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Official websites use. Share sensitive information only on official, secure websites. Cannabidiol CBD is one of many cannabinoid compounds found in cannabis. Evidence points toward a calming effect for CBD in the central nervous system. Interest in CBD as a treatment of a wide range of disorders has exploded, yet few clinical studies of CBD exist in the psychiatric literature. A large retrospective case series at a psychiatric clinic involving clinical application of CBD for anxiety and sleep complaints as an adjunct to usual treatment. The retrospective chart review included monthly documentation of anxiety and sleep quality in adult patients. Anxiety scores decreased within the first month in 57 patients Sleep scores improved within the first month in 48 patients In this chart review, CBD was well tolerated in all but 3 patients. Cannabidiol may hold benefit for anxiety-related disorders. Controlled clinical studies are needed. The Cannabis plant has been cultivated and used for its medicinal and industrial benefits dating back to ancient times. Cannabis sativa and Cannabis indica are the 2 main species. The most abundant cannabinoid, tetrahydrocannabinol THC , is well known for its psychoactive properties, whereas cannabidiol CBD is the second-most abundant and is nonpsychoactive. Hemp plants are grown for their fibers and high levels of CBD that can be extracted to make oil, but marijuana plants grown for recreational use have higher concentrations of THC compared with CBD. Many different cultures have used the Cannabis plant to treat a plethora of ailments. Practitioners in ancient China targeted malaria, menstrual symptoms, gout, and constipation. During medieval times, cannabis was used for pain, epilepsy, nausea, and vomiting, and in Western medicine it was commonly used as an analgesic. California was the first state to go against the federal ban and legalize medical marijuana in CBD has demonstrated preliminary efficacy for a range of physical and mental health care problems. In the decade before , there were only 9 published studies on the use of cannabinoids for medicinal treatment of pain; since then, 30 articles have been published on this topic, according to a PubMed search conducted in December Finally, the most notable benefit of cannabis as a form of treatment is safety. There have been no reports of lethal overdose with either of the cannabinoids and, outside of concerns over abuse, major complications are very limited. Given the promising biochemical, physiologic, and preclinical data on CBD, a remarkable lack of randomized clinical trials and other formal clinical studies exist in the psychiatric arena. The present study describes a series of patients using CBD for treatment of anxiety or sleep disturbances in a clinical practice setting. Given the paucity of data in this area, clinical observations can be quite useful to advance the knowledge base and to offer questions for further investigation. Given the novel nature of this treatment, our study also focused on tolerability and safety concerns. As a part of the evolving legal status of cannabis, our investigation also looked at patient acceptance. A retrospective chart review was conducted of adult psychiatric patients treated with CBD for anxiety or sleep as an adjunct to treatment as usual at a large psychiatric outpatient clinic. Any current psychiatric patient with a diagnosis by a mental health professional psychiatrist, psychiatric nurse practitioner, or physician assistant of a sleep or anxiety disorder was considered. Diagnosis was made by clinical evaluation followed by baseline psychologic measures. These measures were repeated monthly. Comorbid psychiatric illnesses were not a basis for exclusion. Accordingly, other psychiatric medications were administered as per routine patient care. Selection for the case series was contingent on informed consent to be treated with CBD for 1 of these 2 disorders and at least 1 month of active treatment with CBD. Patients treated with CBD were provided with psychiatric care and medications as usual. Most patients continued to receive their psychiatric medications. The patient population mirrored the clinic population at large with the exception that it was younger. If anxiety complaints predominated, the dosing was every morning, after breakfast. If sleep complaints predominated, the dosing was every evening, after dinner. Often CBD was employed as a method to avoid or to reduce psychiatric medications. Informed consent was obtained for each patient who was treated and considered for this study. CBD was added to care, dropped from care, or refused as per individual patient and practitioner preference. Wholeness Center is a large mental health clinic in Fort Collins, CO, that focuses on integrative medicine and psychiatry. Practitioners from a range of disciplines psychiatry, naturopathy, acupuncture, neurofeedback, yoga, etc work together in a collaborative and cross-disciplinary environment. CBD had been widely incorporated into clinical care at Wholeness Center a few years before this study, on the basis of existing research and patient experience. The sampling frame consisted of adult patients who were consecutively treated with CBD at our psychiatric outpatient clinic. Eighty-two Patients with sole or primary diagnoses of schizophrenia, posttraumatic stress disorder, and agitated depression were excluded. Ten patients were further excluded because they had only 1 documented visit, with no follow-up assessment. The final sample consisted of 72 adult patients presenting with primary concerns of anxiety Sleep and anxiety were the targets of this descriptive report. Sleep concerns were tracked at monthly visits using the Pittsburg Sleep Quality Index. Anxiety levels were monitored at monthly visits using the Hamilton Anxiety Rating Scale. Both scales are nonproprietary. The Hamilton Anxiety Rating Scale is a widely used and validated anxiety measure with 14 individual questions. It was first used in and covers a wide range of anxiety-related concerns. The score ranges from 0 to A score under 17 indicates mild anxiety, and a score above 25 indicates severe anxiety. The Pittsburg Sleep Quality Index is a self-report measure that assesses the quality of sleep during a 1-month period. It consists of 19 items that have been found to be reliable and valid in the assessment of a range of sleep-related problems. Each item is rated 0 to 3 and yields a total score from 0 to A higher number indicates more sleep-related concerns. Side effects and tolerability of CBD treatment were assessed through spontaneous patient self-reports and were documented in case records. Any other spontaneous comments or complaints of patients were also documented in case records and included in this analysis. Deidentified patient data