Review argues CBD could be ideal for early-phase psychosis where minimizing side effects is a clinical priority | Research

The takeaway

CBD has shown antipsychotic effects with relatively few adverse effects, potentially making it well-suited for early psychosis treatment, where bad medication experiences can permanently damage patients' attitudes toward treatment.

Psychiatrists treating early psychosis, researchers, patients and families considering treatment options.

No licensed treatment exists for clinical high-risk psychosis

What the researchers found

CBD has demonstrated antipsychotic effects in clinical studies and has a relatively benign side effect profile compared to standard antipsychotics. For clinical high-risk individuals, no licensed treatments exist, and for first-episode psychosis, all licensed medications act via dopamine D2 receptors. CBD acts through different mechanisms, potentially offering a novel approach for patients who do not respond to or cannot tolerate standard treatments.

Why it matters

Early phases of psychosis represent a critical window where treatment experiences shape long-term outcomes. A treatment with fewer side effects could improve engagement and prevent the treatment avoidance that leads to chronic illness.

The numbers in context

No licensed treatment exists for clinical high-risk individuals. All current first-episode antipsychotics target dopamine D2 receptors. CBD acts through different mechanisms.

How the study worked

Narrative review examining CBD's potential as a treatment in clinical high-risk and first-episode psychosis stages, covering mechanisms of action, clinical trial evidence, adverse effects, patient acceptability, and ongoing trials.

What this study cannot tell us

Clinical trial evidence for CBD in psychosis is still limited. Optimal dosing unknown. Long-term effects not established. CBD is not currently approved for psychosis. Recreational cannabis use may confound outcomes in young patients.

How to read the evidence

Narrative review synthesizing clinical evidence. Ongoing trials will provide stronger evidence.

When this study was published

Published in 2022.

The bigger picture

The convergence of CBD's antipsychotic properties, favorable side effect profile, and high patient acceptability positions it as a potentially transformative addition to early psychosis treatment, pending clinical trial confirmation.

Questions still open

Will ongoing clinical trials confirm CBD's antipsychotic efficacy? Could CBD be used as monotherapy or only as adjunctive treatment? How should clinicians distinguish CBD (potentially beneficial) from cannabis (potentially harmful) in patient discussions?

Common questions

Could CBD replace antipsychotic medications?

Not yet. CBD has shown antipsychotic effects in some clinical studies with fewer side effects, but the evidence is not yet strong enough for it to replace licensed antipsychotics. It is being studied as both an alternative and add-on treatment.

Why is early psychosis treatment so important?

First treatment experiences strongly shape patients' long-term attitudes toward medication. Negative side effects during first-episode treatment can lead to treatment avoidance, which worsens outcomes. CBD's milder side effect profile could improve early engagement.

Read the original research

Cannabidiol (CBD) as a novel treatment in the early phases of psychosis.

Psychopharmacology, 239(5), 1179-1190

View on PubMed ↗Publisher’s paper ↗

Citation

Chesney, Edward; Oliver, Dominic; McGuire, Philip. (2022). Cannabidiol (CBD) as a novel treatment in the early phases of psychosis.. Psychopharmacology, 239(5), 1179-1190. https://doi.org/10.1007/s00213-021-05905-9