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...See more It might be at your local bodega, enhancing coffee or seltzer. You might find it online as a capsule, suppository, or cream. Its available by prescription, too, as a drug to treat epileptic seizures in children. Its billed as everything from a pain reliever to a cancer cure. The holder of this impressive résumé? Cannibidiol, or CBD, one of the many compounds known as cannabinoids that are found in marijuana and its sister plant, hemp. For years, CBD lived in the shadow of its intoxicating cousin, tetrahydrocannabinol (THC), the cannabinoid thats responsible for marijuanas high and on which the bulk of research has focused. CBD does not produce a high, but has recently overtaken THC as the cannabinoid du jour. Deemed safe by most experts, it is said to induce calm, boost mood, and relieve pain without the impairment or anxiety that THC can induce. But though CBD is showing real promise for treating conditions such as anxiety and addiction, researchers worry that false claims are flourishing—and far outstripping the ability of science to catch up. The Cannabinoids Within As a plant-derived compound, CBD is known as a phytocannabinoid. But plants dont hold a monopoly on the molecules. Animals—including humans—produce cannabinoids, called endocannabinoids, which work as neurotransmitters in a network of receptors scattered throughout the central and peripheral nervous systems. The endocannabinoid system, or ECS, has a hand in a dizzying array of physiological and psychological processes, from reproduction to memory. Increased knowledge of the ECS has changed the understanding of neurotransmission. One of two known endocannabinoids, 2-arachidonoylglycerol (2-AG), is unusual among neurotransmitters in that it originates on the post-synaptic side of neural pathways. When a neuron is overstimulated, 2-AG travels backward across the synapse and—in a process known as retrograde inhibition—stops the pre-synapse from additional action. It controls how neurons fire and if they can fire repeatedly, explains pharmacologist Aidan Hampson of the National Institute on Drug Abuse-the importance of which, he argues, cant be overstated. Firing too quickly can trigger neuronal death. Also, 2-AG inhibits inhibitory neurotransmitters, a double negative that encourages excitation of neural pathways. A pathway that doesnt get excited regularly weakens, Hampson explains, so 2-AG helps neurotransmitter systems—including those that control mood and memory—maintain homeostasis. Fellow endocannabinoid anandamide doesnt appear to embark on the same reverse synaptic journey. Its range of effects is a bit unclear, although in animal studies it has modulated memory, stress, and anxiety. Chill Out Enter CBD. Its theorized that when its ingested—usually as droplets or capsules of oil extracted from cannabis or hemp—it interacts with the ECS in ways that promote mental health. One area where its shown tangible promise is in relief of anxiety disorders, including social anxiety and PTSD. In one study, participants with social anxiety ingested a capsule of CBD before a public speaking task; compared to a placebo, the drug significantly reduced levels of stress in another, volunteers took CBD after THC; CBD mitigated THCs anxiety-inducing effects. In a trial published this year, daily CBD doses given to 47 adults with anxiety for up to three months rapidly decreased symptoms—with effects staying steady the entirety of the treatment period. [Researchers] are really seeing reductions in anxiety only in folks with anxiety pathology, says Mallory Loffin, a psychologist at the University of California, San Diego, who is currently running a long-term clinical trial of CBD as a treatment for PTSD. That suggests youre actually getting a change in the pathological process—not just an overall dampening of the central nervous system, like what youd see with a benzodiazepine." How CBD reduces anxiety isnt clear. We know it [increases] 2-AG, but were not quite sure how, Loflin says. It also may inhibit production of fatty acid amide hydrolase (FAAH), an enzyme that breaks down anandamide, and it could activate the serotonin receptor 5-HT1A—either of which could lower anxiety by boosting anandamide or serotonin in the brain. Theres not a clear-cut single mechanism, she says. It has diffuse effects on several pathways that were still trying to figure out. In PTSD, CBDs inhibition of FAAH may increase extinction learning, or how quickly a person stops associating environmental cues with a trauma response. Treatment for Addiction Just as THC can raise anxiety, it can induce drug-seeking behavior, research has shown. As the opioid epidemic worsened, psychiatrist