Evaluation of the efficacy, safety, and pharmacokinetics of nanodispersible cannabidiol oral solution (150 mg/mL) versus placebo in mild to moderate anxiety subjects: A double blind multicenter randomized clinical trial

The differential effects of medicinal cannabis on mental health: A systematic review

The use of medicinal cannabis to improve mental health is increasing globally, both in clinical settings and through self-medication. This involves a variety of products containing ∆9-tetrahydrocannabinol (THC), cannabidiol (CBD), THC + CBD combinations, or derivatives. This review provides an up-to-date overview of the positive and negative effects of medicinal cannabis on mental health diagnoses and related symptoms of the Diagnostic and Statistical Manual of Mental Disorders 5th Edition. Searches in PubMed, PsycInfo, Embase, and the Cochrane Library (October 2023 and July 2024) identified 18,341 studies, of which 49 controlled studies from 15 different countries were included. All studies focused on treatment-seeking participants using medicinal cannabis for (symptoms of) their mental health diagnosis. Included diagnoses were anxiety disorders, tic disorders, autism spectrum disorder, attention-deficit hyperactivity disorder, obsessive-compulsive disorders, anorexia nervosa, schizophrenia, psychosis, substance use disorders, insomnia, and bipolar disorders. Varying product compositions showed different effects. Most consistently, high doses of CBD were followed by some acute relief in anxiety, while CBD + THC combinations alleviated withdrawal in cannabis use disorder and improved sleep. In clinical trials, THC was associated most with dose-dependent adverse events and, in some cases, deterioration of primary study outcomes, e.g., in psychosis. In naturalistic studies, participants who used THC reported symptom improvement following usage. Risks of bias across studies were prevalent, and no study found long-lasting medicinal effects or improvement. Overall, medicinal cannabis may provide short-term relief for certain symptoms but is not a cure or without mental health risks.

Unravelling a potential therapeutic effect of polymeric lipid-core nanoencapsulated cannabidiol on anxiety- and panic-like behaviours elicited by Bothrops jararaca lancehead pit vipers

The burgeoning interest in cannabinoid-based therapies for mental disorders motivates research into their efficacy. This study investigates the acute effects of nanoencapsulated Cannabidiol (CBD) on panic attack-like defensive responses elicited in mice by the venomous snake Bothrops jararaca in polygonal arenas validated as a panic attack experimental model. The aim of this work was to investigate if polymeric lipid core-nanoencapsulated CBD at low doses was able to cause antiaversive effects in comparison to non-encapsulated CBD at a higher dose. Mice were habituated in the enriched polygonal arena during three days and treated with either CBD in a dose already demonstrated to cause antiaversive effects (3 mg/kg), used as a positive control, or nanostructured CBD at much lower doses before snake confrontation. Both non-encapsulated and nanoencapsulated CBD significantly attenuated antipredatory responses in mice. Interestingly. Polymeric lipid core-nanoencapsulated CBD, particularly at lower doses, attenuated panic-like responses, including defensive attention, flat back approach, and escape behaviours to safe places after reaching limbic system structures. Additionally, rhodamine-labeled polymeric lipid core-nanoencapsulated CBD, administered either intraperitoneally or intranasally, effectively crossed the blood-brain barrier, with fluorescence observed in multiple limbic and paralimbic brain structures implicated in the elaboration of defensive/antipredatory behavioural responses. These findings indicate that nanoencapsulation improves the bioavailability of CBD and its targeting of the central nervous system, thereby supporting its potential for low-dose therapeutic applications in the treatment of anxiety and panic disorders.

New Agents in the Treatment of Psychiatric Disorders: What Innovations and in What Areas of Psychopathology?

