UPDATED date
This chapter is mainly organized according to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition[APA_2013]. However, chemical addictions are treated separately in the article Chemical Addictions. Psychiatric consequences of neurological conditions are also treated separately in the article Neurological Conditions.
Fragile X syndrome is caused by an inherited genetic defect in a gene that protects against mental retardation. Studies show that CBD helps with fragile-X symptoms such as social avoidance and anxiety. It also helps with other symptoms, improving sleep, feeding, motor coordination, language skills, anxiety, and sensory processing[Tartaglia_2019][Heussler_2019].
Autism spectrum disorder affects how people interact with others, communicate, learn, and behave. Symptoms appear within the first two years of life.
Small-scale studies of autistic children found that cannabis extracts with a very high CBD/THC ratio usually improved autistic symptoms without undue intoxication[Hindocha_2015][Schleider_2019]. The symptoms that improved included:
Tourette Syndrome is a condition of the nervous system that causes people to have involuntary tics — sudden twitches, movements, or sounds that they do repeatedly.
THC has successfully treated Tourette syndrome. A single dose was adequate. THC treatments continued to be effective over six weeks. The effects persisted for several weeks after treatment was stopped. THC successfully treated a refractory case as well[Müller-Vahl_2002][Müller-Vahl_2003][Müller-Vahl_2003b][Hasan_2010].
Schizophrenia involves three kinds of problems:
Negative symptoms are harder to treat than positive symptoms. A hallmark of the disease is that it tends to begin suddenly with a dramatic first break. Paradoxically, the first break may go undiagnosed because schizophrenics tend to hide their symptoms. ⮛ MORE ⮛
The identified symptoms of schizophrenia vary somewhat from one source to the next. The following list is typical.
Executive function involves translating ideas into decisions and actions. Self-awareness includes awareness of being schizophrenic.
The above list of schizophrenia symptoms draws from lists given by the Mayo Clinic[Mayo_Clinic2020], Living with Schizophrenia[Living_With_Schizophrenia2019], and Wikipedia[Signs_and_symptoms2020]
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Schizophrenia is one illness where THC is strongly contraindicated. Daily use of high-THC street marijuana triples the chance of developing schizophrenia. Those who develop schizophrenia as a result of consistent marijuana use do so several years sooner. Moreover, even in those without schizophrenia, marijuana often stimulates schizophrenia-like symptoms. These warnings do not apply to balanced preparations containing equal amounts of THC and CBD.
CBD is at least as effective in treating schizophrenia as conventional antipsychotics. Clozapine is better at treating symptoms but is typically used only for treatment-resistant patients due to its side effects.
Patients with treatment-resistant schizophrenia may not respond to CBD. Its use as a supplement to other antipsychotics may not help. ⮛ RESEARCH ⮛
Several studies have reported on the effect of marijuana on non-psychotic users. Regular users of high THC / low CBD marijuana had significantly increased psychotic symptoms compared to non-users and users of balanced THC/CBD preparations. CBD was able to block positive symptoms, especially delusions and hallucinations[Celia_2008][Bhattacharyya_2009][Schubart_2011]. These effects are visible in functional MRI scans. CBD affected the same regions as THC, but with opposite changes, even in non-users. But for non-users, these changes in brain function did not affect behavior[Bhattacharyya_2009][Bhattacharyya_2018].
Daily use of high-THC street marijuana tripled the chances of developing schizophrenia compared to non-users[Di_Forti_2015]. A related observation is that marijuana use in early adulthood predicts higher use, later on, of prescription antipsychotics, mood stabilizers, and antidepressants[Rognli_2019]. For those who smoke street marijuana and do develop psychosis, the age of onset is three years sooner[Helle_2015]. However, marijuana use versus non-use does not predict what symptoms will later develop in those who develop schizophrenia[Sarrazin_2015].
As a supplemental therapy, CBD often improves positive symptoms of schizophrenia. This result is seen both in clinicians' reports and standardized tests[McGuire_2017][Boggs_2018]. CBD was comparable to the antipsychotic amisulpride in a clinical trial for treating both positive and negative symptoms. The likely reason is that CBD raised anandamide levels[Leweke_2012]. Amisulpride and CBD compare favorably with most conventional antipsychotics. Only clozapine is better at treating symptoms, but its side effects are such that it is reserved for treatment-resistant patients[Amisulpride_2020][Clozapine_2020].
CBD is no magic bullet. In two studies, patients with treatment-resistant schizophrenia failed to respond to CBD monotherapy[Zuardi_2006]. There was also a clinical trial where adjunctive use of CBD was unable to help with cognitive symptoms of schizophrenia[Boggs_2018].
