The pharmacological means of managing mental health can sometimes be unbearable, especially when the side effects seem worse than the sickness that’s being treated. Patients tend to be non-compliant with their medication because they don’t like their drugs’ side effects.
And if a patient isn’t taking their medication, then how can they get better? We need to find alternative medicines with less side effects. In previous episodes, I have discussed both the body’s naturally produced cannabinoids found in the endocannabinoid system (episode 3) and the mental health disorders that are frequently grouped under the same umbrella because they have similar signs and symptoms (episode 5). Due to limited clinical studies, the treatment of mental health with cannabinoids is something we are just beginning to explore. However, there are a few things we do see promising signs about.
Cannabis and cannabinoids’ effect on stress is well documented. Cannabis has a biphasic nature which means that a low dose of the product produces a certain effect, but a high dose of the same product produces an entirely different effect. We know that a low dose of THC can help with stress, but a high dose of THC will make the symptoms worse.
There are some scientific studies showing that people suffering from depression have low endo-cannanboids in their bodies. That makes sense to say that we can supplement it with plant-based cannabinoids, just as if a person has a vitamin D deficiency and takes a multivitamin to help themselves feel better. There are a few other conditions that look like they could benefit from supplementing their natural endocannabinoid systems, including:
- Diabetic neuropathy
- Memory loss
Although cannabinoids are a botanical medicine, they still have side effects just like any other drug. For example, it is important to not take cannabinoids if you have liver damage or a history of liver disease. Nevertheless, there are still many promising benefits of medical cannabis. We would definitely benefit from more careful clinical studies about this encouraging field.
- How the biphasic nature of THC could impact the treatment.
- The well-documented effect of cannabinoids on stress.
- CBDs specific impact on the GABA receptors, and what that might mean for treatment.
- The importance of finding drugs with side effects that do not exacerbate patients’ current symptoms.
- How cannabis could supplement the body’s own endocannabinoid system.
Listen And Learn
This show is for educational purposes and should not be taken as medical advice. Welcome to Let’s Talk About Medical Weed with Dr. O, a clinical pharmacist certified in medical cannabis. Every week you’ll learn about alternative ways to improve your health and wellbeing using the healing power of botanicals such as cannabinoids. Here’s your host, Lola Ohonba.
Welcome to episode six of Let’s Talk About Medical Weed with Dr. O. My name is Lola Ohonba. I’m a clinical pharmacist certified in medical cannabis. On today’s episode we’ll be looking into the second part of our series, the role of cannabinoids in mental health. We’ll be looking at the concluding part. Allow me to say thank you to those of you that already subscribe to the show. Thank you so much. If you are yet to subscribe to the show, we really need your support. Please subscribe to the show. This show is for educational purposes only and should not be taken as medical advice.
This show is for you if you are looking for alternative means to manage your health and wellbeing. It’s for you if you are a young professional and you are looking for means of replenishing lost energy during your day to day activities. And finally, it’s for the healthcare professional looking for evidence-based data to counsel their patients on cannabis and cannabinoid products. Again, thanks for joining me on today’s show today. Here’s the second part of our series role of cannabinoids in mental health.
On our last episode, episode five, we talked about mental health, what types of mental health is available, the signs and symptoms of mental health. We looked into the non-pharmacological treatment like talk therapy. We looked into diet and nutrition. We also looked into the vitamins and minerals, how those are able to affect mental health and what we can do to replenish our diet and replenish our vitamins and minerals lacking in our food.
And finally, we looked into the hormonal changes going on in our day to day life, hormonal changes in our body and what we can do to replace the hormones that is being lost due to life stressors or anything like that.
We talked about other means of hormonal therapy that is not hormone replacement. We talked about using diet and also herbal medicine, how they are being used instead of the hormone replacement therapy for some individuals that do not want to go through the route of the hormone replacement therapy.
And finally, we talked about the neurotransmitters like serotonin, norepinephrine, how do they relate to mental health and what can be done to replenish these chemicals in our brain. So, if you haven’t had a chance to listen to episode five, we highly recommend that that should be listened to first because this is the concluding part of the episode five. Again, thank you so much for joining me.
