Doc, One More Question: What About CBD Oil?

Napping Hippopotamus, Copenhagen, Denmark

These days, the so called hand on the door knob question in my clinic is: "So...Doc, what about CBD oil for his/her [insert disorder, usually depression or anxiety or both]....the cousin of my friend swears by it..."

By the way, door on the knob question refers to the question that patients ask just when you are about to end session/leave the room.

In other words, their MOST important question.

So, here's what we say these days.. What WE say since each of my patients has a treatment team that, besides me, includes at least one other, usually younger, doctor -a resident or fellow physician- who contributes to making sure we are up to date in reviewing informative literature.


1-Yes, we know that CBD is very popular. There is an entire industry branding CBD as benign and miraculously helpful.

2-That industry is shaping to be as powerful as the one behind the non-generic drugs we prescribe but with even less oversight/regulation for claims and disclosure of side effects. The preparation is also far less regulated so there is a risk of contamination including by THC which undoubtedly, over time, has been shown in good studies to worsen depression and anxiety.

3-That said, there have been some studies that suggest that CBD might be very slightly helpful for anxiety. Not extremely good studies. At most, for now, they suggest that the anxiolytic effect of
CBD is slight and less than CBT, SSRIs or SNRIs.

4-If a patient in my or another clinic is on a medicine metabolized through the Cytochrome P450 (essentially every SSRI or SNRI though with inter-drug variations in terms of strength of interface with P450) then CBD, which is also cleared by P450 enzymes, can slow the metabolism of SSRI or SNRI and result in toxicity. Serotonin syndrome is no joke.

5-Many CBD industries have become aware of that but are making light of it and claiming, online, their product is nevertheless entirely safe.

6-The last century has seen series of "miracle, entirely safe, drugs": cocaine (seriously fascinating read on Freud's cocaine addiction), morphine (great book by Bulgakov, doc and writer and morphine addict), cigarettes, benzodiazepines, barbiturates. Some drugs, like St. John's Wort, were not that unsafe, compared to the ones previously cited; but NONE were miracles.

7-Studies on stigma show that when it comes to mental disorders, the most stigmatized situation (by the way...this is by non doc patients and docs as patients alike) is the one where they are treated with drugs like SSRIs or TCAs or SNRIs....In other words, drugs that don't feel like there is a "natural" (or more sinister-ly, more addictive) remedy for something that needs a happy ending of "I had this terrible problem and it completely miraculously went away."

The number of narratives about depression being due to diet, etc...is high.  Those narratives are always more triumphant than the "yep, I'm depressed and I take Prozac" ones.  It's not that they are untrue: there are many factors that impact well-being or lead to its opposite, including inflammation factors we are starting to understand better, and diet, activity, brain environment choices etc...are extraordinarily important.

It's clear though that the narrative of depression or anxiety as (for many) chronic conditions which require a number of approaches including at this point in time, for optimal results, prioritizing something as "un-natural" as an SSRI, a TCA or an SNRI" is just not as popular as the idea of CBD or other snake oil.

I do not blame patients.
I would blame myself if I did not know what to say when they ask.

With love and till later,

Anne