CBD for Depression

Henry Emmons, MD

Most research on cannabidiol (CBD) has looked at its possible benefits in anxiety disorders, but studies have also showed CBD to have direct antidepressant effects as well. Early evidence suggests that it may work quickly against depression, a potential advantage over traditional antidepressants.*

The Type of Mood Matters 

In my psychiatric practice, I usually add CBD to help calm anxiety, improve sleep or stabilize mood. I’m less likely to suggest it purely for depression, especially when the symptoms of depression include a lot of sluggishness and lethargy. However, most people with depression also have anxiety and/or insomnia, either of which can make it much harder to recover from the depression itself. So, if we can calm the nervous system, and especially if we can support better sleep, the chances of recovery from depression may improve dramatically.*

CBD, Serotonin, and Inflammation*

CBD appears to work directly on serotonin receptors, which is a bit different from how the most commonly used antidepressants, the serotonin reuptake-inhibitors, work. One problem with long-term antidepressant use is the tendency for them to become less effective over time, and it often helps to add something that works a bit differently on the serotonin system. That may be a reason to consider augmenting with CBD.*

There is also growing evidence that depression is partly an inflammatory disease, which may, in fact, be why traditional antidepressants work for some people better than others, because they have anti-inflammatory properties. CBD is also known to work both as a potent anti-inflammatory and as an anti-oxidant, which may be another reason for its anti-depressant effects.*

CBD Dosage and Use*

The typical dose range for CBD in adults is 15-30 mg daily. With some conditions, such as those involving pain or inflammation, the recommended dose is often higher, but I find it is best-tolerated and most effective for anxiety, sleep, and mood in this moderate range. 

After discussing with a doctor, look for a broad-spectrum, all natural, non-GMO hemp product that is THC-free (i.e. measures less than 0.3% THC). It may be taken in doses of 10-15 mg twice times daily, with or without meals, or in a single dose of 20-30 mg daily. If used to help with sleep, you can take the full 20-30 mg dose at bedtime. 

CBD Side Effects 

As noted, CBD is generally considered well-tolerated. However, CBD can cause side effects. These side effects can be more confusing given the unreliability of the purity and dosage of CBD in products (which is why purchasing a high-quality product is essential).*

Side effects of CBD may inlude:

• Drowsiness
• Dizziness and lightheadedness
• Dry Mouth
• Diarrhea
• Increased Appetite 
• Lowered blood pressure

In my practice, I find that the most common side effect is very mild sedation, though that is usually not a problem for those with high anxiety, and may be a welcome effect for those with sleep trouble. Like most things that are calming, adding CBD to other sedating medications, or combining CBD with alcohol, may cause excess sedation.*

There is too little information about the safety of CBD during pregnancy or while breastfeeding, so it is not recommended. *

CBD Interactions*

Research suggests many of the side effects that occur with CBD are likely the result of drug-to-drug interactions between CBD and other medications an individual may be taking. That's why it's so important to speak with your doctor before starting any supplement, and this is particularly true with CBD.*

Here's how these interactions occur: CBD is broken down by the body via the same pathway as many prescription drugs. If multiple compounds are competing in this pathway (e.g., CBD and a prescription drug), then something called "altered concentration" can occur. This means that too little or too much of the drug is left in the body. When too little remains, a drug may no longer work as intended. When too much remains, side effects may increase.*

This altered concentration should be considered when taking CBD with any other prescription, supplement, or over-the-counter product that causes sleepiness. These include (but are not limited to):

• Antidepressants
• Antipsychotics
• Benzodiazepines
• Opioids
• Antihistamines
• Herbal products to support sleep
• Alchohol

Additionally, there are other medication interactions with CBD that can be serious. Penn State College of Medicine has a really handy list of medications that may be impacted by altered concentration due to a combination with cannabinoids. Unfortunately, this list does not make any distinctions between CBD or THC, but it provides some guidance. Bring this list to your doctor before starting any CBD product.*  

Penn State also found potentially serious interactions between prescription CBD and THC products and the following products:

• Warfarin and other blood thinners
• Amiodarone (heart medication)
• Levothyroxine (thyroid medication)
• Seizure medications (clobazam, lamotrigine, valproate)

CBD Supplements at Resilient Remedies

Sleep CBD is a blend of broad-spectrum CBD (30 mg per serving) combined with 5 mg of CBN (cannabinol) and 3 mg of melatonin. CBN is a form of phytocannabinoid shown to be more specifically helpful for sleep, and melatonin is nature’s internal timekeeper, helping set a more consistent bedtime. CBD Sleep may improve a variety of challenging sleep issues, and is especially helpful for those who have trouble falling asleep.*

Calm CBD combines 30 mg of broad-spectrum CBD with 200 mg of l-theanine, an amino acid that can also help reduce anxiety and stabilize mood. Together, they may improve stress resilience and calm anxiety without sedation. Taken at bedtime, CBD Calm may also be helpful for those who tend to wake in the middle of the night.*

Restore CBD gummies are infused with the highest quality, all-natural, US-grown hemp. Each gummy offers a precise dose of broad-spectrum CBD to support your endocannabinoid system with naturally occurring, plant-based ingredients. This synergy of multiple cannabinoids work together for the greatest impact to restore your natural resilience.*

*Note: Some of the supplements discussed in this article can cause side effects, but many people tolerate them much better than prescription medications. They are generally considered safe, however, they should not be started without your doctor’s knowledge and supervision. If you are taking medication already, be sure to talk with your doctor before adding any of these items. If you are considering going off medication, remember never to stop your medication suddenly—always consult with your doctor about how to safely taper off any psychiatric medication. See terms.

*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

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