CBD could help with anxiety, depression and emotional exhaustion affecting frontline healthcare professionals – shows a new study published in the Journal of the American Medical Association. However, it is necessary to balance the benefits with potential side effects, the scientists point out.
A randomized clinical trial of 120 frontline health care professionals, the first to look into therapeutic benefits of CBD for burnout syndrome, shows that CBD reduces emotional exhaustion among participants receiving CBD along with standard care compared with those receiving standard care only. Yet, two participants in this study who received CBD besides standard care experienced serious side effects.
As a result of oral CBD administration, the CBD group experienced significant relief in depression symptoms, followed by even greater relief in anxiety symptoms, and the emotional exhaustion was more than halved comparing to the control group.
The research lead by famous Dr. José Alexandre de Souza Crippa from the University of São Paulo took place at the Ribeirão Preto Medical School University Hospital in São Paulo between June 12 and November 12, 2020. The 214 physicians, nurses, and physical therapists working with COVID-19 patients were recruited and assessed for eligibility. After the assessment, 120 participants were randomized in a 1:1 ratio. The assessed were represented by 50 physicians, 65 nurses, and three physical therapists, divided into two groups – the one administrated with CBD and the control group.
In the group administrated with CBD, there were 13 (22.0%) participants suffering from physical illness, 16 (27.1%) on current clinical medication, and nine (15.3%) on current psychiatric medication.
All the selected participants were held to be healthy male and female adults (aged 24-60 years), and those who were currently using any medication that may have had potential interactions with CBD, had a history of adverse or undesirable reactions to cannabidiol or other cannabinoids, belonged to a COVID-19 risk group (eg, had diabetes, hypertension, lung disease, hematological disease, chronic kidney disease, and/or immunosuppression), or were pregnant (including male participants who had a pregnant partner) were excluded.
Two cases of serious side effects
As the authors of the study report, a total of four participants (3.4%) discontinued intervention; three of those were in the CBD treatment group (one experienced severe pharmacodermia, one had a critical elevation of liver enzymes, and one withdrew to participate in the clinical trial of a COVID-19 vaccine). One of the participants that discontinued the intervention was in the control group (did not adhere to completion of assessments). The case of severe pharmacodermia was confirmed by serological tests (excluding COVID-19 and other infections), biopsy, and a test based on the CBD formulation.
In the CBD treatment group, there were four cases of elevated liver enzymes (one critical and three milds, with the mild elevations reported at the final 28-day assessment) and one case of severe pharmacodermia (dermatitis medicamentosa). In two of those cases (one with a critical elevation of liver enzymes and one with severe pharmacodermia), CBD therapy was discontinued. During the follow-up, both participants in the treatment group who discontinued CBD therapy because of serious adverse events experienced a full recovery.
However, when one compares the adverse events recorded in both groups in that interval of time, it’s remarkable that the CBD group had lower numbers in all the other adverse events (22) except for the sore throat.
The study dosage: 300 mg of CBD a day for 28 days
The participants received 300 mg of cannabidiol (150 mg twice per day) plus standard care or standard care alone for 28 days.
According to our past research, this dose wouldn’t be considered high dosage if consumed as a single dose for healthy volunteers but represent a fairly hard dose when used on daily basis, proportional with the one used for, e.g. epilepsy.
Possible CBD liver toxicity was previously established in a study in which the participants were administrated with 1500 mg of CBD per day for 3,5 weeks. The recommended dose for a healthy adult is 70 mg per day. After those findings, an industry-sponsored study on 839 participants found no evidence of liver toxicity, although 70% of study participants reported taking medication for different illnesses.
99.6% CBD in MCT oil (150 mg/mL)
Oral CBD used in this study was of 99.6% purity dissolved in medium-chain triglyceride (MCT) oil (150 mg/mL). MCT oil is found to be accelerating the efficiency of CBD, and pet studies have found that MCT oil causes side effects in dogs.
As we wrote in one of our past articles, the highest CBD concentrations don’t always bring the best results. With everyone’s best interest at heart, Ilesol Pharmaceuticals would strongly advise lowering the CBD concentration for most of the consumers in favor of higher efficiency of the product.
Standard care for the control group consisted of motivational and instructional videos on low-impact physical exercise plus weekly consultations with psychiatrists who offered psychological support. Also, hospital executives were active in maintaining a safe and supportive working environment, repeatedly offering personal protective equipment, modifications to work schedules, and ongoing testing. Hiring new personnel and providing a specific outpatient treatment unit was also in practice.
Therapy for PTSD and burnout is not supported by the findings
Apart from the efficacy and safety of daily CBD administration on top of standard care compared to usual care alone for four weeks in reducing or preventing emotional exhaustion and burnout symptoms, symptom levels of anxiety, depression, and PTSD as secondary outcomes were also observed. However, there was not enough evidence in this study in support of the CBD treatment for PTSD, except a conclusion that it prevented the development of new cases of PTSD in the CBD group. Also, even though this was the first study to examine CBD effects on burnout syndrome, there was not enough evidence to suggest this protocol would be an appropriate therapy for such cases. Symptoms of burnout syndrome did decrease to a certain extent. At the beginning of the study, there were 24 participants with burnout symptoms, and after four weeks, there were 17. However, the difference between 40. 7% at the baseline and 28.8% after four weeks of the trial is found to be statistically insignificant.
However, it is evident that the standard care group started with over 30% of the participants experiencing burnout symptoms and finished the trial at almost 40% with burnout symptoms; while CBD along standard care group started the trial with over 40% of participants experiencing burnout symptoms and finished the trial with less than 30% of the participants with burnout symptoms.
Future double-blind placebo-controlled clinical trials are needed to assess whether the conclusions drawn from the present study can be more broadly applied.