Clinical research shows CBD is as effective as antipsychotic meds with fewer side effects. Schizophrenia is a neurological disorder affecting the perception of reality and cognition. We explore if CBD is safe and how it might help.
CBD for Schizophrenia
Schizophrenia is a mental disorder that affects a person’s ability to think, feel, and behave clearly. It can cause psychotic episodes, and treatment is usually lifelong and involves antipsychotic medications with toxic side effects.
In 2012, researchers published a study in Translational Psychiatry showing that a CBD isolate can treat schizophrenia as effectively as antipsychotic pharmaceuticals — and with far fewer side effects. 1
In this study, researchers led by Markus Leweke, MD , of the University of Cologne in Germany recruited 39 people with schizophrenia who were hospitalized for a psychotic episode. Nineteen of the study participants received an antipsychotic medication called amisulpride, while the other 20 were given CBD . After four weeks, both groups significantly improved. There was no difference in psychiatric symptoms between those getting CBD or amisulpride. But those taking CBD had fewer undesirable side effects, such as weight gain and movement disorders, compared to those taking amisulpride. The authors concluded, “These results suggest that cannabidiol is as effective at improving psychotic symptoms as the standard antipsychotic amisulpride.”
CBD appears to provide antipsychotic relief by raising the levels of anandamide, an endogenous cannabinoid compound that acts on the same brain receptors as THC . Curiously, in an earlier study, Daniele Piomelli, director of the Center for the Study of Cannabis at the University of California in Irvine, discovered that people with schizophrenia had anandamide levels that were on average twice as high as mentally healthy people without the disorder. 2 Some scientists speculated that perhaps people with schizophrenia were essentially too high on elevated levels of their own endocannabinoids! But in reality, it seems that the brain actually increases anandamide levels to buffer stress and ease the symptoms of psychosis. The preponderance of evidence suggests that the higher the anandamide levels are in people with schizophrenia, the less severe their symptoms.
Atypical brain scans
More recently, in 2020, researchers from Kings College in London used fMRI scans to monitor the brain activity of 13 people with psychosis while they performed a memory test after taking CBD or a placebo and compared it to 16 people without psychosis performing the same test. Those taking placebo had different brain activity in the prefrontal and mediotemporal brain areas associated with memory than the people without psychosis. When participants who had psychosis took one dose of CBD , their brain activity becomes more like their counterparts without the disease.
CBD influences areas of the brain that have been shown to have unusual activity in people with psychosis.
“Our study provides important insight into which areas of the brain CBD targets. It is the first time research has scanned the brains of people with a diagnosis of psychosis who have taken CBD and, although the sample is small, the results are compelling in that they demonstrate that CBD influences those very areas of the brain that have been shown to have unusual activity in people with psychosis,” said the senior author on the study, Sagnik Bhattacharyya, MD , PhD. 3
Importantly, in terms of cannabis and safety, one of the biggest health concerns and stigmas about cannabis use has been the idea that it can cause psychosis in vulnerable individuals. This has never been proven. It’s worth noting that a 2012 meta-analysis published in Schizophrenia Bulletin showed that people diagnosed with schizophrenia who use cannabis function better cognitively than people with schizophrenia who do not use cannabis. 4
An excerpt from The Essential Guide to CBD by the editors of Reader’s Digest & Project CBD .
Copyright, Project CBD . May not be reprinted without permission.
CBD Oil for Schizophrenia & Psychosis: Can It Help?
Schizophrenia is a neurological disorder affecting the perception of reality.
We explore if CBD is safe & how it might help.
Schizophrenia causes disordered thoughts and speech, visual or auditory hallucinations, and a myriad of other symptoms that can vary from one person to the next.
Researchers are continuously looking for new, effective treatment options for schizophrenia, and in recent years have turned their focus toward CBD — a powerful, medicinal (non-psychoactive) compound contained in the cannabis plant.
In this article, we’ll discuss what we know so far about this debilitating mental health condition and how CBD can be used to support symptoms.
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Updated on November 13, 2021
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Can CBD Help With Schizophrenia?
Schizophrenia is a complex psychiatric disorder involving many different confounding factors working together to produce symptoms. Schizophrenia is a serious chronic, debilitating psychotic disorder listed in the top 15 leading causes of disability worldwide according to the National Institute of Mental Health.
