CBD Use: What Does The Research Say? with Dr. Rebecca Siegel

Dr. Daniel Amen: Welcome to The Brain Warrior's Way podcast. I'm Dr. Daniel Amen.
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Dr. Daniel Amen: Welcome back to CBD week. We're here with Dr. Rebecca Siegel, a child, adolescent, and adult psychiatrist in our Manhattan, New York clinic. We are having a very interesting time talking about the difference between marijuana and hemp and THC and CBD. Most of the country now thinks it's innocuous and should be legal. It's legal in 26 states, 10 states for dementia.
The problem I have with it all, and I always say, "I have no dog in this fight," is that for the last 30 years, we've been looking at people's brains, and brains of marijuana smokers are not healthy. It's just been a pattern I have seen for decades. And we published two large studies, one on a thousand people showing virtually every area of their brain is lower in activity. That's a bad thing. And in a study of 62,454 scans, we showed that marijuana was one of those things that prematurely aged the brain.
Now, is it worse than alcohol? Is it worse than Xanax? Is it worse than sleeping pills? It's an interesting question, but as far as we know ... There have been a couple of studies now, I think out of Norway, showing that marijuana in young people actually increases the risk of psychosis 450%. A brand new study, the teenagers who smoke or ingest marijuana have a higher incidence of depression in their 20s, and a higher incidence of suicide. Those things are not correlated with early drinking, although it sort of probably wouldn't surprise Rebecca or I that early drinking is associated to brain damage and more psychiatric problems.
The Daily Mail did a big article on my marijuana piece, and there were over 500 comments.
Tana Amen: Probably not all positive.
Dr. Daniel Amen: Oh no, the haters totally come out.
Tana Amen: Right. People who want to smoke pot.
Dr. Daniel Amen: The pot smokers totally come out. But one of the comments was, "My dad always regrets that he was smoking pot because he never felt as sharp. Even though he stopped in his 40s, he had cognitive problems in his 50s. Why compare it to alcohol? They're both bad for you." And from sort of a neuroscience perspective, that's clearly what we've seen on scans, yet when our father-in-law was dying of cancer-
Tana Amen: He was terminal, so no one cares.
Dr. Daniel Amen: ... I'd go pick it up for him, that it would help him with pain-
Tana Amen: Right. Because it's the only thing that killed his pain.
Dr. Daniel Amen: ... it would help him eat-
Tana Amen: Stimulate his appetite.
Dr. Daniel Amen: ... so it's not like I'm saying, "All opiates are bad," but please don't start them too soon, because they can ruin your life.
Tana Amen: And now the question is, which I hope you're going to talk about, Dr. Siegel, is you just talked about marijuana. The question is, what about CBD?
Dr Rebecca Siegel: [crosstalk 00:04:32]
Tana Amen: We talked about that in the last episode, but I want to hear more, like what do you know about the studies on CBD? Is it as bad? What do we know?
Dr Rebecca Siegel: Well, that's the issue. The studies that have been done mostly have been done in mice or rats, or in individuals in very small numbers. That's the problem. Much larger scale trials need to be done, and that is how the medical community can feel better. I see that CBD and medical marijuana are options. I see them like you said, for end-stage cancer, pain relief, chemo-related nausea, things like that. I see it as an option.
But what they're finding, and now that there's a FDA-approved medication, EPIDIOLEX, they're finding what CBD side effects can be, things like sleepiness, decreased appetite, potentially increases in the liver enzyme. Now that's very concerning.
Tana Amen: That's concerning.
Dr Rebecca Siegel: That's very concerning.
Dr. Daniel Amen: There's a 2012 study, a brain imaging study, looking at blood flow and CBD and THC. I think it was not done in the United States, it was done in the UK. They did a randomized placebo crossover trial in 16 healthy male subjects and they gave them 10 milligrams of THC or 600 milligrams of CBD. And that's very important, because a lot of the CBD you'll find, I guess CVS is now going to carry it, or online, it's 10 milligrams, 20 milligrams, and the EPIDIOLEX, the antiseizure dose, I believe it's 600 milligrams.
Tana Amen: There's a big difference.
