to finding a mental health professional who you feel comfortable working with
• Fitness 4Mind4Body: Diet and Nutrition
• The Exercise Effect
• A Comprehensive List of Digital Resources for Mental Health
• NAMI 2024 Mental Health Awareness Month Toolkit