Yasmin Hurd at the Mt. Sinai Icahn School of Medicine in New York wondered whether CBD might dampen those same behaviors. Individuals with heroin use disorder who took a daily CBD solution for three days saw significantly reduced anxiety, as well as lower levels of the stress hormone [https://www.psychologytoday.com/us/basics/hormones] cortisol, in a clinical trial [https://www.ncbi.nlm.nih.gov/pubmed/31109198] Hurd published in May. More critically, CBD lessened drug craving, a key contributor to prolonged use. Addiction is really a disorder of craving, Hurd says. People who develop drug addiction are sensitive to environmental cues—such as seeing an object associated with drug use—and to stress, which impacts cognition [https://www.psychologytoday.com/us/basics/cognition] and decision-making [https://www.psychologytoday.com/us/basics/decision-making], triggering relapse [https://www.psychologytoday.com/us/basics/relapse] even after withdrawal has faded. CBDs dampening effect on cravings—an effect that endured for a week after the last dose—represents a breakthrough, Hurd says. Other opioid treatments, like naloxone or methadone [https://www.psychologytoday.com/us/conditions/opioids], block opioid reward or serve as safer substitutions. But they dont target cravings or anxiety, which often rise and fall in tandem. Cravings are one of the most critical parts of the addiction cycle, she says. If we can treat them, we have a much better shot that people will reduce their drug use. CBD also provides some hope for schizophrenia [https://www.psychologytoday.com/us/conditions/schizophrenia]. When administered to patients along with a traditional antipsychotic, CBD significantly reduced the severity of hallucinations [https://www.psychologytoday.com/us/conditions/hallucinogen-persisting-perception-disorder] and delusions compared to the antipsychotic alone, as well as slightly improving scores on cognitive tests, in a small trial published last year. [https://www.ncbi.nlm.nih.gov/pubmed/29241357] Unlike other antipsychotics [https://www.psychologytoday.com/us/basics/psychopharmacology], CBD does not appear to antagonize dopamine [https://www.psychologytoday.com/us/basics/dopamine] receptors—possibly unlocking a new mechanism for treating psychosis [https://www.psychologytoday.com/us/basics/psychosis]. Dosing - An Open Question With approximately 20 percent of U.S. adults affected by anxiety and nearly 50,000 deaths from opioid overdose each year, CBD looks to some like a general-purpose wonder drug—one that can be shipped to you in a few clicks. But theres a catch, experts say. Most of the clinical trials that begat results did so courtesy of daily doses that ranged from 400 mg to more than 1,000. Thats exponentially more than youre going to find in commercial CBD extract, Loflin says. Commercial capsules tend to hover between 10 and 25 mg each. Lower doses than those tested may well be highly effective—but thats yet to be determined. Dosing has not been established for any indications except for epilepsy, Hurd says. That hasnt slowed the market. Consumers shelled out an estimated $500 million in 2018 for commercial CBD to manage anxiety, insomnia [https://www.psychologytoday.com/us/basics/insomnia], or chronic pain [https://www.psychologytoday.com/us/basics/chronic-pain]. By 2025, sales are projected to pass $23 billion. But commercial CBD is inconsistently regulated, Loflin warns. Potency, labeling accuracy, and safety vary widely. Of 84 products Loflin tested for a 2017 study [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5818782/], about 70 percent contained either more or less CBD than claimed. Twenty percent contained THC—which can intoxicate or induce anxiety, particularly in kids, or set off drug tests. Some products have also been found to contain contaminants like pesticides; others have contained no CBD at all. It may pay to buy from more reputable retailers. [See Is CBD Legal? Its Complicated, below.] Someone who buys CBD to treat anxiety or addiction may see results—perhaps via a placebo effect [https://www.psychologytoday.com/us/basics/placebo]—or they might not. When it doesnt work, they may say, ‘Its just snake oil, Hurd observes. Its a double-edged sword. One group thinks its a wonder drug without any proof; another thinks its snake oil—again, with limited information. CBD could also interact with other medications in potentially harmful ways. [Some] companies are promising CBD for things they have never tested, Hurd warns, singling out vaginal suppositories touted to increase libido. When we put it in everything from sliced bread to water, it trivializes its potential benefits. Still, she describes herself as cautiously optimistic [https://www.psychologytoday.com/us/basics/optimism] about CBDs future. Im cautious because Im a scientist—and at the end of the day, its the data that count. But what shes seen so far has given her hope that CBD could be a safe, effective option for many disorders, including addiction. Is CBD Legal? Its Complicated Whether from the marijuana plant or the closely-related hemp plant, all CBD is nonintoxicating and interacts with the body in the same way. Hemp-sourced CBD can be sold in certain stores and online. While cannabis is still highly controlled at the federal level, hemp was legalized nationwide in the 2018 Farm Bill. In those states where marijuana is legal, either medically or for adult use, CBD products may be sold in regulated dispensaries. Those CBD products could be derived from cannabis plants, which are regulated under the applicable state marijuana program, or they could be derived from hemp plants, which are regulated under the Farm Bill. Some consumers may be unaware of the difference, but talking to their local dispensary about the source of their CBD is a wise first step. Many larger retailers, including Curaleaf, a major U.S. retailer of cannabis and hemp, label the source (hemp or cannabis) of each CBD product. They also test each batch—for CBD, THC, and contaminants—in labs certified by the International Organization for Standardization (ISO). But such labs are not necessarily FDA-compliant, says UCSDs Mallory Loflin—and since testing is done at a companys expense, smaller mom-and-pop operations may not be able to incur the cost. Retailers cannot make specific claims about the benefits of CBD that have not been FDA-vetted—and the agency has sent warning letters to violators, including at least 15 companies that claimed their CBD could cure cancer or ward off Alzheimers. Its also technically illegal to sell CBD in food—and while some localities still look the other way on CBD-infused coffee, others (including New York City) are yanking such products from shelves. The FDA convened hearings in May to clarify regulation going forward. By early fall, the agency plans to report progress on addressing the many questions about CBD. Resource Frye, Devon. (2019) How CBD Is Changing Mental Health Treatment. Cannabidiol, or CBD, is touted as a remedy for all that ails us. It may not cure cancer—but it's showing promise for anxiety and addiction.

...See more What is depression? Is it a normal reaction to difficulty and loss? A problematic way of coping? A disease of the brain that has little or nothing to do with psychology? Even though depression is the leading cause of ill health and disability worldwide, there remains much confusion and debate about the best way to conceptualize it. I argue that we should think about depression as a state of behavioral shutdown, biological in an evolutionary sense but not necessarily a disease of the brain. This explains why some people are more prone to getting depressed and how they might climb out of a depressive cave—or set up their lives to prevent ever getting into it. To grasp why it is more productive to regard depression as a state of behavioral shutdown, rather than a disease of the brain, we need to understand something about the evolution of the animal mind. From an evolutionary perspective, animal behavior can be thought of as the process of expending energy to control the environment in accordance with goals. Many of our goals are grounded in deep motives that connect to survival and reproductive success—we strive for control of resources and territory, status and belonging, better food, and more appealing mates. However, the behavioral investment needed to acquire and maintain such resources is expensive. It costs energy in terms of both basic calories and increased risk of injury and loss. Resources are not always available, and behavioral action is not always successful. Whats more, competition can be fierce; we can end up defeated or rejected. Mammals have two broad systems of behavioral investment. The positive emotional investment system energizes the animal, fills it with curiosity and desires, and orients it to seek and approach things that are emotionally nourishing, such as high-quality relationships and rewarding activities. In contrast, the negative emotional investment system orients the animal to danger, loss, and avoidance and withdrawal into a defensive posture. Animals generally work to maximize the benefit-to-cost ratio of their actions, either by increasing benefits or by decreasing costs. Increasing benefits is associated with actively acquiring some resource (food, sex, status) in the environment via behavioral investment. The intensity of actively working to increase benefits can be