This means that there is no single effective treatment for the disorder. Successful treatment, therefore, requires an all-encompassing approach. Everything from changes in diet and lifestyle to supplements and medications should be combined to manage the condition.
CBD has been shown to offer some unique benefits that may be combined with other treatments to maximize the management of schizophrenia.
While the mechanism of action for CBD remains unclear, the results so far have been promising.
The potential benefits of CBD oil for schizophrenia include:
- Alleviates anxiety & depression
- Regulates neurotransmitter balance (dopamine, serotonin, & glutamate)
- Increased blood flow to cortical regions of the brain
- Improves sleep quality & duration
- Regulates the vanilloid receptors (TRPV1)
What is Schizophrenia?
Schizophrenia is a diagnosable psychotic disorder involving delusions, hallucinations, disorganized speech, difficulty staying focused, lack of motivation, and disorganized or catatonic behavior. Diagnosis by a physician requires at least a month or two or more symptoms over at least six months, with at least one positive symptom and social/occupational dysfunction.
Seeing a doctor early is important because schizophrenia must be carefully distinguished from other mood and psychotic disorders with similar symptoms, in order to optimize correct treatment and minimize long-term harm.
However, it’s a rare condition affecting ~1% of the US population, according to the American Psychiatric Association. They also note that approximately half of schizophrenia patients may also suffer from another mental or behavioral disorder.
There are a lot of misconceptions in public understanding of this condition. Despite popular belief, most schizophrenics aren’t dangerous. They don’t all live in hospitals nor have split personalities. Many, albeit not most people, who have the condition can live reasonably normal lives — they often have jobs and families and can live independently.
Schizophrenia affects both men and women equally, but symptoms tend to appear sooner in males than females. Men usually begin experiencing symptoms around their late-teens to mid 20s, while females typically start showing signs in their mid 20s or early 30s. It’s rarer for anybody under the age of 12, or over 40, to show symptoms of schizophrenia — but still possible.
Schizophrenia itself isn’t deadly, but it’s often associated with other medical conditions that can lead to problems later in life — such as heart disease or diabetes. Patients, in general, are at higher risk of premature death from such preventable causes, also including metabolic and liver disease, and suicide.
Three Phases of Schizophrenia
1. Prodromal Phase
This is the phase leading up to the first display of active psychotic symptoms, usually starting here with negative symptoms. “Negative” symptoms can be thought of as irregular social behaviors or speech/affect opposite of the norm (listed below). There is also some accompanying decline in daily functioning. If detected early enough, the onset and severity of schizophrenia can be significantly reduced and better managed in the long-term .
In the prodromal phase, patients often experience a decline in social and cognitive functions like memory, judgement, attention, depression, anxiety, isolation, and learning difficulties. Patients may also have mood symptoms such as depression, anxiety, and suicidal thoughts which should be taken seriously.
The prodromal phase can last anywhere from several weeks to several years .
2. Active Phase
During this phase, distinct positive symptoms become evident and perhaps more severe, involving delusions, hallucinations, and catatonic behavior. These “positive” symptoms may involve delusions, hallucinations, disorders of thought, and either agitation/aggression or catatonic behavior. This is when treatment is most important and when most schizophrenia diagnoses are made.
3. Residual Phase
In the residual phase, symptoms may begin to disappear, but patients are often left feeling “flat,” with poor motivation, low mood, and inability to focus or concentrate. Treatment during this phase is still important, directed toward controlling psychotic episodes and mood symptoms.
In the long run, about 30% will improve or return to normal function, another 30% will be hospitalized intermittently, and another 30% will be institutionalized or incapacitated. Unfortunately, ~10% of patients are lost to suicide.
Signs & Symptoms of Schizophrenia
The symptoms of schizophrenia can be divided into three main categories:
A) Positive (Psychotic) Symptoms
B) Negative Symptoms
C) Cognitive Symptoms
What Causes of Schizophrenia?
Unfortunately, there isn’t a single identified cause of schizophrenia. Research has linked the disorder with some different potential causes, including environmental influences, genetics (i.e. chromosome 6), changes in brain chemistry, and physical or emotional trauma.
