Table of contents
1. Overview of Depression
3. Treatment of Depression
4. Studies about CBD and Depression
5. Choosing the right dose of CBD
6. How to use
7.Notice when using CBD to treat depression
8. Customer feedback
Overview of depression
According to WHO, depression is a common illness worldwide, with an estimated 280 million people affected, including 5.0% among adults, and 5.7% among adults over 60 years of age. Depression is different from usual mood fluctuation or short-lived emotional responses to challenges in everyday life. Especially, when recurrent and with moderate to severe symptoms, depression becomes a serious condition. It can impair daily activities and function poorly at work, at school, and in the family. At its worst, depression leads to suicide which is the fourth leading cause of death in 15-29 years old.
Although they are known, there remains a gap in depression treatment with 75% of people in low or middle-income countries receiving no treatment due to a lack of resources and trained healthcare providers. In addition to the existing issues, in countries of all income levels, the barrier to accessing effective care includes a lack of effective antidepressants, side effects, cost, and inaccurate diagnosis.
Depression (Major depressive disorder) is a common medical illness that negatively affects how you feel, the way you think, and how you act. Fortunately, it can be treatable. It can lead to a variety of emotional and physical symptoms that decrease the quality of life, social relationships as well as the ability to function at work.
The manifestation may vary from mild to severe and includes:
- Depressive mood most of the day
- Loss of interest or pleasure in almost daily activities
- Feeling of sadness
- Loss of energy or fatigue
- Weight loss or weight gain
- Feeling of worthlessness
- Difficulty in concentrating and making decisions
- Insomnia or hypersomnia
- Thoughts of suicide or recurrent suicidal ideation
Patients must present with at least 5 of the mentioned-above symptoms during the same 2-week period and with significant distress/functional impairment which is not attributable to another medical condition and substance.
Depression is a complex disease resulting from interactions of social, psychological, and biological factors. To date, no one knows exactly what causes it, however, scientists indicated several possible causes contributing to depression, including the following:
Stressful life events: Unemployment, childhood trauma and even good events, such as starting a new job or graduating can lead to depression.
Medical illness, changes in female hormones during the menstrual cycle, and postpartum may raise a person's risk for depression. Additionally, certain medical conditions may put you at high risk of depression, namely cardiovascular disease, Parkinson's disease, etc.
Medications: Isotretinoin, beta-blockers, and corticosteroids can increase the risk of depression
Substance abuse: Even if alcohol consumption makes you feel better, they ultimately aggravate depression. Nearly 30% of people with drug misuse problems also have major or clinical depression.
Contributing factors: gene, family history, gender (female > male), age 18-29, people with low self-esteem, and low living conditions.
In terms of depressive pathophysiology, researchers have noted that the decreased levels and function of neurotransmitters, such as serotonin, dopamine, norepinephrine, and GABA are observed in patients with depression. These compounds play an important role in managing sleep, behavior, mood, and appetite.
Some areas in the brains of people who have clinical depression are different from those who do not. For instance, hyperactivity of the hypothalamus-pituitary gland–adrenal axis may promote the excessive secretion of cortisol resulting in clinical symptoms of depression. Another hypothesis is that chronic stress and high cortisol levels may reduce brain-derived neurotrophic factor (BDNF) expression which regulates the growth, maturation, and survival of neurons and evidence suggests that there are lower BDNF levels in depressed patients.
Treatment of Depression
As the exact cause of depression is being explored by scientists, you may successfully manage and prevent the symptoms of depression. A combination of non-pharmacological therapy and medications works best for treating depression.
Lifestyle modifications can help you alleviate the symptoms of depression. They are often considered adjunct therapy, which is used together with psychotherapy and/or antidepressants for a better outcome. Lifestyle changes include regular exercise, getting enough sleep, spending time taking care of yourself, participating in enjoyable activities, eating a healthy diet, and avoiding alcohol.
In mild to moderate depressive patients who dislike drug therapy or don’t use it because of side effects of medicine, psychotherapy may be an eligible option that is shown to be as effective as drug therapy. Besides, psychotherapy helps patients use antidepressants to respond better to pharmaceutical treatment. In psychotherapy, patients speak to trained therapists to identify and learn to cope with factors contributing to negative feelings. Cognitive behavioral therapy and interpersonal therapy are the two common measures used to treat depression.