Psychiatric disorders are a major cause of illness in the world. Unfortunately, many patients are resistant to treatment and present serious complications. Schizophrenia is refractory to treatment in about one-third of patients. Antidepressants are effective in about half of patients. Suicidal ideation is an increasing issue in patients with mixed features in bipolar disorder (BD). Therefore, there is a need to develop and test new drugs or new indications of available medications for the treatment of psychiatric disorders through evidence-based investigations. This narrative review aims to present the molecules approved by the main drug agencies, the Food and Drug Administration (FDA) and the European Medicines Agency (EMA), from 2018 to date, along with new indications and new formulations of existing medications. We searched PubMed for new drugs approved for schizophrenia, BD, major depressive disorder (MDD), anxiety disorders, and obsessive-compulsive disorder (OCD). We evaluated their clinical benefits, safety, and tolerability profiles. Finally, we considered studies on the main molecules that have shown initial evidence of efficacy and are in the process of obtaining approval. Our search suggested that a new antipsychotic, lumateperone, and two drug combinations, olanzapine/samidorphan (OLZ/SAM) and xanomeline/trospium (KarXT), were approved for schizophrenia. In addition, some new methods of administration-monthly risperidone administration, subcutaneous risperidone administration, and transdermal asenapine administration-obtained approval from the main drug agencies. Lumateperone and OLZ/SAM were also approved in BD. Esketamine, a compound that modulates glutamatergic transmission, was approved to treat treatment-resistant depression and acute suicidal ideation. The dextromethorphan/bupropion combination was approved for MDD. Two new agents, brexanolone and zuranolone, were approved for treatment of postpartum depression. On the other hand, no new drugs received approval for anxiety disorders or OCD. In summary, some new psychotropic medications have been developed, in particular with the aim to improve the symptoms of resistant patients and to decrease the incidence of adverse effects. It is necessary to continue testing the effectiveness of new compounds in methodologically rigorous studies.

Anxiety disorders, PTSD and OCD: systematic review of approved psychiatric medications (2008-2024) and pipeline phase III medications

Objective

This systematic review examines psychiatric medications approved by the FDA for anxiety disorders, post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD) from 2008 to 2024 and describes the mechanism of action, indications for both labelled and off-label uses, evidence for efficacy, dosing and adverse effects for each medication.

Methods

The methodology involved a literature search of the PubMed database for studies published from 1 January 2008 to 31 December 2024 on FDA-approved psychiatric medications and phase III pipeline medications, using the keywords: "anxiety" OR "PTSD" OR "OCD" AND "psychopharm*" OR "medic*" OR "pharm*". The authors conducted independent assessments of the resulting articles and reached a consensus on eligible studies to include in this systematic review.

Results

Our review revealed that, in the past 16 years, the FDA approved only two medications for anxiety disorders (a delayed-release form of duloxetine for generalized anxiety disorder and an extended-release form of lorazepam) and none for PTSD or OCD. We also identified 14 pipeline medications for anxiety disorders, eight for PTSD and one for OCD, all of which are currently in phase III clinical trials.

Conclusion

Our results showed a paucity of new medications for anxiety disorders and none for PTSD and OCD in the past 16 years. However, phase III psychiatric medications for anxiety disorders, PTSD and OCD seem to show several agents with novel mechanisms of action, various modes of administration, and improved side-effect profiles.

Cannabidiol Ameliorates Doxorubicin-Induced Myocardial Injury via Activating Hippo Pathway

Background

Doxorubicin (DOX) is a chemotherapeutic agent widely used for cancer treatment and has non-negligible cardiotoxicity. Some previous studies have reported that cannabidiol (CBD) has cardioprotective effects. In this study, we evaluated the protective effects of CBD against DOX-induced cardiomyocyte injury, and explored the downstream molecular mechanism.

Methods and Materials

GSE193861, containing healthy myocardial tissues and myocardial tissues with DOX-induced injury, was analyzed to screen for the involved proteins and pathways. Molecular docking was performed to identify candidate drugs. After H9c2 cells were treated with DOX and CBD, their viability, oxidative stress, and apoptosis were assessed. After YAP depletion, the role of the Hippo pathway in CBD function was investigated. C57BL/6 mice were treated with DOX to establish an in vivo model, and CBD and verteporfin (VP) were used to treat the mice. Histological analyses and immunofluorescence were used to evaluate myocardial tissue injury, and apoptosis and oxidative stress of the myocardial tissues were also analyzed. Western blotting was used to investigate the regulatory effects of CBD on the Hippo and apoptosis-related pathways.

Results

Bioinformatic analysis suggested that the Hippo pathway was a crucial pathway involved in DOX-induced myocardial injury. Molecular docking showed that CBD targeted multiple regulators of the Hippo pathway. CBD showed cardioprotective effects against DOX-induced myocardial injury both in vitro and in vivo and regulated Hippo pathway activity in cardiomyocytes. After inactivation of the Hippo pathway by YAP knockdown or VP intervention, the protective effects of CBD were reversed.

