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Traumatic Brain Injury: Definition, Classification, and Management

We hear a lot about traumatic brain injury (TBI) nowadays: among NFL players (as in the movie ‘Concussion’), and as a signature diagnosis among recent combat veterans. What doesn’t get as much press coverage is the impact of TBI on those suffering from addiction. Having an alcohol or other substance use disorder greatly increases the risk of TBI. But what is TBI? How do I diagnose it? How does it manifest? How do I manage it?

Defining TBI
Although there is no universally accepted definition for TBI, recently updated guidelines from the Department of Veterans Affairs (VA/DoD Clinical Practice Guideline for the Management of Concussion-mild Traumatic Brain Injury, 2016; https://tinyurl.com/y8e6owdx) state that a TBI is an injury to the brain caused by an external force accompanied by one of several clinical signs following the event). These signs can be an intracranial lesion, loss of consciousness, amnesia, confusion, slowed thinking, muscle weakness, sensory loss, or another neurological deficit. The severity of a TBI (mild, moderate, or severe) is determined by the symptoms immediately following the injury (see the VA TBI severity table below). If the patient meets different ratings for the different criteria, go with the more severe rating. The lay term “concussion” equates to a mild TBI. In addition to the neurological symptoms, patients may experience cognitive problems affecting their attention, memory, processing speed, and executive function. Mental health effects include irritability, impulsivity, depression, and anxiety. However, these symptoms can be an effect of the TBI or part of a comorbid, major depressive disorder, posttraumatic stress disorder (PTSD), or substance use disorder.

Table: Classification of TBI Severity

Table: Classification of TBI Severity

(Click to view full-size PDF.)

Assessment and treatment
But what symptoms should I really be concerned about? For any TBI that is associated with progressively declining neurological function or worsening headache, pupil asymmetry, seizures, intractable vomiting, ongoing disorientation or neurological deficit, slurred speech, or new bizarre behavior, you should immediately refer for emergency evaluation.

The good news is that the vast majority of mild TBI cases resolve without any intervention. It’s important for the physician to provide education and reassurance to the patient and family. Any interventions should be tailored to the specific symptoms while reinforcing good sleep hygiene, relaxation techniques, and limiting use of caffeine, tobacco, and alcohol. Return to normal functioning at work or school should be encouraged in a gradual, monitored fashion. Patients with a TBI who report ongoing symptoms need appropriate referral and a comprehensive treatment plan (Silver JM et al, Textbook of Traumatic Brain Injury, American Psychiatric Publishing, Inc; 2nd ed;2011).

Cognitive rehabilitation therapy (CRT) 
You may have heard of cognitive rehabilitation therapy (CRT) as a treatment for TBI. But what exactly does it involve? And does it work? After a TBI there may be functional deficits that are both physical and mental in nature. CRT is a therapeutic process structured to improve the patient’s functioning in their daily lives. Patients are first guided through recognizing their strengths, weaknesses, and what deficits they want to improve. Then techniques are relearned when possible (solve the problem), or compensatory strategies are identified (work around the problem). The last step is to incorporate these relearned or new skills into daily life. This process can be applied to both physical and cognitive deficits that arise from a TBI.

CRT sessions should be tailored to the individual but most incorporate memory compensation techniques. Such techniques include having the patient write down at each session what was important to them, then reviewing their notes and memory of what was said during the next session. This method not only increases their participation in the therapy sessions but teaches them how to use the memory compensation techniques in their daily lives.

The evidence for CRT after stroke and moderate to severe TBI has long been established, showing improvement in the domains of memory, attention, and communication (Cicerone KD et al, Arch Phys Med Rehabil 2005;86(8):1681-1692). However, for mild TBI, CRT remains more controversial as there isn’t strong evidence for improved functional outcomes. The 2016 VA clinical guidelines recommend short-term CRT for moderate to severe TBI and discourages prolonged treatment courses without measurable improvements.

Sometimes the most concerning symptoms the patient will come to us for are the cognitive deficits and they may press for neuropsychological (NP) testing early. However, NP testing should not be done in the first 30 days. Most cognitive deficits of mild TBI will improve within this time period. And if the problems last longer than 30 days, NP testing may be helpful. Whenever referring for NP testing, be specific in why you are making the request. A targeted referral allows the NP examiner to choose the right tests to provide the most useful information.