1. Dopamine Theory
One of the leading theories for the causes of schizophrenia comes from early behavioral studies that found if you increase dopaminergic activity in certain brain pathways then psychotic symptoms appear (as in overdoses of cocaine, amphetamine, L-dopa).
This mesocorticolimbic projection is now the primary target mechanism of antipsychotic drugs.
In fact, all anti-psychotic medications work by blocking dopamine (D2) receptors in the brain to some degree — suggesting that schizophrenia is caused by too much dopamine in certain brain pathways.
The trade-off is that either over-activating or blocking dopamine in certain brain areas may cause unpleasant side-effects, which can be addressed.
For example, blocking dopamine receptors in one area produces Parkinsonian-like effects and involuntary muscle spasms. Too little dopamine activity in the frontal cortex is thought to cause the negative and cognitive symptoms.
First generation anti-psychotics are effective at blocking psychotic symptoms, however, they often come with many other side effects. Second generation (or “atypical”) anti-psychotics are better at avoiding the side-effect pathways, and also block a greater number of serotonin receptors.
2. Brain Structure Abnormality Theory
Neuroimaging studies have shown that patients with differing symptoms have physiological abnormalities (such as reduced blood flow) in different areas of the brain.
For example, patientshave been shown to have abnormalities in the thalamus — the area of the brain tasked with filtering and processing sensory signals such as sight, sound, or touch. Other studies have found that patients show signs of reduced neurons, which may be related to the faulty, overactive C4 pruning gene researchers found on chromosome 6.
All of these different factors suggest that schizophrenia can be caused by dysfunctions in many different areas of the brain. Symptoms will be determined by the parts of the brain that are most affected.
Low doses of cannabis improve blood flow to regions of the brain involved with regulating mood, sociability, and cognition — potentially reducing psychotic symptoms associated with schizophrenia .
3. Glutamate Theory
Glutamate is the most abundant neurotransmitter in the brain, and the one responsible for neural excitement. One theory regarding schizophrenia involves inappropriate glutamate activity and NMDA receptor expression alteration in the brain. This theory could be used to explain many of the symptoms associated with the condition. Additionally, the psychoactive drug phencyclidine (PCP) is known for producing acute, schizophrenia-like psychosis through activation of the glutamate receptors in the brain .
This has led some medical researchers to suggest schizophrenia involves similar over- or underactivation of glutamate in certain areas of the brain.
Studies show that synthetic cannabinoids reduce PCP-induced schizophrenic symptoms in rats .
4. Anandamide Excess Theory
Other research findings suggest schizophrenic patients have significantly higher levels of anandamide in their blood . Follow up studies show high levels of anandamide present in the cerebrospinal fluid of actively psychotic, schizophrenic patients who have never been treated. Interestingly, researchers now pose that high anandamide may not be the cause, but is actually a homeostatic compensation to fight the disease state.
In a double-blind, randomized clinical trial, CBD was shown to improve psychotic symptoms by improving anandamide signalling. CBD was just as effective as the potent, second generation antipsychotic amisulpride at reducing symptoms — but had less unpleasant side effects.
CBD inhibits the enzyme FAAH from degrading anandamide, suggesting the endocannabinoid system is somehow altered in schizophrenia, but may now play a new role in treatment.
Similar studies report dysfunctional CB1 receptor activity in schizophrenic patients, especially in regions of the brain relating to cognition and memory — two functions highly compromised in schizophrenia [5, 6].
Patients with schizophrenia are more likely to be negatively affected by THC — which is a well-known CB1 receptor agonist .
This, of course, makes schizophrenia challenging to treat because there are so many different factors to take into account. It also explains why some patients respond to treatment, and others don’t.
5. Other Potential Causes
- Severe or long-term stress
- Substance abuse, particularly in adolescence
- Genetic factors
- Viral infection
- Developmental problems
- Autoimmune disorders
- Neurodegenerative disorders
Treatment Options for Schizophrenia
The most effective treatments for schizophrenia have an all-encompassing approach. Medications, lifestyle coaching, psychiatric care, and group therapy are all necessary aspects of treatment for this condition.
