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Table 3 Studies of the use of CBD and CBD-containing compounds such as nabiximols in the treatment of other psychiatric disorders and levels of evidence (1–5)*

From: The therapeutic role of Cannabidiol in mental health: a systematic review

AuthorDiagnosisStudy designPharmacological agentStrength of evidenceGroup (n)DurationAge range (years)Dose range (mg)Scales to measure the clinical outcomeClinical outcomeCommon side effectsReference number
Cooper et al., 2017ADHDRCTNabiximolsLevel 2Nabiximols = 15
Placebo = 15
6 weeks18–55Nabiximols oromucosal spray = 2.7 mg Δ9-THC and 2.5 mg CBD
Mean dose = 4.7 sprays per day
Maximum dose = 14 sprays/day
QbTest- The experimental group had better scores compared to placebo group (Est = 0.17, 95%CI-0.40 to 0.07, p = 0.16, n = 15/11 active/placebo).
- Nabiximols was associated with a nominally significant improvement in hyperactivity/impulsivity (p = 0.03) and a cognitive measure of inhibition (p = 0.05), and a trend towards improvement for inattention (p = 0.10) and executive learning (p = 0.11).
Muscular seizures and spasms34
Barchel et al., 2018ASD and related comorbidities
1. Hyperactivity
2. Sleep problems
3. Self-injury
4. Anxiety
Open-label trialCBD and Δ9-THCLevel 35330–588 days
Median duration = 66 days
4–22
Median age = 11 years
CBD oil solution with CBD and Δ9-THC at 1:20 ratio
CBD
16 mg/kg (maximal daily dose 600 mg)
CBD median IQR daily dose = 90 (45–143) mgΔ9-THC
0.8 mg/kg (maximal daily dose 40 mg).
THC median IQR daily dose = 7 (4–11) mg
Not mentioned- These patients were taking concomitant medications including stimulants, antipsychotics, anti-epileptics, melatonin, anti-depressants, alpha-agonists, and anti-muscarinic agents.
- Out of 53 patients, 74.5% reported improvement in comorbid symptoms.
- About 68.4% reported improvement in hyperactivity, 67.6% in self-injurious behaviors, 71.4% in sleep problems, and 47.1% in anxiety symptoms.
Somnolence and change in appetite35
Bergamasci et al., 2011Anxiety related to public speakingRCTCBDLevel 4CBD = 12
Placebo = 12
Single doseSAD-placebo = 22.8
SAD-CBD = 24.6
Healthy = 23.3
600 mgMini-SPIN, VAMS, SSPS, SSPS-N, BSS- Pretreatment with a single dose of CBD significantly decreased anxiety, cognitive impairment and discomfort in speech performance. It also resulted in significantly decreased alertness in anticipatory speech.
- There were significant effect of phases (F3.6,118.51/432.7; p < 0.001), group (F2,331/413.5; p < 0.001) and phases by group interaction (F7.2,118.5 1/4 6.4; p < 0.001).
- There were also significant differences between placebo and healthy control group at the initial (p < 0.018), anticipatory (p < 0.001), speech (p < 0.001) and post-speech (0.018) phases.
- The CBD group differs from the placebo (p < 0.012) and control (p < 0.007) groups during the speech phase
No side effects were reported.36
Shannon et al., 2019Anxiety and insomniaRetrospective chart reviewCBDLevel 4Anxiety = 47
Sleep disorder = 25
3 monthsSleep disorder = 18–72
Mean age = 36.5 years
Anxiety = 18–70
Mean age = 34 years
25–175 mgMost patients received 25 mg/dayHAM-A, PSQI- Most patients received 25 mg/day CBD; a handful of patients received 50 or 75 mg/day. One patient with schizoaffective disorder and trauma was given up to 175 mg/day.
- After 1 month of treatment, 79.2 and 66.7% of patients reported improvement in anxiety and sleep, respectively.
- After 2 months, 78.1 and 56.1% of patients reported improvement in anxiety and sleep, respectively, which were also observed at 3-month follow-up.
- Greater improvement in anxiety scores than sleep scores.
- 2 patients discontinued treatment due to fatigue and 1 patient with a development disorder had increased sexually inappropriate behaviors, resulting in discontinuation
- Transient mild sedation was also reported in some patients.
37
Zuard et al., 2010Bipolar disorderCase reportCBDLevel 4238 days34 and 361–5 days for both participants: Placebo
Case 1:
5–19 days: CBD 600 mg and olanzapine 10–15 mg
20–33 days: CBD 900–1200 mg
Case 2:
5–33 days: CBD 600–1200 mg
33–38 days: Placebo
BPRS, YMRS- Case 1: 37 and 33% improvement on BPRS and YMRS with CBD and olanzapine, but no additional improvement with CBD monotherapy.
- Case 2: CBD failed to improve symptoms of bipolar disorder at any of the prescribed doses.
No side effects were reported.38
Shannon & Opila-Lehman., 2016Posttraumatic stress disorderCase reportCBDLevel 415 months of CBD10CBD oil 25 mg
Liquid CBD 6–12 mg sublingual spray as needed for anxiety
SDSC, SCARED- CBD scores improved from 34 to 18 at endpoint, indicating no anxiety.
- Sleep Disturbance Scale scores improved from 59 to 38, suggesting no problem with sleep.
No side effects were reported.39
Trainor et al., 2016Tourette syndromeCase reportNabiximolsLevel 414 weeks26Two oromucosal sprays of nabiximols BID
Total dose = 10.8 mg Δ9-THC, 10 mg CBD per day
YGTSS, ORVRS- Using the ORVRS to evaluate tics, motor tics were reduced by 85% and vocal tics by 90%
- Number of affected body areas decreased.
- mprovement of 35% on YGTSS.
No side effects were reported.40
Pichler et al., 2018Tourette syndromeCase reportCannabis tincture
THC combined with CBD
Level 412 months4734 drops cannabis tincture 3 times a day = 10 mg Δ9-THC combined with 20 mg of CBDYGTSS- With the combination of Δ9-THC and CBD, there was significant improvement in tic frequency and severity.
- Scores decreased from 73/100 to 44/100 on YGTSS.
- Patient reported improvement in quality of life and enhanced social activity.
Slight xerostomia41
  1. ADHD: Attention-deficit/hyperactivity disorder, ASD: Autism spectrum disorder, BPRS: Brief Psychiatric Rating Scale, BSS: Bodily Symptoms Scale, CBD: cannabidiol, HAM-A: Hamilton Anxiety Rating Scale, IQR: Interquartile range, Mini-SPIN: Mini-Social Phobia Inventory, ORVRS: Original Rush Videotape Rating Scale, PSQI: Pittsburg Sleep Quality Index, QbTest: Quantified Behavioral Test, RCT: randomized controlled trial, SCARED: Screen for Anxiety Related Disorders, SDSC: Sleep Disturbance Scale for Children, SSPS: Self-Statements During Public Speaking, SSPS-N: Negative Self-Statements, VAMS: Visual Analog Mood Scales, YGTSS: Yale Global Tic Severity Scale, YMRS: Young Mania Rating Scale, Δ9-THC: Δ9-tetrahydrocannabinol
  2. *The Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence was used to grade the quality of evidence (OCEBM, 2019). Level 1 evidence is for systematic review of RCTs or individual RCT of narrow confidence interval, Level 2 for cohort studies or systematic review of cohort studies, Level 3 for case-control studies or systematic review of case-control studies, and Level 4 for case-series for studies focused on therapy, prevention, etiology and harm (OCEBM, 2019)