Pharmacologic treatment 
When considering medication treatment for symptoms following a TBI, there are several general guidelines to follow (Silver JM et al, Neurology 2006;67(5):748-755.2011). Again, most symptoms of a mild TBI will abate within a month, so watchful waiting and reassurance are important. Symptom improvement may continue throughout the first year as the brain continues to heal, so be sure to reassess the need for the medication intervention. Many times, the neuropsychiatric symptoms after a TBI can be complicated by concurrent major depressive disorder, PTSD, or a substance use disorder. Untreated depression can be the root cause of cognitive problems, irritability, sleep disturbance, fatigue, and headache. Be sure to perform a thorough psychiatric assessment so that you can tailor the treatment plan accordingly. Target specific symptoms or concurrent conditions with your medication choices. After a TBI the brain can be more susceptible to side effects of medications, underscoring the importance of “starting low, and going slow.”

Here are a few specific medication recommendations to target neuropsychiatric symptoms (Silver JM et al, 2011). For improving processing speed, methylphenidate has the most evidence. Donepezil and rivastigmine also may have some utility for treating memory impairment. When targeting depression and anxiety, SSRIs are first-line and choose a specific SSRI based on side effect profile and limiting medication interactions (sertraline, citalopram, and escitalopram are favorable choices) (Salter DL et al, J Head Trauma Rehabil 2016;31(4):E21-32). Be cautious with bupropion due to increased seizure risk. Caution is also advised with typical antipsychotics as they may inhibit neuronal recovery, and also benzodiazepines due to the memory impairment effects. For controlling mania or irritability, valproate is preferred due to its anti-seizure effect as well as having less cognitive side effects in long term treatment than other mood stabilizers (carbamazepine or lithium). Atypical antipsychotics may also be helpful in controlling irritability especially when combined with psychosis, and are preferred over typical antipsychotics. More recent research shows beneficial effects of amantadine in treating aggression from TBI even 6 months post-injury and more studies are evaluating its use in the acute phase after a severe TBI (Hammond FM et al, J Head Trauma Rehabil. 2017;32(5):308-318).

CATR Verdict: When treating patients with TBI, always remember that the brain has a great capacity for plasticity and recovery. Encourage patients to see their treatment as a process and journey. Take care to evaluate for comorbid mental health disorders, and handle accordingly. Those with substance use disorders, whether existing pre-TBI or newly occurring, should be encouraged to enter into treatment promptly. With the right combination of cognitive rehabilitation, pharmacotherapy, and a good therapeutic alliance, your patients can make great strides in recovery after a TBI.

Ohio State TBI

Alcohol use and TBI are closely related. Up to two-thirds of people with TBI have a history of alcohol abuse or risky drinking. Between 30-50% of people with TBI were injured while they were drunk and about one-third were under the influence of other drugs. Around half of those who have a TBI cut down on their drinking or stop altogether after injury, but some people with TBI continue to drink heavily, which increases their risk of having negative outcomes.

After TBI, many people notice their brains are more sensitive to alcohol. Drinking increases your chances of getting injured again, makes cognitive (thinking) problems worse, and increases your chances of having emotional problems such as depression. In addition, drinking can reduce brain injury recovery. For these reasons, staying away from alcohol is strongly recommended to avoid further injury to the brain and to promote as much healing as possible.

Facts about TBI and alcohol

Alcohol and brain injury recovery

  • Recovery from brain injury continues for much longer than we used to think possible. Many people notice improvements for many years after injury.
  • Alcohol slows down or stops brain injury recovery.
  • Not drinking is one way to give the brain the best chance to heal.
  • People’s lives often continue to improve many years after brain injury. Not drinking will increase the chance of improvement.

Alcohol, brain injury and seizures

  • Traumatic brain injury puts survivors at risk for developing seizures (epilepsy).
  • Alcohol lowers the seizure threshold and may trigger seizures.
  • Not drinking can reduce the risk of developing seizures.

Alcohol and the risk of having another brain injury

  • After a brain injury, survivors are at higher risk (3 to 8 times higher) of having another brain injury.
  • Drinking alcohol puts survivors at an even higher risk of having a second brain injury. This may be because both brain injury and alcohol can affect coordination and balance.
  • Not drinking can reduce the risk of having another brain injury.

Alcohol and mental functioning

  • Alcohol and brain injury have similar negative effects on mental abilities like memory and thinking flexibility.
  • Alcohol magnifies some of the cognitive problems caused by brain injury.
  • Alcohol may affect brain injury survivors more than it did before their injury.
  • The negative mental effects of alcohol can last from days to weeks after drinking stops.
  • Not drinking is one way to keep your mental abilities at their best and stay sharp and focused.

Alcohol and mood

  • Depression is about 8 times more common in the first year after TBI than in the general population.
  • Alcohol is a “depressant” drug, and using alcohol can cause or worsen depression.
  • Alcohol can reduce the effectiveness of anti-depressant medications. People who are taking antidepressants should not drink alcohol.
  • One way to improve problems with sadness or depression after TBI is to stop or cut down on the use of alcohol.