were evaluated using descriptive statistics and plotted graphically for visual analysis and interpretation of trends. Most patients with an anxiety diagnosis were men All 72 patients completed sleep and anxiety assessments at the onset of CBD treatment and at the first monthly follow-up. By the second monthly follow-up, 41 patients Table 1 provides means and standard deviations for sleep and anxiety scores at baseline and during the follow-up period for adults taking CBD. Figure 1 graphically displays the trend in anxiety and sleep scores over the study period. On average, anxiety and sleep improved for most patients, and these improvements were sustained over time. At the first monthly assessment after the start of CBD treatment, Two months after the start of CBD treatment, These results demonstrated a more sustained response to anxiety than for sleep over time. Patient records displayed a larger decrease in anxiety scores than in sleep scores. The sleep scores demonstrated mild improvement. The anxiety scores decreased within the first month and then remained decreased during the study duration. CBD was well tolerated, with few patients reporting side effects. Two patients discontinued treatment within the first week because of fatigue. Three patients noted mild sedation initially that appeared to abate in the first few weeks. One patient with a developmental disorder aged 21 years had to be taken off the CBD regimen because of increased sexually inappropriate behavior. The CBD was held, and the behavior disappeared. The behavior reappeared on redosing 2 weeks later, and the CBD regimen was formally discontinued. One patient noted dry eyes. Reasons for patients not following-up at later assessment points are largely unknown but are probably because of standard attrition experienced in usual clinical practice. There was no evidence to suggest patients discontinued care because of tolerability concerns. The attrition rates were similar in nature and size to those found in routinely scheduled visits in this clinic. Four patients declined CBD treatment because of religious or ethical concerns about the relation to cannabis. Nearly all patients easily provided informed consent once the nature of the treatment was explained. Most patients appreciated the opportunity to try something natural and avoid further or initial psychiatric medication use. In an outpatient psychiatric population, sleep scores displayed no sustained improvements during the 3-month study. Anxiety scores decreased fairly rapidly, and this decrease was sustained during the study period. These results are consistent with the existing preclinical and clinical data on CBD. CBD was well accepted and well tolerated in our patients. Side effects were minimal mainly fatigue and may be related to dosing. The first is that in our experience lower doses appear to elicit an adequate clinical response. These results must be interpreted cautiously because this was a naturalistic study, all patients were receiving open-label treatment, and there was no comparison group. Concurrent psychiatric medications were employed as in routine clinical care. This is both a limitation and strength, as very few publications exist in this population. Other researchers have noted that the large societal notoriety about cannabis and medical marijuana probably contributes to a larger-than-normal placebo effect. Likewise, the clinical population in this case series is skewed younger than typical for our clinic, and future studies could explore the possible selection bias inherent in this treatment option. Most patients were also taking psychiatric medications and receiving other mental health services, such as counseling, which limits the ability to make any causal links to CBD treatment. Clinical attrition is evident in the dataset. The reason for this might be related to CBD ingestion or not, so the overall component remains unclear. Furthermore, patients at our clinic often express a desire to reduce or to avoid use of psychiatric medications, which may contribute to an enhanced placebo effect or additional bias. The length of clinical monitoring may help to decrease this concern. However, the clinical data in this analysis show a trend toward clinically significant relief of anxiety upon the start of CBD treatment. The legality of CBD is not clear. Like the issues surrounding the legality of cannabis in general, CBD presents the clinician with a confusing state vs federal legal quandary, and this keeps the issue in question. The federal government has announced that it is not focused on this compound in terms of enforcement or interdiction. Pending federal legislation to redefine the legal status of cannabis would clarify this complex issue. Formal studies on efficacy and dose finding are much needed. Some urgency exists, given the explosion of lay interest in this topic and the rush to market these compounds. Current understanding of the physiology and neurologic pathways points to a benefit with anxiety-related issues. The results of our clinical report support the existing scientific evidence. In our study, we saw no evidence of a safety issue that would limit future studies. In this evaluation, CBD appears to be better tolerated than routine psychiatric medications. Furthermore, CBD displays promise as a tool for reducing anxiety in clinical populations, but given the open-label and nonrandomized nature of this large case series, all results must be interpreted very cautiously. Randomized and controlled trials are needed to provide definitive clinical guidance. CV Sciences was not involved in the data collection, data interpretation, preparation of the report, or decision to submit the report for publication. No other financial support was provided. The authors would like to express their deep appreciation to the staff and clinicians at Wholeness Center for their professionalism. Dr Shannon has published several professional books on integrative mental health. Dr Shannon is a Principal Investigator for a Phase 3 study of 3,4-methylenedioxy-methamphetamine MDMA -assisted psychotherapy for severe posttraumatic stress disorder and receives compensation for his clinical work from the Multidisciplinary Association for Psychedelic Studies, Santa Cruz, CA. The other authors have no conflicts of interests to disclose. As a library, NLM provides access to scientific literature. Perm J. Find articles by Scott Shannon. Find articles by Nicole Lewis. Find articles by Heather Lee. Find articles by Shannon Hughes. Collection date Descriptive statistics for anxiety and sleep scores among adults using cannabidiol treatment. Open in a new tab. Disclosure Statement Dr Shannon has published several professional books on integrative mental health. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

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