Among these therapies, the initiation of antidepressant medication is the most common method to treat the symptoms of depression. Taking antidepressants along with non-pharm measures is shown to be more beneficial for depressed patients than using medications alone. Normally, antidepressants often take 2-4 weeks to provide clinical effects, and you should continue the medications for 6-8 weeks to monitor the improvements of depressive symptoms. To prevent recurrent depression, patients must maintain drug therapy from 6 to 9 months, even 2 years in high-risk recurrence. Among pharmacological treatments, serotonin selective reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake (SNRIs) are first-line options, which are only switched when having no improvement or patients can’t achieve medication adherence because of side effects. The second or third-line drugs include atypical antidepressants, MAOIs, and tricyclic antidepressants (TCA) which generally aren’t prescribed unless you tried first-line medications first.
To get the best result from taking antidepressants, you must follow doctors’ instructions, keep in contact with your healthcare professionals to monitor the side effects and treatment response, and most importantly apply combination drug therapy with lifestyle changes and/or psychotherapy.
A Promising Alternative for the Treatment of Depression
As we mentioned above, depression is a complex phenomenon with many subtypes and many likely etiologies. There are multiple treatments with varying success rates, but the efficacy of currently used drugs is limited, especially for the prevention of relapse and recurrence. Among therapeutic options, selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioral therapy (CBT) are first-line treatments for depression. Although SSRIs are commonly prescribed worldwide and more well-tolerated than others, they have side effects, such as erectile dysfunction, nausea, insomnia, drowsiness, and confusion, and when discontinued, the patients might experience withdrawal and rebound phenomena.
According to a systematic review collecting data from the FDA basis on approval reports of 62 antidepressant trials, the authors indicated that many patients don’t respond to SSRIs with 60% of depressive patients reporting residual impairments even after treatment with SSRIs and 33% develop resistance to antidepressant drugs. Additionally, non-adherence caused by side effects may withhold initiation of drugs and mainly contribute to treatment discontinuation. The experts suggested that the partial success in treating depression is related to our inadequate understanding of the mechanism of the disorder. Therefore, many efforts have been made to bridge the gaps in treatment for depression, including the development of new antidepressants with fewer side effects and a high rate of successful treatment.
In this sense, there is evidence to show that the endocannabinoid system is impaired in depression, resulting in depressive presentation. Hence, some cannabis Sativa plant compounds, such as CBD, which target the ECS system, have been attracting interest for potential therapeutic use. CBD is the main cannabinoid compound derived directly from cannabis and hemp plants. Through interaction with the ECS system, CBD involves a wide range of physiological functions, namely emotion and cognition. Unlike THC, CBD exhibits no risk of dependence or drug abuse in humans.
It seems that depressed patients may start using CBD to relieve the symptoms and the trend is increasingly growing. It is important to determine whether CBD is effective for managing depression. In the following section, we will provide some studies about the antidepressant effects of CBD conducted on both animal and human models.
Studies about CBD and anxiety
Antidepressant-like effects of cannabidiol and cannabidiolic acid in rat with depressions: An animal study
The objective of the research was to further explore the benefits of CBD for the treatment of depressive symptoms. The study was performed by Israeli researchers in 2017 and published in the journal of the European College of Neuropsychopharmacology. In that study, the rats consumed cannabidiolic acid (a derivative of CBD) and underwent the forced swim test which is used to evaluate the behavioral effects of antidepressant agents. The results concluded that Cannabidiolic acid improves helplessness in rats, which is a common symptom of depression, by reducing the time of immobility and increasing the time of swimming.
CBD induces rapid and sustained antidepressant-like effects through increased Brain-derived neurotrophic factor in the brain: An animal study
The aims of this study were to find in male rodents whether CBD could create rapid and sustained antidepressant effects to address the time lag of current antidepressants. The Swiss mice take the CBD dose of 7-30 mg/kg and perform a forced swim test after 30 minutes and 7 days of treatment. The results indicated the effects of CBD are fast and stable that may be related to a change in activation of the BDNF pathway. (In depressive patients, the concentration of BDNF in the brain was far lower than normal population)
A real-world examination of the perceived effects of cannabis on negative feelings
An app named Strainpront collected data provided by medical cannabis users to monitor the symptoms of depression, anxiety, and stress. In the CBD-using group, the researchers suggested cannabis significantly reduced ratings of negative affects, such as depression, anxiety, and stress in the short term. The low THC and high CBD cannabis seem to be effective for dampening perceived symptoms of depression, while the high THC/low CBD may be best for the symptoms of stress.