Alcohol and sexuality

  • Lowered desire is the most common effect of TBI on sexuality.
  • Alcohol reduces testosterone production in males.
  • Alcohol reduces sexual performance (erection and ejaculation) in men.
  • Alcohol reduces sexual satisfaction in men and women.
  • Avoiding alcohol improves sexual ability and activity in men and women.

How much alcohol is “safe” after TBI?

After TBI the brain is more sensitive to alcohol. This means that even one or two drinks may not be safe, especially when you need to do things that require balance, coordination and quick reactions, such as walking on uneven surfaces, riding a bicycle or driving a car. The fact is, there is no safe level of alcohol use after TBI.

Alcohol and medications

Alcohol is especially dangerous after TBI if you are taking certain prescription medications. Alcohol can make some medicines less effective and can greatly increase the effects of others, potentially leading to overdose and death. Using alcohol along with anti-anxiety medications or pain medications can be highly dangerous because of the possible multiplying effect.

What about using other drugs?

Alcohol is a drug. Almost everything mentioned above about alcohol applies equally to other drugs. If your drug of choice is something other than alcohol-such as marijuana, cocaine, methamphetamine or prescription drugs, anti-anxiety medications (benzodiazepines such as Ativan, Valium, or Xanax), or pain medication (opioids like Percocet, Oxycodone or Oxycontin)-many of the same principles apply. In addition, use of illegal drugs or misuse of prescription drugs can lead to legal problems.

If you use multiple drugs like alcohol and marijuana, or alcohol and pain pills, there is a higher risk of addiction and overdose. Using alcohol and pain medications together, or alcohol and anti-anxiety medications, has killed many people. Contact your doctor if you are drinking and using prescription drugs.

What should you do?

The stakes are higher when people choose to use alcohol after having a TBI. Some people continue drinking after a TBI and don’t have any desire to change that behavior. Others know they probably should stop or reduce alcohol use, but don’t know how or have tried in the past and not been successful.

There are many ways to stop using alcohol or other drugs and many ways to reduce the potential for harm. The great majority of people who have stopped having alcohol problems did it on their own. They got no professional help or counseling and did not use Alcoholics Anonymous (AA). Don’t underestimate your ability to change if you want to.

There are many ways to change, cut down or stop drinking

The key ingredients to changing your drinking are: (1) find people who will support your efforts to change your drinking; (2) set a specific goal; (3) make clear how you will meet your goal; (4) identify situations or emotions that can trigger drinking, and figure out ways to cope with those triggers ahead of time; and (5) find ways to reward yourself for sticking to your plan and meeting your goals.

If you have questions or concerns about your drinking, there are many ways to get information or help:

  • Take a confidential on-line drinking assessment: http://www.alcoholscreening.org/.
  • Talk to your physician about your concerns, and ask about medications that can help you resist relapse or reduce cravings for alcohol, such as naltrexone (Revia).
  • Psychologists or other counselors in your brain injury rehabilitation program can help you get started on a treatment program that is right for you.
  • Alcoholics Anonymous (AA) has helped millions of people. There are meetings in most towns and cities (http://www.aa.org/).
  • Moderation Management (http://www.moderation.org/) and Smart Recovery (http://www.smartrecovery.org/) are alternatives to AA that do not use the 12-step model.
  • Substance Abuse and Mental Health Services Administration (SAMHSA) is a federal program that can help you find a treatment facility wherever you live (http://findtreatment.samhsa.gov/; 800-662-4357).
  • Private treatment: look in the Yellow Pages under substance abuse, chemical dependency counselor, or addiction treatment.

Reduce the harm from drinking

For those who don’t want to stop drinking, it is still possible to reduce some harm from drinking:

  • Eat food and drink water before you drink alcohol. This will help reduce the sharp spike in blood alcohol level that can cause nausea, vomiting, falls, blackouts and alcohol poisoning.
  • Plan your transportation so you don’t drink and drive: have a non-drinking designated driver; plan to spend the night where you are doing your drinking; or drink only at home.
  • To avoid dangerous peaks in blood alcohol concentrations, drink beer rather than hard liquor, or mix hard liquor with water instead of with sweet, carbonated beverages.
  • Sip your drinks slowly (no more than one per hour). Drinking too fast can make the pleasant feelings of alcohol go away.
  • Drinking in bars slows some people down because of the expense. However, be sure you do not drive after drinking.
  • Take vitamins B1 (thiamine), B12 and folate to reduce the chances of alcohol-related brain damage.
  • Keep your drinking to no more than two drinks per day. Or cut back on certain days of the week, such as weeknights.
  • Take a drinking “holiday” (days or weeks when you decide not to drink at all). This can remind you of some of the benefits of being sober.