considered a measure of desire. Decreasing behavioral investment can also be a way animals deal with the cost-benefit ratio. Nature itself deploys many types of behavioral shutdown—sleep, hibernation, exhaustion—to decrease behavioral expenditure. Depression can emerge as a state of shutdown when we perceive a lack of opportunities for positive investment in a world full of threats. A shift in mood occurs as the positive emotional investment system is toned down and the negative emotional system is jacked up. The behavioral shutdown model (BSM) of depression efficiently explains many features of depression. For example, it immediately captures the core presentation—a fundamental shift in mood and mindset toward the negative and away from the positive. People exhibit increases in sadness, irritability, shame and anxiety in addition to anhedonia, an inability to experience pleasure. Seeing depression as behavioral shutdown explains why depression is more likely to be found in situations that are chronically dangerous or humiliating or that repeatedly result in failure to achieve ones goals. And it accounts for why depressed individuals often experience fatigue, focus on past losses, tend to discount future gains, have difficulty starting new activities, and experience problems with sleeping and eating. Who is vulnerable? Some people are by temperament particularly vulnerable to depression, quicker than others to shut down behaviorally in response to failure or rejection. Studies document that there have been significant increases in the number of people who are getting depressed, especially among the young. The BSM highlights four key variables that help explain this phenomenon: a mismatch between modern lifestyles and those to which our bodies and brains are adapted, adverse life events that are hard to escape, individual differences in levels of negative emotion and negative emotional reactivity, and problematic coping styles that drive individuals into the emotional bleakness of depressive caves. In his excellent book The Depression Cure, psychologist Stephen Ilardi blames modern lifestyles for what he sees as an emerging epidemic of depression. He cites research suggesting that people who live in traditional hunter-gatherer communities are much less likely to be depressed. Theres risk of an evolutionary mismatch between modern life and the environment our minds and bodies evolved to live in. Just as we experience tooth decay because we eat very different kinds of food than our ancestors did, so we are inclined to depression because the fast-paced, socially fractured lives we lead differ from the close-knit tribes in which our ancestors met the challenges of survival and reproduction in natural environments. We can become socially isolated. Our modern lifestyle makes us vulnerable to getting trapped in cycles of shutdown. But, of course, not everyone living in the modern world is depressed. People have differing temperaments and styles of coping and they experience varying levels of stress and adversity. Research demonstrates that the more psychological injuries and adverse and highly stressful events (abuse, neglect, highly conflictual relationships, trauma) individuals experience, the greater the chance they have of becoming depressed over their lifetime. Individuals also vary greatly in how reactive their negative emotional system is in general. Those who have highly sensitive negative emotion systems are said to be high in trait neroticism (TN). Someone who is high in TN is more sensitive to stressors, is more likely to have frequent activation of negative emotions, has more intense negative feelings, and experiences them for longer periods. Not surprisingly, people who are high in TN are prone to develop anxiety and depressive disorders. The way people cope with stress and respond to their feelings is another major contributor to depression vulnerability. Individuals who react to problems by avoidance and have strong critical thoughts about themselves and their negative feelings are likely to set off an inner battle that leaves them depleted, stressed, and vulnerable to ending up depressed. Feeding the Beast The most common pathway to a depressive shutdown that I see is a downward spiral: (a) difficult stressors that trigger (b) strong negative emotional reactions that (c) result in the instinct to avoid and withdraw, which resolves nothing but only (d) makes things worse and ends up (e)generating more negative reactions. Consider an exchange I had with Denise, a middle-aged woman who came into my office struggling with her third major depressive episode. I dont want to do it, Denise said to me, her eyes looking down at the floor. The it was decorating her house