Conclusion

For the first time, we revealed that CBD is likely to reduce DOX-induced myocardial injury by regulating the Hippo signaling pathway.

Effects of a cannabidiol/terpene formulation on sleep in individuals with insomnia: a double-blind, placebo-controlled, randomized, crossover study

STUDY OBJECTIVES

Cannabidiol (CBD) is increasingly used as a health supplement, though few clinical studies have demonstrated benefits. The primary objective of this study was to evaluate the effects of an oral CBD-terpene formulation on sleep physiology in individuals with insomnia.

METHODS

In this double-blind, placebo-controlled, randomized clinical trial, 125 individuals with insomnia received an oral administration of CBD (300 mg) and terpenes (1 mg each of linalool, myrcene, phytol, limonene, α-terpinene, α-terpineol, α-pinene, and β-caryophyllene) for ≥ 4 days/wk over 4 weeks using a crossover design. The study medication was devoid of Δ9-tetrahydrocannabinol. The primary outcome measure was the percentage of time participants spent in the combination of slow-wave sleep (SWS) and rapid eye movement (REM) sleep stages, as measured by a wrist-worn sleep-tracking device.

RESULTS

This CBD-terpene regimen marginally increased the mean nightly percentage of time participants spent in SWS + REM sleep compared to the placebo (mean [standard error], 1.3% [0.60%]; 95% confidence interval, 0.1-2.5%; P = .03). More robust increases were observed in participants with low baseline SWS + REM sleep, as well as in day sleepers. For select participants, the increase in SWS + REM sleep averaged as much as 48 minutes/night over a 4-week treatment period. This treatment had no effect on total sleep time, resting heart rate, or heart rate variability, and no adverse events were reported.

CONCLUSIONS

Select CBD-terpene ratios may increase SWS + REM sleep in some individuals with insomnia and may have the potential to provide a safe and efficacious alternative to over-the-counter sleep aids and commonly prescribed sleep medications.

CLINICAL TRIAL REGISTRATION

Registry: ClinicalTrials.gov; Name: Evaluation of an Oral Cannabidiol (CBD)-Terpene Formulation on Sleep Physiology in Participants With Insomnia; URL: https://clinicaltrials.gov/study/NCT05233761; Identifier: NCT05233761.

CITATION

Wang M, Faust M, Abbott S, et al. Effects of a cannabidiol/terpene formulation on sleep in individuals with insomnia: a double-blind, placebo-controlled, randomized, crossover study. J Clin Sleep Med. 2025;21(1):69-80.

Postmarketing Surveillance of Full Spectrum Hemp Extract CBD Products: Reported Adverse Events and Serious Adverse Events

BACKGROUND

There is a growing interest in products featuring hemp extracts and a demand for more data regarding their safety. To date, there is a paucity of published data on the safety of these products.

METHODS

A retrospective analysis of postmarketing surveillance data collected in the United States on full spectrum hemp extract (FSHE) products manufactured by Charlotte's Web (CW) was conducted over an 18-month period (January 2019 to July 2020). The frequency of adverse events (AEs) and serious adverse events (SAEs) was assessed by analyzing AE reports against the estimated number of consumers who purchased products and the total number of products sold.

RESULTS

During the 18-month period, approximately 646,391 consumers purchased 1,939,172 products and 431 AEs were reported by 304 individuals. The estimated percentage of consumers who reported at least one adverse event was 0.05%. The percentage of AEs per products sold was 0.02%. Most AEs (98.14%) reported were Grade 1 (i.e., asymptomatic or causing mild symptoms), as classified by the Common Terminology Criteria for Adverse Events. Seven AEs were classified as serious, and the percentage of SAEs per products sold was 0.0004%. None of the reported SAEs were classified as a Grade 4 or Grade 5 (i.e., life threatening or fatal).

CONCLUSIONS

Approximately 0.05% of consumers who purchased the CW FSHE products from January 2019 to July 2020 reported an adverse event. The percentage of AEs and SAEs per products sold was 0.02% and 0.0004%, respectively. These data demonstrate that CW FSHE products appear to be well tolerated at recommended doses.