There is a genetic link between heavy cannabis use and developing schizophrenia. So drawing cause-and-effect conclusions about the relationship between the two conditions requires caution[Aas_2017].
The above research differs significantly from research on cannabis compounds in treating other illnesses. The more informative studies regarding schizophrenia have all been on humans rather than animals. And the only two cannabis compounds studied have been THC and CBD. There is no obvious reason why this should be the case.
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Bipolar disorder is a mood disorder characterized by periods of depression and periods of abnormally-elevated energy or happiness.
Cannabis use is strongly correlated with bipolar disorder. According to a lengthy research review, it is associated with an early age of onset, increased severity, increased disability, increased risk for suicide, increased risk of manic symptoms, and general disability[Suryadevara_2017]. None of the studies reviewed address the issue of cause and effect, and there is good reason for suspicion. People with bipolar disorder are seven times more likely to use cannabis than others[Suryadevara_2017]. One possibility is that THC has a causal role in the development of bipolar disorder. But a competing explanation based on patient reports is that people with bipolar disorder are attracted too marijuana because its calming effect tends to smooth out bipolar highs and lows.
One small-scale study found that marijuana may bring about a "substantial decrease in a composite measure of mood symptoms." Moreover, marijuana does not increase cognitive impairment beyond that already due to the bipolar disorder[Sagar_2016]. Furthermore, cannabis use has been associated with a lower remission rate following successful treatment for bipolar disorder[Suryadevara_2017].
Unfortunately, none of this bipolar research involves a clear intention to treat, and none of it has moved beyond the study of undifferentiated street marijuana.
Depression is a mental and behavioral disorder characterized by loss of interest or a loss of feeling of pleasure in activities that usually bring joy to people.
Smoking marijuana reduces depression. The best strains for depression are those high in CBD and low in THC. A couple of puffs may be enough to produce significant relief. Animal studies provide additional results on depression.
CBD lessens depression by stimulating some of the serotonin receptors in the brain. Moreover, CBD is rapid-acting. Moderate doses of THC have antidepressant properties, whereas high doses do not.
CBC also has antidepressant properties, as does BCP (β-caryophyllene). The terpenes linalool and d-limonene also have antidepressant effects. Their mechanism of action is different from that of THC or CBD.
Unhappiness. People with consistently high levels of the endocannabinoid anandamide tend to be happier and thus less depressed. The cannabinoids CBD, CBN, and THC all raise anandamide levels. ⮛ RESEARCH ⮛
Two large-scale surveys showed that marijuana reduces objective measures of depression[Denson_2005][Cuttler_2005]. One of the surveys dealt with Canadian medical marijuana users who used the Strainprint app. This utility provides exact data on marijuana strains[Strainprint_2020]. That survey showed that high-CBD, low-THC strains worked best. Surprisingly, two puffs sufficed to cut depression levels in half. The apparent explanation behind CBD's antidepressant properties is that it is a 5-HT1A serotonin agonist[Russo_2005].
CBD's effectiveness in mice is similar to imipramine, but unlike imipramine, CBD acts quickly[Zanelati_2009][Sales_2018][Linge_2015]. THC, CBD, and CBC all have antidepressant effects in animal models of despair[El-Alfy_2010].
BCP has antidepressant effects because it is a CB2 agonist[Bahi_2017]. Perhaps THC's antidepressant effect is also due to its being a CB2 agonist. The mechanisms behind the antidepressant effects of linalool and limonene are different from those of the cannabinoids[Dos_Santos_2017][Zhang_2019].
Mouse experiments have shown that CBD, CBN, and THC inhibit the breakdown of anandamide, which also goes by the name N-arachidonoylethanolamide[Watanabe_1996]. Higher levels of anandamide are statistically associated with greater happiness. In more detail, worldwide surveys have shown that happiness is associated with a gene variant that slows anandamide's breakdown[Minkov_2016][Macrae_2016].
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These are similar conditions:
Marijuana strains that have a balanced content of CBD and THC may be the best for stress and anxiety, anxiety more so than stress.
CBD has been found helpful for social anxiety disorder and anxiety induced by public speaking. However, CBD may not be helpful for anxiety that is not caused by anxiety-producing events. Moderate doses of CBD are more effective than large doses.
Low doses of THC may provide modest relief in stressful encounters, while high doses are counterproductive. THC itself is known to induce anxiety. CBD can counter such anxiety, which is another reason to avoid CBD deficient strains of marijuana.