for the holidays. Denises dog had died two weeks earlier. She had been feeling a bit low before that, and with the unexpected loss, the bottom dropped out of her mood. I just dont see the point, she said. All I see is pain. I just want to go home and get into bed and pull the covers over my head. When individuals are hard hit by depression, the landscape of their mental vision narrows; pain, hopelessness, and helplessness are most prominent in their mind. Denises response is an example of what I call the paradox of shutdown. The instinctual response to depression is to avoid and withdraw. Unfortunately, such a response often makes things worse. To interrupt the cycle of shutdown, one needs both an attitude of hope and the willingness to expend effort to do things differently. Yet, depression saps ones energy and leaves one depleted, making the expenditure of effort difficult. That contrast is what I call the paradox of effort. That is why it is so important that individuals learn ways to stop and even reverse the cycle. Reversing the Cycle If depression is a state of behavioral shutdown that often emerges from vicious downward spirals, then it makes sense to be aware of shutdown cycles and to counter them with strategies that lead to more positive investment. I advocate for fostering awareness, acceptance, and active change toward more valued states of being. Consider how I responded to Denise: I am sorry you are in so much pain, I said. It is because you are in such pain that we need to take care of you the right way. We need to both hold on to your feelings and help you respond to them in a way that is helpful and does not drive you deeper into a depressive cave. Denise and I then discussed her options and played out the two scenarios of decorating or not decorating her house. As she envisioned her young son realizing that she was not going to decorate the house for the holidays, she felt a sting of pain. That would really hurt him, she said. I followed up: Perhaps we should think about doing it for him. Is there a way to both attend to your feelings and motivate yourself toward acting in a way that would help you and those around you? We then planned out her tasks in detail and after listing the steps she could take, she felt she could hold on to her depression and her grief but muster the energy to act anyway. Later that week she called to say that she was glad she did. We decided to put up a picture of Jackson (the dog) and decorate it. We cried some, but I think it was a nice moment. I know my son is glad we decorated the house. Thanks for helping me see that. Notice that my questioning helped Denise become aware that she was in a mode of depression that oriented her to avoid and withdraw and that made sense at one level. There was no attempt to dismiss her pain; rather, we worked with it. What we didnt do was give in to the impulse to avoid and withdraw. Instead, we explored the consequences of shutting down relative to other forms of engagement, and we oriented her to do the thing that would move her toward her valued way of being. This way of responding to cycles of shutdown is grounded in what psychologists call behavioral activation, the single most scientifically validated principle for reversing cycles of depressive shutdown. Antidepressant Lifestyles The BSM points toward several lifestyle elements we can manipulate to make us more resistant to depressive cycles. Most obviously, we should minimize exposure to serious adverse experiences like neglect and abuse. Ilardi also recommends increasing intake of omega-3 fats, increasing activity (in order to decrease rumination), engaging in physical exercise, finding sources of social support, increasing sunlight exposure, and improving sleep hygiene. All are proven ways of counteracting pathways of depression. In addition to incorporating such changes into daily life, many of us could also benefit from learning skills of healthy coping under duress and of recognizing and holding negative emotions without reacting to them. Such skills are particularly important for people who are high in trait neuroticism. They are also invaluable to those who tend to be self-critical and those who cope by avoiding and withdrawing. Avoidance may feel like the most natural response in the world. But it will never pull anyone out of the cave that is depression. Reference Henriques, Gregg. (2019). How to Break the Depression Cycle. The instinctual response to negative experiences sets off cycles of avoidance that feed the beast of depression. Thats when its necessary to work against instinct. https://www.psychologytoday.com/us/articles/201910/how-break-the-depression-cycle

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