Dr. Daniel Amen: What they found was relative to both placebo and CBD, that the administration of THC was associated with anxiety, dysphoria, sadness, positive psychotic symptoms, mental and physical sedation, and a subjective sense of intoxication, and an increased heart rate. There was no difference between CBD and placebo on any of the symptomatic, physiological variables. So, I think that's really important.
Tana Amen: Yeah, that's kind of wild.
Dr. Daniel Amen: It's one of the only imaging studies comparing CBD and THC.
There's a new study that just came out this year in the Brazilian Journal of Psychiatry on CBD. It was 300 milligrams, significantly reduced anxiety during public speaking. But 150 milligrams didn't do anything, which is a more common dose for people to take. Actually, they take much less. And 600 milligrams didn't do anything. So, there was this inverted U-shape dose response curve, which means it didn't work at small doses, there was sort of a sweet spot, and it didn't work at larger doses.
Tana Amen: Too extreme.
Dr. Daniel Amen: What other studies do you know about, Rebecca-
Dr Rebecca Siegel: Well, it's important to-
Dr. Daniel Amen: ... on the benefits of CBD?
Dr Rebecca Siegel: There may be a very small therapeutic window of dosing that we need to figure out, and that is going to take time. But you said with EPIDIOLEX, you need to use tremendous amounts of CBD. Most people will not be using tremendous amounts. You know, they say, "Twice a day, daily dosing, every day," to do something, but this may do nothing. It may not be harmful, but might it be ... will it actually be helpful? [inaudible 00:08:47]
Tana Amen: So, my question before about we have so many patients who, they don't ... They've stopped drinking, or they don't want to smoke pot. Is CBD better for their anxiety, for sleep, for pain? And your response in the last episode was, "I'm not sure. We're not sure yet. We don't have enough information." I mean, do we have any information? Is it dose-dependent? Are there any studies showing that it's better than alcohol or marijuana?
Dr. Daniel Amen: Well, you just saw the study that I talked about-
Tana Amen: But that was high doses.
Dr. Daniel Amen: ... with marijuana. Now, with marijuana, it was, well, it was still high dose. But marijuana caused anxiety and psychotic symptoms, depression, where CBD did not.
Tana Amen: Okay.
Dr. Daniel Amen: But you know, getting ready for this, I went to PubMed, and when you actually go to clinical trials on humans with CBD, there is only a total of 84 studies in history for something that everybody and their mother and their dog is using.
Tana Amen: Literally.
Dr. Daniel Amen: That's ridiculous.
Dr Rebecca Siegel: [inaudible 00:10:07] we're going to-
Dr. Daniel Amen: And part of it is because of it's just not been legal for a very long time.
Dr Rebecca Siegel: Correct. There are places where it's still not legal, and especially if you're going to use marijuana, CBD from marijuana, that is federally not legal. That's actually a whole 'nother topic that is incredibly interesting. [crosstalk 00:10:32]
Tana Amen: So, Dr. Siegel, would you prefer that CBD and marijuana are both for medical use only, prescribed by a practicing physician? Or-
Dr Rebecca Siegel: I think that is a much safer and much better way to go, because if it's going to be sold over the counter at CVS or Walgreens, people don't necessarily know what they're getting. They don't know how to dose it. The other thing is they don't necessarily know how much CBD is actually in the product. It may say it is a certain amount, but that's not necessarily so. There's been research to show that, I think 70% of ... There's inaccuracy in the dosage claims of how much CBD, the percent of CBD. Could be more, could be less, and [crosstalk 00:11:28]-
Tana Amen: Well, they also don't have anyone to follow up with if they have side effects.
Dr Rebecca Siegel: Absolutely, which is why I would only feel comfortable prescribing medical CBD or medical marijuana. I'm very cautious and very concerned about over the counter CBD.
Tana Amen: All you have to do is look at the states where they've legalized marijuana and see the problems that we're having associated to legalized marijuana and the increased use in teenagers, because it's now accessible. I mean, it's not that hard to figure out.
Dr Rebecca Siegel: I have-
Dr. Daniel Amen: There's a brand new study in translational psychiatry which when we come back, we're going to talk more about marijuana, CBD. Is this something you should give to your mother-in-law if you like her, or if you don't like her? Stick with us.
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