Linalool and linalyl acetate are the principal components of lavender. Lavender's effectiveness for anxiety may be comparable to the benzodiazepine lorazepam (Ativan). Of course, lavender is superior to benzodiazepines in side effects, including freedom from addiction. Lavender is also useful for restlessness and insomnia. Eucalyptol, apigenin, and d-limonene may also reduce anxiety. ⮛ RESEARCH ⮛
A large-scale survey of medical cannabis users found that marijuana strains with a balanced CBD and THC content are best for stress and anxiety. Alleviation from stress may require as many as ten puffs. The survey relied on the Strainprint app to obtain exact data on what products users consume[Cuttler_2005][Strainprint_2020].
Patients with anxiety or sleep disorders were given CBD over three months in a large case series and showed improvement[Shannon_2019]. CBD noticeably reduced anxiety in teens with a social anxiety disorder[Masataka_2019]. In a similar experiment, patients with a social anxiety disorder were almost normal after taking CBD[Bergamaschi_2011]. One study of normal subjects found CBD ineffective for general anxiety but effective for anxiety induced by simulated public speaking[Zuardi_1993]. Another study found that moderate doses of CBD, but not large doses, quelled anxiety caused by public speaking[Zuardi_2017].
Using functional MRI imagining on humans, it is possible to observe, in
real-time, CBD blocking anxiety as it travels from the amygdala to the anterior
cingulate gyrus[Fusar-Poli_2009].
Low doses of THC provided relief to stressful encounters, while high doses were counterproductive[Childs_2017]. However, THC itself is known to induce anxiety. CBD can counter it[Zuardi_1982].
Several clinical trials have demonstrated the effectiveness of Linalool and linalyl acetate in treating anxiety. In one trial, lavender oil was comparable to the benzodiazepine lorazepam (Ativan). Moreover, lavender is superior to benzodiazepines in terms of side effects. In particular, lavender is non-addictive[Malcolm_2018]. Lavender is also regarded as useful for restlessness and insomnia[Goldberg_2000].
Inhaling eucalyptol (aka 1,8-Cineole) may reduce anxiety before surgery[Kim_2014]. The flavonoid apigenin reduced stress in animal studies, and the terpene d-limonene reduced anxiety[Viola_1995][dAlessio_2014].
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PTSD is characterized by residual feelings of stress or fright experienced even when one is no longer in danger. It is a frequent result of trauma. Roughly 17% of the veterans from Iraq and Afghanistan have PTSD. Data from a New Mexico shows that taking marijuana for PTSD can result in a 75% reduction in symptoms.
In a survey of 2,000 medical cannabis users, the most popular strains for PTSD were Jack Herer, Island Sweet Skunk, White Widow, and Jean Guy. Jack Herer is a relatively high THC strain whose top terpenes include pinene, myrcene, and trans-nerolidol.
Rats tend to get PTSD from hanging out with hungry house cats. Repeated CBD administration prevents them from having long-lasting trauma-induced anxiety. The same is true of traumatized humans. For example, a traumatized ten-year-old girl responded positively to CBD after prescription medications had failed. ⮛ RESEARCH ⮛
According to a Veterans Health Administration report, roughly 17% of the veterans from Iraq and Afghanistan have PTSD[Epidemiology_2012]. A survey of medical marijuana use for PTSD in New Mexico found that marijuana use results in a 75% reduction in symptoms. New Mexico was the first state to approve marijuana for PTSD[Greer_2014].
In a survey of two thousand medical cannabis users, the most popular strains for PTSD were Jack Herer, Island Sweet Skunk, White Widow, and Jean Guy. The most common forms of ingestion were smoking and vaporizing (vaping). The paper presenting this survey includes an outstanding review of previous relevant research. This 2018 survey was the first research to address the undeniable fact that different strains have different medical benefits[Baron_2018]. Jack Herer is a high THC strain whose top terpenes include caryophyllene, myrcene, and pinene[Jack_Herer_2018].
Rats that received repeated CBD administration starting an hour after a cat encounter avoided long-lasting trauma-induced anxiety[Campos_2012]. The same is true of traumatized humans. CBD acts to consolidate new fear-extinction learning[Das_2013]. A 10-year-old girl who did not respond well to commercial medications and their adverse side effects maintained a decrease in anxiety and a steady improvement in the quality and quantity of sleep when given CBD[Shannon_2016].
THC appears to improve the effectiveness of fear-extinction training in which PTSD patients learn to calmly experience a traumatic memory that previously induced strong emotion[Rabinak_2017]. A 19-year-old male patient with a spectrum of severe PTSD symptoms discovered that some of his significant symptoms were dramatically reduced by smoking cannabis resin. His symptoms included intense flashbacks, panic attacks, and self-mutilation[Passie_2012].
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Increased use of cannabis products is associated with decreased sales of OTC sleep aids. Multiple cannabis compounds have sedative properties.