So, on today we’ll be looking into the pharmacological means of managing mental health first. When we say pharmacological therapy, what are we actually talking about? We are talking about the medication, the traditional medication, that you go to your pharmacy to get for the management of mental health. As I mentioned earlier, serotonin is one of the main neurotransmitters targeted in most of the condition we mentioned earlier, like OCD, obsessive compulsive disorder, panic disorder, anxiety, depression.
In the beginning when the physician, when they want to start managing this disorder, sometimes they start from the lower pharmaceutics, the serotonin-based medication. One of the most common antidepressants is the selective serotonin reuptake inhibitors. This is what we call a SSRI. For a limited time, you might have head of Zoloft or Lexapro. These two agents, they belong to that class of the SSRI, anti-depressive medication.
Another class of medication that is often used in the management of mental health is the what we call tricyclic antidepressants. The common one that comes to mind is the amitriptyline or Elavil. Those are tricyclic antidepressants. A lot of the medication, the traditional pharmaceutics, that’s used in the management of this mental health conditions tends to have a side effect that is unbearable to a lot of patients, especially the elderly population. The side effects tend to be a little bit unbearable sometimes.
And when people are going through these side effects, it can lead to what we call noncompliance in their medication. Basically, what that means is that if I’m going through side effects from my medication that is really disturbing what I’m doing in my life, this person can decide to not take the medication as they were supposed to. So, we look at a situation here whereby the medication that an individual is supposed to take to help them to get better, because of the bad side effect they are getting from it, they are not taking this medication.
So, if an individual is not taking the medication to help them get better, how are they going to get better? That’s why we need to start looking into alternative ways to help people get and stay well and with less side effects. Common side effects that are generally seen in all these medications like SSRI or the tricyclic antidepressants like Elavil or amitriptyline are what we call anticholinergic effect.
What does anticholinergic effect mean? Basically, what it means is something like dry mouth. People can have blurred vision, people can have constipation, they can go to a urinary retention. You go to the bathroom; you are not able to empty your bladder fully. There can be memory impairment or memory loss and for some people they can even have delirium. So, when we mention all these side effects like blurry vision, dry mouth, urinary retention, memory impairment… this can be very, very problematic in the elderly population that already having some of these kinds of signs deal to aging and other.
So, if you are already having issue with your vision or memory issues, then when you take another medication that is also adding to it, this can be very dangerous in those population. Another side effect that is common with the agents, the medication, that we use in treating mental health like depression and mental health like depression is what we call orthostatic hypotension. Hypotension with an O.
When you say hypotension, that means the blood pressure drops. That’s what hypotension means. There’s a drop in blood pressure. But when you say orthostatic hypotension, that means when you stand up from a sitting position, your blood pressure suddenly drops and that causes a syncope or fainting spell.
The other part of when you talk about hypotension, we are not talking about hypertension. Hypertension is increase in blood pressure while hypotension is a drop in the blood pressure and when this happens people can have fainting spells. There can be cardiac related issues such as a heart block, especially in people with a history of cardiovascular disease or heart disease.
A lot of the time the people directly need this medication are the people that are already going through one form or another of those disorders. Population that might need the treatment are the ones going through this maybe cardiac issue already or issue with your blood pressure. So, when the medication is worsening, the side effects, we might have to reconsider what agents to give this population.
Another reason why people might not be compliant, might not want to take this class of medication is weight gain. A lot of the medication that we use in the management of mental health can have weight gain as their side effects and some might even have a sexual dysfunction as part of the side effects with these drugs. Patients find it difficult to put up with that kind of side effects so they can decide to not take their medication.
So, we already discussed how important it is to treat and manage your mental health. So, when people are not taking their medication, they are not compliant due to side effects, what can we do to help? In what way can cannabis and cannabinoids probably have helped people or the potential benefit that might be seen in using cannabinoid products?
So, in the beginning of the series we mentioned how most of this condition, the mental health conditions, most of the conditions under this umbrella have similar signs and symptoms. So, there is similar signs and symptoms, but the degree of expression sometimes varies with this disorder. Using cannabinoids in targeting mental health is relatively new due to limited clinical studies all though evidence backs up its effectiveness as well. So, basically what that means is that people that are using cannabis or cannabinoid products are attesting to the fact that is helping them manage their symptoms.