How family members can help

No one can force another person to stop using alcohol or drugs, but you can have an influence. Attending Al Anon meetings can be a good source of support for a friend or family member of someone who abuses alcohol or drugs, and it can help promote change. Planning an “intervention” where family and friends confront the person may help.

A program called Community Reinforcement and Family Training (CRAFT) has been found to work best. CRAFT takes a more positive, motivational approach that helps loved ones make not drinking more rewarding for the person with the alcohol problem. Research has shown that alcoholics are more likely to go into treatment if their loved ones follow the CRAFT method. To learn about CRAFT, see the book Get Your Loved One Sober in the Resources section below, or find a counselor familiar with this approach.

Reference

Bombardier, C.H. & Turner, A. (2009). Alcohol and traumatic disability. In R. Frank & T. Elliott (Eds.), The Handbook of Rehabilitation Psychology, Second Edition (pp. 241-258). Washington, DC: American Psychological Association Press.

Resources

  • Brown, J., Corrigan, J., & Hammer, P. (2010). “Substance Abuse and TBI.” Brainline Webcast #4, Defense and Veterans Brain Injury Center. (http://www.brainline.org/webcasts/4-TBI_and_Substance_Abuse/index.html)
  • Corrigan, J., & Lamb-Hart, G. (2004). Alcohol, Other Drugs, and Brain Injury. Columbus, Ohio: Ohio Valley Center for Brain Injury Prevention and Rehabilitation, Ohio State University Dept. of Physical Medicine and Rehabilitation. (Available from the Brain Injury Association, http://www.biausa.org/LiteratureRetrieve.aspx?ID=43235. )
  • Meyers, R.J., & Wolfe, B.L. (2004). Get Your Loved One Sober: Alternatives to Nagging, Pleading, and Threatening. Center City, MN: Hazelden Publications.
  • Substance Abuse Resources and Disability Issues (SARDI); http://www.med.wright.edu/citar/sardi/index. html.

Disclaimer

This information is not meant to replace the advice from a medical professional. You should consult your health care provider regarding specific medical concerns or treatment.

Source

Our health information content is based on research evidence whenever available and represents the consensus of expert opinion of the TBI Model System directors.

Authorship

Alcohol Use After Traumatic Brain Injury was developed by Charles Bombardier, PhD, in collaboration with the University of Washington Model Systems Knowledge Translation Center.

https://msktc.org/tbi/factsheets/Alcohol-Use-After-Traumatic-Brain-Injury

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CBD become one of the most sought-after medicines on the market today. Not only is it able to treat a wide range of ailments ranging from cancer to arthritis, CBD is known to be effective without causing any obvious side effects. It can be used safely in the long-term without causing addiction and dependence.

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There are tons of ways to use CBD, and one of the most popular is to use CBD gummies. These products provide patients with a tasty and fun way to medicate themselves. In this article, we’re going to talk about the use of CBD gummies for helping to fight off anxiety and depression.

What is CBD?

CBD, also known as cannabidiol, is one of the main cannabinoids found in the cannabis and hemp plants. CBD is known to treat a number of illnesses, both mental and physical. Some of the things that CBD is most commonly used to treat include:

  • Arthritis and other inflammatory conditions
  • Anxiety, depression, and other mental health problems
  • Cancer
  • Various diseases of the intestinal tract like IBS and Crohn’s disease
  • Various forms of pain, both chronic and acute

These are just a few of the things that CBD can be useful for treating. CBD works by affecting the body’s endocannabinoid system, a system of neurotransmitters that affects a huge number of our bodily processes. We’ll touch on that later in the neurochemistry section.

CBD is attractive to a number of people because it presents a holistic alternative to a lot of pharmaceutical medications. Many people find that their pharmaceuticals may be effective for treating a problem on the surface, but the side effects often compete with the benefits and in the long-run the illness is rarely treated.

CBD gummies, on the other hand, can help people manage the symptoms of their illnesses without actually becoming dependent on a drug or overwhelmed by side effects. This provides a unique opportunity to actually heal the root of the problem.

CBD vs THC

Many people are hesitant to use CBD because they know that it comes from the same plant as THC. THC, or tetrahydrocannabinol, is another cannabinoid. This one is largely responsible for many of the psychoactive effects that a person can experience when smoking marijuana.

Marijuana is quite a powerful drug and it’s understandable that some people would want to ensure that they’re not going to get high when using CBD. Rest assured, CBD and THC have vastly different effects, and CBD is not psychoactive at all.