CBD treatment in an adolescent with depression and multiple substance abuse: A case report
In a case a 16-year-old girl with multiple substance abuse disorders, severe depression, and social phobia was taken CBD capsules with starting dose of 100 mg after successful treatment with antidepressants. The dose was adjusted up to 600 mg within 8 weeks. Upon treatment with CBD and cessation of current antidepressant medications, the patient improved depressive as well as anxiety symptoms, including simple phobias, and dissociation. This is the first report of CBD consumption in patients with depression and multiple substance abuse.
Choosing the right dose of CBD
There is no one size fits all dosage for CBD. What’s optimal mainly depends on a range of factors, such as body weight, tolerance, symptoms, metabolism, and so on. These factors can yield unique effects for each CBD consumer. Keep in mind that you should pay close attention to how you feel after each dose. It might not occur immediately, or even overnight. As soon as you experience positive effects, lock in that dose and stick with it.
Start at a dose of 20 milligrams per day (using twice or three times a day) and increase the dose gradually to achieve desirable effects.
The recommended dosage forms are CBD capsule, sublingual CBD oil, and CBD oil for vaping.
How to use
Taking capsules is the simplest and most convenient way to use CBD. You only need to swallow the capsule with at least 300 ml of water. The drawbacks of the oral route are low availability and delayed onset of effects.
The method of applying CBD sublingually is incredibly easy. CBD oil needs to be put under the tongue and held from 60 to 120 seconds without swallowing to allow adequate time for CBD to diffuse completely across the epithelial cells. The method remains the same when you use CBD oils or tinctures. You must hold the CBD under the tongue since different areas of the mouth might not be permeable enough for diffusion into the bloodstream. Taking CBD sublingually provides fast onset of action and high bioavailability.
Vaping CBD seems to be slightly more difficult than taking CBD sublingually. The first step to vaping properly is to determine how much CBD you consume each time. If you feel unconfident at first, you should start with the easiest option. Disposable cartridges and pods are the simplest tools for new users. Refillable vape pens are a little bit more advanced but more cost-effective in the long term. It is important to read the instructions carefully before using them.
Advices when using CBD for Depression
Overall, it is vital that your doctor checks your improvements, disease progression, side effects, and interaction with food or drugs at regular visits to make sure CBD is working properly.
Notice any side effects and tell your doctor right away.
Only buy CBD products from reliable sources with business registration, certificate of analysis, third-party tests, etc…
Don’t take other medicine (including ETC, OTC medicines, herbal, or vitamin supplements) unless they have been discussed with your doctor.
If you use CBD by taking it under the tongue or vaping, there are a few things that you should take into account. We will provide details in the following section.
Applying CBD sublingually
Shake well before use
Determine the number of drops in accordance with the dose of CBD consuming each time
Start at a low dose as we recommend above and increase the dose to have the therapeutic effects.
Hold the CBD under the tongue for at least 60 seconds
Accidentally swallowing the CBD oil won’t pose any risks to your body. However, once you swallow this substance, you no longer take it sublingually. Instead, you are eating it, which means that it has to pass the digestive system and metabolism before your body can utilize it. Although it’s not dangerous, it does mean decreased bioavailability and slower onset of action.
Taking CBD sublingual bypasses the digestive system, there’s no need to worry about taking it with or without food.
After the necessary time is up, drinking water or eating food won’t interfere with the working of the CBD. At best, you might wait a few minutes prior to drinking water.
Putting a few drops of CBD under the tongue won’t turn your teeth yellow as well as make your breath smell.
Determine your suitable CBD dosage, the number of puffs each time, and types of CBD vape
Read carefully the user manual, especially if you are a new user
Wait 5 – 10 minutes between puffs and observe how CBD affects you
Always start at low dose, and work your way up to the optimal dose
After inhaling, you should check the battery life or clean the vape tank if needed
People considering or taking CBD product should always mention their use to their doctor, especially if you are taking other medications or have underlying ailments, such as kidney disease, liver disease, heart failure, or immunocompromised condition. Pharmacists are also a reliable source to help you learn about potential drug interaction with supplements, over-the-counter drugs or prescribed drugs.
Feedback after 1 month of using CBD oil from HempSapa:
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We mentioned all aspects about potential benefits of CBD to manage depression, namely evidence, improvement of symptoms, dosage, drug interaction, etc. Keeping in mind that CBD isn’t approved by the FDA for treating depression, you should talk with your doctor prior to using CBD.