In a survey of two thousand medical cannabis users, the most popular strains for insomnia were Lemon Sour Diesel, OG Shark, Skywalker OG, and Pink Kush. Lemon Sour Diesel has high THC and almost no CBD. Its top terpenes are caryophyllene, humulene, and linalool. THC induces sleepiness but brings impaired functioning and increased sleepiness the next morning. CBD promotes improved sleep in insomniacs.
Among terpenes, linalool has sedative effects on mood states and the autonomic nervous system (which regulates heart rate, digestion, respiratory rate, pupillary response, urination, and sexual arousal). studies have shown that d-Limonene, α-pinene, and terpinolene have sedative effects. ⮛ RESEARCH ⮛
In Colorado, a month-by-month comparison of grocery store scanner data with month-by-month recreational cannabis access showed a shift from OTC sleep aids to cannabis as more cannabis dispensaries became available[Doremus_2019].
In a survey of two thousand medical cannabis users, the most popular strains for insomnia were Lemon Sour Diesel, OG Shark, Skywalker OG, and Pink Kush[Baron_2018]. Lemon Sour Diesel has high THC and almost no CBD. Its top terpenes include caryophyllene, humulene, and linalool[Lemon_Sour_Diesel_2020]. THC induces sleepiness but brings impaired functioning and increased sleepiness the next morning[Nicholson_2004]. This survey also found that CBD promoted wakefulness. But another study found that CBD improved sleep in insomniacs[Carlini_1981].
Among terpenes, linalool has sedative effects on mood states and the autonomic nervous system[Kuroda_2005]. In animal studies, d-Limonene had sedative and motor relaxant properties[do_Vale_2002]. For mice, the sedative effect of α-pinene is similar to that of Ambien[Yang_2016]. Terpinolene also has sedative effects[Ito_2013].
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People who smoke marijuana have more sex. Its use doesn't promote risky sexual behavior unless it is accompanied by heavy drinking. Marijuana increases overall satisfaction, sensitivity to touch, and the ability to relax during sex. But it may not increase desire, the intensity of orgasms, or the ease of achieving orgasms. There is a 10% chance that marijuana will actually make things worse.
Among teenagers, using marijuana may increase the likelihood of becoming sexually active and may increase the possibility of having multiple partners. ⮛ RESEARCH ⮛
Marijuana use is positively correlated with sexual frequency in men and women[Sun_2017][Metrik_2016]. Marijuana use does not increase the likelihood of risky sexual behavior unless accompanied by heavy drinking[Metrik_2016].
In a survey, a substantial majority said that marijuana increased overall satisfaction, sensitivity to touch, and the ability to relax during sex. Reports were divided on whether marijuana increased desire, the intensity of orgasms, or the ease of achieving orgasms. Reports also differed on whether marijuana helped with sex, but only 10% said it made sex worse[Wiebe_2019].
Among teenagers, using marijuana may increase the likelihood of becoming sexually active. Among those who have had sex, it may increase the likelihood of having multiple partners[Smith_2019]. Among teenagers who occasionally play hooky and sometimes use marijuana, using marijuana while playing hooky on a given day increases the likelihood of having sex[Graves_2019].
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A psychoactive compound* is a chemical substance that changes brain function, resulting in alterations in perception, mood, consciousness, cognition, or behavior. Some psychoactive drugs have all five effects — sedatives, for example.
The words psychoactive, psychotropic, intoxicating, and psychomimetic are often used contrary to their definitions, as found in Webster's Dictionary[Merriam-Webster_2019], Wikipedia[Psychoactive_drug_2019], and elsewhere.
psychoactive: affecting mood, perception, cognition, mind or behavior
psychotropic: acting on the mind
intoxicating: exciting or stupefying with possible loss of physical and mental control
psychomimetic: producing effects that resemble psychotic symptoms
According to extensive, publicly available published research, the cannabis compounds listed in the following table appear to be psychoactive.
| THC | Elevates mood, promotes sleep, reduces stress and anxiety, is an antidepressant, may be intoxicating, and in large doses, may be psychomimetic. |
| CBD | Prevents epileptic seizures, elevates mood, reduces anxiety, inhibits addiction relapse, fights schizophrenic psychosis, and is an antidepressant. |
| CBN | Elevates mood. |
| BCP | Elevates mood and helps with obsessive-compulsive disorder. |
| Linalool | Elevates mood, promotes sleep, lowers anxiety, is an anticonvulsant, and is an antidepressant. |
| d-Limonene | Reduces stress; is an antidepressant, sedative, and motor relaxant. |
| Terpinolene | Promotes sleep. |
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