This is interesting because structurally, CBD and THC are almost identical. Their molecules have the same number and same type of atoms; they are simply arranged differently. This contributes to the vast differences in experiences when using these two compounds.

CBD Effects

The interesting thing about CBD is that it will not have many effects if you are not treating an actual problem. That is to say, CBD works by helping to restore balance and function to the endocannabinoid system (ECS), as mentioned earlier. If your endocannabinoid system is in perfect health, then taking CBD won’t do much for you.

Unfortunately, the reality is that most of us have at least some imbalance in our ECS. These imbalances can come from a number of things that we’re exposed to on a daily basis: pollution, stress, unhealthy food, etc.

For these people, CBD is known for providing a number of positive benefits:

  • Reduced inflammation, improving pain and swelling for people with problems like arthritis
  • Increased relaxation and ability to fall asleep
  • Reduced anxiety and depression
  • Improved sociability
  • Improved concentration
  • Improved digestion

All of these benefits can work together to help ward off various illnesses and diseases.

Does CBD Get You High?

CBD does not get you high. As mentioned earlier, the CBD molecule is nearly identical to the THC molecule. However, because of the arrangement of these molecules, the two compounds act entirely different inside the body.

THC directly affects the body whereas CBD indirectly affects the body. This is why THC is much more apparent when ingested than CBD.

CBD Gummies

CBD Products

There are a huge number of different products containing CBD available. The variety in products allows for patients to choose from a number of ways of consuming CBD. The different methods of taking CBD will provide differences in the effects and duration of the substance.

  • CBD oil and tinctures are among the most popular CBD products. These oils and tinctures are so popular that we have dedicated a section to them below.
  • CBD capsules. Capsules are great for oral use but they can also be broken apart and taken sublingually or under-the-tongue. Capsules tend to come on slower than the other methods of using CBD but they also last for a bit longer.
  • Smokeables and vape products are useful for people who have acute problems like pain or panic attacks. These products can be inhaled and the effects felt almost immediately, though they tend to wear off much quicker.
  • Topical products. There are a number of products made with CBD that can be applied directly to the skin. These products are great because the active ingredient can be absorbed into the skin and there won’t be any effects on a person’s mental or physical site except where they apply it.

CBD Oil

CBD oil is one of the most popular forms of using CBD. This is because the oil provides you with a concentrated form of the active extract that can be consumed in a number of ways

The most effective way to use CBD oil is to take it sublingually. This involves holding the oil under your tongue for about 5 minutes so the CBD can be absorbed into the blood vessels there. This causes it to hit you faster and you’ll end up using less of it this way, thus saving money.

CBD oil is also used in the making of a number of other CBD products, like edibles.

CBD Edibles

CBD edibles are one of the most popular ways to consume CBD. People have had great success using CBD oil to make snacks and treats filled with CBD that people can eat. Ranging from CBD gummies to CBD peanut butter, edibles are a great way to medicate yourself.

One of the best things about edibles is that they are more slowly metabolized than the other forms of CBD. This means that the active effects may come on a bit slower but they will linger for much longer.

CBD and Anxiety

One of the most popular uses for CBD gummies and other forms of CBD is for helping people manage anxiety.

Many people were baffled by the implications of this, particularly because THC is well-known for causing anxiety in many people. Folks were wondering how a cannabinoid – especially one so similar to THC – could be used for fighting anxiety.

We’ll discuss the reasoning a bit more in the neurochemistry section below. For now, the simple fact of the matter is that CBD helps to manage anxiety by relaxing the mind and body, as well as balancing out the endocannabinoid system.

CBD has been shown to be useful for fighting all sorts of anxiety, ranging from generalized anxiety to panic disorder. Many have found success using a vape pen to help them manage acute panic attacks. CBD has even been shown to help fight anxiety associated with serious conditions like post-traumatic stress disorder.

CBD and Depression

CBD has proven to be a very exciting alternative for helping people manage depression.

Many traditional antidepressants are known for causing a huge number of side effects. These drugs often take a long time to work – many people have to use them for up to three weeks before these drugs work – and they often have drastic effects on a person’s physical and mental health.

CBD might not be as potent as some of these antidepressants, but it targets the problem in a much more holistic manner. Instead of blunting your emotions or inhibiting your ability to feel depressed by overloading your brain with neurotransmitters, CBD helps you overcome acute symptoms of depression so you’re actually able to identify and heal the root of the problem.

CBD gummies and other forms of CBD are a great tool for helping some people get the treatment that they need to actually eliminate their depression. After this, they can stop using CBD. This is in stark contrast to traditional antidepressants which many people find themselves using for the rest of their lives.