I mean a lot of people are exposed to cannabis. Cannabis has been around for generations, it’s not a new plant or botanical to us. It’s been around for generations and is being used for various ailments for generations. So, because there’s very little clinical studies due to prohibition, most of the evidence that we have is from word of mouth from people that are using it.
Scientists are discovering the cannabinoids works with our body’s endocannabinoid system to help stabilize the mood. In our previous episode three we’re talking details about the endocannabinoid system. Endocannabinoid system: endo means inside; cannabinoid means like plants, cannabis, cannabinoids are the chemicals that is made from the cannabis plant.
So, when we say endocannabinoid it means that is the traditional cannabinoid product that is produced by our body itself and the system that produces that endocannabinoid is endocannabinoid system. I call it the super computer of our body. It controls everything. It controls our balance, homeostasis. That’s what the endocannabinoid system does. And the two agents that is produced is the 2-AG which is similar to CBD and the anandamide. Anandamide is similar to THC in characteristics. So, if you haven’t checked out our episode three you need to go and check that one now. We talked in detail about endocannabinoid system, what it does and things like that.
Really the series, it like goes into each other. You have to listen to one for you to really be able to grasp the next one. So, if you haven’t listened to those previous steps, so please do so. Cannabis and cannabinoid’s effects on stress and anxiety is well documented, with many studies showing that it decreases stress and anxiety. We need to be cautious though when we are talking about cannabis when it comes to mental health and stress because cannabis has what we call biphasic nature. What biphasic means is the low dose of a product can produce a certain effect while a high dose of that same product will produce a different effect.
For example, low dose THC is said to reduce anxiety while a high dose THC can worsen anxiety and mental health related symptoms… that’s the psychoactive part of the THC. So, basically for THC, increased high doses of THC can worsen psychoactive symptoms for, especially in, mental health population. So, if somebody is going to take any product with THC, it is better to make it very, very little THC.
A lot of people that have used cannabis and cannabinoid products attest to the fact that it helps them with their depressive episodes and helps them to have a sense of calmness to their day to day life. Whenever we encounter a scary or fear evoking situation, our first line of action would be either to fight or to run for our lives. This is called fight or flight mechanism. The brain, our brain, controls what we call sympathetic and parasympathetic nervous system. This system is what is a responsible for us when we are in a situation and it is either that we run for our life or we stay there and face the consequences of that.
It’s really what I call our survival mode. There is no need to be show boating when you are in a situation of intense fear. You either run for your dear life, or you will face the whatever this fear can be. I tell my kids every day, either fight or run, live to fight another day. So, there is no point in you going to the playground and somebody’s trying to fight. You just say, yeah, okay fine, you win. You can have it. It’s fine. Go home, come home. He that fights and runs lives to fight another day.
So, why did I bring that into this discussion? CBD is said to work on the GABA receptor. The GABA receptor, when activated, directs the brain to release chemicals that helps us in fear evoking situations to experience a sense of calmness. So, basically what it’s saying is that our sympathetic and parasympathetic nervous system, when we are in stressful situations or fear evoking situations, CBD works on the GABA receptor and helps us to keep calm even though we are going through a fearful situation.
Another example, we can look at it in that situation of a GABA receptor is for those that have used Gabapentin or Neurontin for management of neuropathic pain or any form of neuroglia like shingles or diabetic, peripheral neuralgia… The same mechanism that CBD uses to help us in keeping calm, that is the same GABA receptor that is used in drugs like Neurontin and Gabapentin. Basically, what will happen in situations like diabetic neuropathy or shingles is that these are hyperactive nerves that are causing the pain. So, what the medication like Gabapentin does is calm the nerves that is causing the hyper activities and this is how it is a mechanism in situations like shingles or peripheral or diabetic neuropathy.
This same mechanism is what is CBD is said to also use to help people that have anxiety, OCD, PTSD, depression, to mention just a few, to help them to deal with stress and anxiety. But unlike CBD, when you look at agents like Gabapentin or Neurontin, CBD has less side effects. There’s no drug that does not have side effects, but CBD has less side effects when you compare them to the pharmaceutic agents like Neurontin, that is trying to do the same thing. But when we talk about CBD, we have to be very careful, especially in the populations that have either a history of liver disease or liver injury because CBD is metabolized in the liver and there is an addictive nature of cannabis and cannabinoids. So, for people with liver disease or liver injury, they have to be very careful in what product they choose.