With early and proper treatment involving antipsychotic medications, most of the symptoms of schizophrenia can be reduced or eliminated, and episodes of active-phase schizophrenia become less frequent.
Unfortunately, all of these medications come with potentially negative side-effects, especially in the long term. Sudden, abnormal or painful muscle movements, diabetes, and heart complications are especially common in people taking these medications. There’s also a risk of CBD interacting with medications, so always talk to your doctor first.
However, side effects can be addressed with your doctor and managed if they appear. Families should seek support for their affected loved ones and themselves, with assistance like home care and ensuring patients can access and maintain treatment long-term.
Communities should provide opportunities for employment and assisted/independent living, giving patients a base from which to set and achieve goals.
Treatment for Schizophrenia May Include:
Medications Often Used For Schizophrenia:
What the Research Says: CBD Oil for Schizophrenia
Over the past decade, there’s been a growing interest in the use of CBD for treating schizophrenia.
This research started following a case report released in 1995 highlighting the improvement in a schizophrenic patient who was unresponsive to the standard antipsychotic medication haloperidol . In 2012, the results of the clinical study highlighted above on CBD vs amulisopride and enhanced anandamide signalling was published.
Even more recently, the pharmaceutical company GW Pharmaceuticals Plc recently ran a series of clinical trials on a new CBD-based drug it’s been developing called Sativex®. One of these studies explored whether or not CBD was able to relieve symptoms of schizophrenia in patients who were unresponsive to standard antipsychotic medications .
The GW Pharmaceuticals study was a phase 2, double-blind clinical trial conducted across 15 different hospitals in the UK, Romania, and Poland. Patients in the study were randomly put into either a treatment group (using 1000 mg per day of CBD split into two doses) or a control group (using a placebo).
At the end of the six-week trial, the CBD group showed modest improvements in schizophrenic symptoms. The most substantial improvements from the study involved motor speed and executive functioning.
The most significant finding in this research was that CBD didn’t appear to rely on dopamine receptor modulation — which is the primary target for current schizophrenia treatments. Instead, researchers in this study suggested the mechanism of action to be through inhibition of fatty acid amide hydrolase (FAAH), inhibition of adenosine reuptake, vanilloid receptor activation (VR1), and serotonin (5HT1A) receptor activation .
They concluded by stating that: “Because CBD acts in a way different from conventional antipsychotic medication, it may represent a new class of treatment for schizophrenia.”
More clinical trials are scheduled to explore the use of CBD for schizophrenia in larger populations and longer duration of treatment.
Results of the GW Pharmaceuticals Research Study:
(Source: McGuire et al., 2017)
THC vs. CBD for Schizophrenia
High-THC and low-CBD extracts have been associated with a higher risk of psychotic episodes . Other studies have shown that cannabis containing a high level of CBD and a level of low THC is associated with a lower risk of psychotic episodes .
Other studies have shown that CBD offered improvement in symptoms of schizophrenia to a similar degree as amisulpride — an antipsychotic medication . CBD also had fewer side-effects.
The differences between CBD and THC and their effect on schizophrenia is very important — and likely to be the reason behind the conflicting evidence for cannabis users and schizophrenia. Some patients find relief from symptoms with cannabis use; others experience dramatically worsened symptoms after using cannabis.
It is not recommended, but if using cannabis for schizophrenia, make sure you pay attention to the THC content. Additionally, only choose products with low or “not detectable” THC concentrations when buying CBD.
Key Takeaways: Using CBD for Schizophrenia
Schizophrenia is a highly complex neurological disorder that continues to puzzle medical researchers. However, there are several significant theories about the underlying causes of schizophrenia.
Some patients respond very well to medications; others do not.
Although CBD may improve the side-effects of the condition using several different models of schizophrenia (clinical and PCP-induced), there is also evidence that other cannabinoids — namely THC — can worsen schizophrenia.
For this reason, it’s recommended that you only use CBD for schizophrenia under the close watch of a medical professional. It’s also recommended that you only use CBD products that are entirely void of THC. Additionally, research suggests that a high dose (1000 mg per day) of CBD is needed to produce even modest improvements in symptoms.
Patients and families are encouraged to seek further support and resources from their doctor, and groups like NAMI and the American Psychiatric Association.