Neurochemistry and CBD

We have touched on the subject of CBD and neurochemistry in this article, but only briefly. In this section we will give a bit more information about the way CBD affects our brain and nervous system.

As mentioned, CBD affects the ECS. This massive system of neurotransmitters and receptors is responsible for governing many facets of our brains and bodies. It helps to regulate our immune system, manage our digestion, regulate our mental health, and generally help to ensure that we function properly.

Unfortunately, many of us have an imbalance in the ECS. CBD works by helping to restore balance to this vast system by indirectly influencing it.

This is one of the reasons that CBD has such vastly different effects than THC. THC directly binds to what are known as cannabinoid receptors. By binding to these receptors, THC can have a direct, immediate, and profound effect on this entire system.

CBD, on the other hand, works indirectly. Not only does it not bind to the receptors, but it actually makes it more difficult for substances like THC to bind to them. Instead, CBD works ‘behind the scenes’ to have a positive and regulatory effect on certain neurotransmitters like dopamine, serotonin, and our own naturally produced cannabinoids.

CBD Dosage

The dosage that one requires when they are using CBD depends on their condition and how serious it is. Dosages vary greatly between people and since CBD hasn’t been approved by federal organizations there is no standard dosage.

However, there are certainly some standards that one could expect to use.

  • People with anxiety may need anywhere from 10 to 50 mg of CBD. 10 mg doses of capsules or oils can be useful for helping to treat mild-to-moderate social anxiety and general anxiety. Higher doses can stave off a panic attack in its tracks.
  • People with pain or inflammation often require slightly higher doses. 20 mg can be effective for mild-to-moderate inflammation, but doses of anywhere from 50-100 mg are quite common.
  • People with depression often take higher doses, beginning at around 50 mg. However, people with melancholy or mild depression caused by situations or events can find some improvement using around 20 mg.

Keep in mind the way that you consume your CBD also has an impact on how much you need. Consuming CBD gummies or tinctures orally causes some of the drug to be destroyed by the liver before it’s absorbed into the bloodstream. Taking it sublingually helps to prevent this and reduces the amount required by about 40 percent.

CBD Side Effects

The vast majority of people won’t experience any side effects from CBD. Aside from the fact that higher doses might make you sleepy and unfit to drive a motor vehicle, CBD won’t cause any serious side effects unless you are allergic to cannabinoids.

That said, some people are extremely sensitive to the compound. These people may experience symptoms like dry mouth, diarrhea, and nausea. However, this may indicate that the medicine was not prepared properly or was produced in a facility with low safety and health standards.

One thing to be noted is that people using THC for recreational purposes might find the effects diminished if they use CBD. However, people who are using THC for medicinal purposes often find that the benefits are enhanced when they are using CBD in addition to THC.

Hopefully, this article has helped you to better understand CBD and the powerful benefits that it can provide for you and those that you love. Good luck healing yourself with this fantastic medicine.

What is Depression?

Depression is a mental health disorder associated with significant morbidity and mortality, being a major risk factor for suicide, substance abuse, poor outcomes of medical conditions, and impaired functionality. It is characterized by flattening of mood, loss of emotional expression, and retardation of thought and movements. Individuals who have depression usually have a depressed mood, loss of interest in activities they were usually interested in, sleep disturbance, loss of energy, and reduced ability to thick or focus.

The American Psychiatric Association’s Diagnostic Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) categorizes depressive disorders into major depressive disorder, persistent depressive disorder, premenstrual dysphoric disorder, disruptive mood dysregulation disorder, and depressive disorder due to a medical condition. However, all these classes of depression are characterized by the presence of a sad or irritable mood with associated difficulty in thinking, concentrating, and carrying out normal physical tasks, impairing the individual’s daily functioning.

Stats about Depression

Between 2009 and 2012, approximately 7.6% of Americans aged 12 and above were diagnosed with depression and it was more common among females and persons aged 40 and 59. In 2015, about 16.1 million adults aged 18 and over had a minimum of one depressive episode in the previous year.

Depression has been found to occur in children at an incidence rate of 0.9% in preschool-aged children, 1.9% in school-aged children, and approximately 4.7% in adolescents. In prepubertal children, depression occurs in boys and girls at an equal rate. Generally, depression in men and women has the highest rates in those aged between 25 to 44 years and the incidence of severe depression increases with age.

What are the Traditional Treatments for Depression?

There is a wide range of treatments for depression which have proven effective in improving symptoms. A combination of medications and psychotherapy is effective in reducing the symptoms of depression, and therapy with either form alone is often ineffective. Combination therapy has been found to increase quality of life and improve treatment compliance in patients with depression.