The good news is that there are other routes of administration other than edibles that people can choose from, like the sublingual, that means you put it under your tongue, you put the product under your tongue. Or, like patches. The patches do not pass through the liver. Those are what we call first pass metabolism, it does not pass through the liver. So, it doesn’t mean that if you have a liver disease or liver injury, then you cannot use your CBD. That’s not true. There are other routes of administration that is available out there. That’s why education and a podcast like this is very important and that is part of the reason why we started this podcast in the first instance.
According to scientific studies, individuals suffering from depression are said to have lower endocannabinoids in them. Endocannabinoid, like I mentioned earlier, are the cannabinoid produced in our body, the anandamide and the 2-AG. The anandamide is similar to THC and the 2-AG is similar to CBD. So, if a patient suffering from depression is said to have low endocannabinoids in their body, that’s the cannabinoid that’s produced in our body, then it will make sense to say if they have lower level of endocannabinoid, then we can supplement it with the plant based cannabinoid like the CBD and sometime maybe the THC.
So, the way I look at it is just like our vitamins, our over the counter vitamins we buy. It’s not like we don’t eat or we don’t have nutrients or vitamins from our daily food. But a lot of the times we don’t have a balanced diet. Some of us just pick whatever we eat and keep going because of work. So, in this situation, what do we do? We pick over the counter supplements to help us get the necessary nutrients that we need. It’s similar to that.
So, if people have less endocannabinoids in their body, it will make sense to introduce other forms of cannabinoid to help balance what is missing. I mean, when I was a young, as a teenager, I never cared about what I ate. My family, they used to look at me like, you just eat anything. I don’t care what I eat. But as I grow order things changed; I began to notice that maybe sometimes my body, my joints are hurting and all that stuff. So, it’s actually after I had my kids. So, I thought that using daily multivitamin, one a day woman, every time I used my vitamins, I feel fine. Sometimes life happens and I would forget to use it.
If I forget like one or two days, that’s fine but if I miss it for like say a week, then I start feeling the effect of me not using it. As soon as I start feeling the effect, I know what’s going on. As soon as I pick it up, I use it again. I start feeling normal. So, the same scenario can be applied here, especially as we grow older. The endocannabinoid that is produced in our body might not be enough. Or, the endocannabinoid system might not work as effective as they used to. I mean its part of aging.
So, in that situation we supplement all these other products when we are deficient in them. Why can’t we supplement our endocannabinoids when it’s deficient? That’s my question, really. So, supplemental plants cannabinoids like CBD, THC, CBG, just to mention a few might be a smart alternative that we need to begin to look into and do a lot of more research to see if this is a good way to go in the future.
According to an article published in the PubMed, CBD is said to have potential therapeutic effects on a wide range of neuropsychiatric disorders. CBD is said to stop brain damage associated with neurodegenerative disorder. And CBD is also said to have positive effect in hearts in psychotic anxiety or depressive like behaviors. It’s also said to have neurogenesis. Neurogenesis is a regeneration of the brain cells. I mean, if your brain is able to regenerate itself, that would eventually help with memory impairment, especially in elderly population. And it’s also been shown to have a neuroprotective ability, so it is not just regenerating the brain cells, it also has the potential to protect the brain.
The mechanism that cannabinoid is using or uses to carry out its functions is still not fully clear due to less clinical studies, but it’s said to involve multiple targets and receptors. So basically, it’s using different targets because cannabis and cannabinoids, they don’t just work in one way. They work in a retrograde fashion. Like it can go forward and talk to the brain then it can also come backward and talk to our body. This is not, this is totally different from other nervous systems, like the peripheral nervous system—they work in a straight fashion. But cannabinoid in the endocannabinoid system, it is said to work in a retrograde fashion. So, a lot of studies, a lot of clinical trials need to be done for us to be able to grasp the effects of cannabis in the cannabinoids system.
Thank you so much for today’s show. This is the end of today’s show. I’d like to say thank you for you guys hanging out with me again today. If you have not subscribed to the show, like I always say, please do so. And if you are already subscribed, we like to say thank you so much. For more information about cannabis cannabinoids, some products out there, you can visit on the web www.wci-health.com and you can also follow us on social. Thank you so much. Have a great day. And until next time, always remember, health is equal to wealth.
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