Advanced treatment techniques used for the treatment of depression include electroconvulsive therapy which uses high-energy electric stimulation, and bright-light therapy involving exposure of an individual with depression to bright light at an intensity of 10,000 lux for a period of one hour in the morning.

Therapy for Depression

Psychotherapy is often combined with medications in the treatment of depression. There are different types of therapy for depression and these can be grouped based on their efficacies. A therapy is considered “efficacious and specific” if studies in at least two settings (hospital, home therapy, rehab center etc.) have proven it more effective than medications. A therapy is considered “efficacious” if it has been proven from at least two settings that it is superior to no treatment at all, and it is “possibly efficacious” if it has been proven effective in at least one study in a single setting.

Examples of efficacious and specific therapies include cognitive behavioral therapy, problem-solving therapy, and interpersonal therapy which help the individual modify their behaviors and interpersonal relationships. An example of an efficacious therapy includes mindfulness-based cognitive therapy to prevent a recurrence or relapse, and an example of possibly efficacious therapy is continuation cognitive therapy to prevent recurrence by helping the individual develop positive thinking and behavioral patterns.

Medications for Depression

Medications used for treating depression are of different classes, each with a different mechanism of action, characteristics, and side effects. Some of these drugs include Fluoxetine (Prozac), Citalopram, Amitriptyline, Imipramine, and Nortriptyline. These drugs generally increase the concentration of stimulant substances in the brain to improve the depressive symptoms.

Home Remedies for Depression

Patients with depression could benefit from a number of home remedies which could help to improve their symptoms, in addition to antidepressants and therapy:

  • St. John’s wort – This plant, although not approved for treatment of depression by the FDA, has been linked with increased amounts of serotonin in the body correlating to improvement of depressive symptoms.
  • Omega-3 fatty acids – Omega-3 fatty acids are commonly found in fish such as salmon, sardines, and trout, and this substance has been linked to improvement in depressive symptoms.
  • SAM-e – S-adenosylmethionine (SAM-e) is artificially designed to function like chemicals in the brain which elevate mood. It is considered a supplement useful in improving symptoms of depression.
  • Folate – Folic acid which is found in a number of foods such as beans, lentils, dark leafy greens, and fortified cereals have been found to improve the effectiveness of medications used in treating the disorder.

What is CBD?

Cannabidiol (CBD) is a naturally occurring chemical compound found in the hemp plant. It is one of the numerous unique compounds called cannabinoids which naturally occur in hemp. Generally, cannabinoids can be produced in the body (these are known as endocannabinoids) or found in the hemp plant as phytocannabinoids. CBD is industrially extracted from the cannabis plant and separated from the other cannabinoids, representing about 40% of cannabis extracts.

CBD is a phytocannabinoid which helps to stimulate the regulation of the central nervous system. CBD, therefore, helps supplement the effects of endocannabinoids in regulating appetite, mood, functions of the immune system, sensation, and keeping our bodies working normally. CBD oil is made from hemp plants and can be purchased legally in the United States. CBD is available in different forms such as tinctures, concentrates, capsules, sprays, tapes, and topicals.

CBD vs. THC

Most times, people interchange CBD for tetrahydrocannabinol (THC), another cannabinoid found in the hemp plant. Both of them represent the commonest compounds found in the plant. However, they have numerous differences.

THC, unlike CBD, is intoxicating causing a high and euphoria. It is responsible for the “high” felt by marijuana users. CBD, on the other hand, is not a psychoactive substance as it does not act via the same biological pathways in the body as THC.

CBD Oil Effects

Although, CBD oil has not been approved by the FDA for the treatment of any condition, there have been several studies demonstrating some of its health benefits:

  • CBD has been shown to have anti-oxidant properties which means that it is capable of mopping up toxic substances obtained from food or generated in the body. These substances are often at the center of inflammatory conditions such as myocardial infarction, inflammatory bowel disease, and stroke.
  • Oxidative stress caused by the release of these toxic substances causes age-related diseases such as Alzheimer’s disease and Parkinson’s disease and CBD has been found to protect against these degenerative diseases of the brain and reduce their clinical progression in patients suffering from them. CBD may also help in the clinical improvement of some autoimmune disease such as lupus and rheumatoid arthritis.
  • Clinical trials have shown that CBD oils are effective in the treatment of epilepsy and other seizure disorders.
  • Studies have shown that CBD may have therapeutic benefits for brain disorders such as psychosis, depression, and multiple sclerosis.
  • Other benefits of CBD are currently being investigated, including its effects on anxiety and depression, as well as on social anxiety disorder and post-traumatic stress disorder.

Does CBD Get You High?

CBD is a non-psychoactive form of cannabinoid which has been found not to interfere with the cognitive functions of the brain. It does not get you “high,” in contrast to THC, which alters the cognitive functions of the brain.

Is CBD Addictive?

According to a recent report by the World Health Organization (WHO), CBD is not addictive and it has no potential for abuse or dependence. This is mainly because CBD does not contain any addictive substances, in contrast to THC and some cannabinoids which contain such and are, therefore, capable of being addictive.

Is CBD Safe?

There have been extensive reviews on the toxic potentials of CBD and reports have revealed that CBD has a relatively low toxicity. It has been found to be safe with little potential for adverse effects. CBD was found to have no effect on fetal development and other bodily functions. Generally, CBD does not produce the adverse effects seen with THC and other psychoactive cannabinoids. However, reports demonstrate that some reactions may occur as a result of its interactions with other drugs co-administered with it.

How Could CBD Help with Depression?

CBD has been found to be effective in the treatment of depression. While CBD does not cure the condition, it has been linked to improvement of the symptoms.

The cannabinoids produced in our bodies (endocannabinoids) help to regulate several functions of the body such as mood, pain sensation, sleep, and appetite. These substances exert their actions by binding to specific points of brain cells called the receptors through which they potentiate the actions of a substance called serotonin which acts to improve mood and reduce stress levels. Serotonin also acts by binding to its receptors in brain cells. When these chemical substances bind to their respective receptors, they trigger a series of events within each brain cell stimulating processes that improve mood and stress control.

CBD has been found to help improve depressive symptoms by modulating the actions of the endocannabinoids and also potentiating the effects of serotonin by enhancing the activity of the receptors unto which serotonin binds.

CBD oil helps to significantly improve depressive symptoms and the individual’s quality of life.

CBD Oil Dosage

CBD oil is available in several forms including tinctures, capsules, concentrates, and topical forms. However, it is most commonly administered orally. It is important to note that CBD is most effective when used regularly in maintenance doses, though it may be used for treating acute flare-ups.

In the management of depression, CBD oil may be taken in the tincture and capsule forms. Individuals with depression can begin with a dose of 5 to 10mg daily until the desired results are achieved. Gel capsules of CBD are available as 25mg per pill and it is safe to begin at this dosage as CBD has a good safety profile. The effects of CBD lasts several hours after a dose is ingested and most persons report feeling better for up to 24 hours. However, you will only begin to notice these improvements after 90 minutes of ingestion of CBD oil.

For managing acute flare-ups, it is best to vaporize CBD isolate for fast relief of symptoms. However, the maintenance dose should not be discontinued. Although you may also use the ingestible forms of CBD in treating acute flare-ups, these, generally, have a relatively longer onset of action.

Generally, it is recommended that you consult with your physician before starting CBD oils to prevent drug interactions and exacerbations of any medical conditions you may have. Do not, also, discontinue or start any drug while using CBD without consulting your physician.

For information on where to obtain CBD Oil, go here.

CBD Oil Side Effects

CBD oil is generally safe to use with minimal risk of adverse effects. Side effects may be seen when high doses are taken. Some studies have revealed that if taken at high doses, it may cause a weakening of your immune system. However, the main concern with the use of CBD is the risk of drug interactions, therefore, it is recommended that you consult your physician before using CBD oil.

Bottom Line: Can CBD Help You?

CBD is one of the naturally occurring chemical substances found in the cannabis plant and though the stigma associated with the psychoactive counterpart, THC, has rubbed off on it, it has been shown to have immense health benefits in treating conditions such as anxiety, depression, mood disorders, and inflammatory diseases. CBD oil helps to significantly improve depressive symptoms and the individual’s quality of life. However, it should be noted that CBD does not provide a cure for the disorder, but leads to a better quality of life for the patient.

Resources

https://emedicine.medscape.com/article/286759-overview#a4

https://www.webmd.com/depression/features/natural-treatments#1

https://www.healthline.com/health/depression/herbs-supplements

https://ministryofhemp.com/wp-content/uploads/2016/10/The-Complete-CBD-Resource.pdf

https://www.royalqueenseeds.com/blog-new-who-report-shows-cbd-is-not-addictive-nor-dangerous-n771

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3648779/

https://keytocannabis.com/blogs/cannabis/cbd-for-depression

https://www.ncbi.nlm.nih.gov/pubmed/24923339

https://www.ncbi.nlm.nih.gov/pubmed/22729452

https://www.ncbi.nlm.nih.gov/pubmed/20002102