Cannabidiol products are touted for healing everything from anxiety to pain. But can they help with hallucinations and delusions, too?
by Amy Marturana Winderl Health Writer
Cannabidiol, more commonly known as CBD, has been praised in recent years for being something close to a miracle elixir. Got a headache? Check. Feeling anxious or stressed out? Yep, CBD has been reported to be good for that, too. Cancer symptoms, seizures, and even acne may be relieved with this natural remedy, some scientists say. And, while studies are small and inconclusive at this point, research does suggest that CBD may also help treat the 5 million people in the U.S. who are diagnosed with dementia, as well as the psychosis and agitation that so often accompany this degenerative condition.
Sound far-fetched? It may not be: CBD oil is now being studied for its neuroprotective properties that may aid in disorders likes Alzheimer’s disease and Parkinson’s disease, both of which are leading causes of dementia. Now consider that 90% of dementia patients experience behavioral and psychological symptoms (BPSD), including disturbed perception and mood, according to research. Yet despite the prevalence of such upsetting symptoms—which can include sensory hallucinations and delusionary thinking—traditionally there has been no good way to treat BPSD.
Ashwin Kotwal, M.D., assistant professor of medicine in the Division of Geriatrics at the University of California, San Francisco School of Medicine, says that doctors will sometimes prescribe off-label antipsychotics, which block certain pathways in the brain to slow it down, reducing psychosis. (There is one antipsychotic drug to specifically treat dementia-related psychosis that is waiting for FDA approval, but it’s not yet available, and not all doctors are convinced of its effectiveness.)
The problem is that you can’t pick and choose which parts of the brain antipsychotics impact. “You’re basically slowing everything down, so all the good things are being slowed down, too,” Dr. Kotwal says. Because of this, antipsychotics can cause a whole host of undesirable side effects, including blunted emotional responses, sedation, drowsiness, and confusion. Ultimately, it can impact “people’s abilities to engage meaningfully in their lives,” he adds. Antipsychotics have also been shown to increase mortality in dementia patients.
None of this news to the families of dementia patients. And, as they witness an ailing spouse or parent talking to people who aren’t really there, lashing out in unfounded anger, struggling with confusion, or falsely believing family members are out to harm them, they want help, fast. Which is the reason why some people are looking to alternative treatments like CBD.
Does CBD Have Potential as an Alternative Treatment?
CBD, a compound found in the cannabis plant, theoretically works by interacting with the endocannabinoid system, a system in the human body that regulates cognition, pain sensation, appetite, memory, sleep, immune function, and mood. Research suggests that the endocannabinoid system also plays a role in psychosis. So, if a compound can alter the signals sent by the endocannabinoid system, maybe it can alter the course of psychosis. That’s the theory, at least.
Blake Pearson, M.D., a primary care physician and cannabinoid-based medicine expert in Sarnia Ontario, Canada, who specializes in treating the elderly and palliative-care patients, says that CBD is often too mild for dementia patients with really aggressive behaviors. “Usually, you need a mix of CBD and THC.” THC, or delta-9-tetrahydrocannabinol, is another compound in cannabis that’s known for producing a high. Both CBD and THC are types of cannabinoids. Medical cannabis experts suggest using a combination of CBD and THC to reap any medical benefits. (The problem is that products that contain THC are not as widely available and are still federally illegal in the U.S.)
“These are emerging as a potential option because they are so well-tolerated—you don’t have nearly the side effects that you would with an antipsychotic,” Dr. Pearson says. The thing that most experts are concerned about is how cannabinoids might interact with other drugs, based on what we know about how our bodies metabolize the chemical compounds. There’s an extensive list of possible drug-drug interactions, which includes medications used to treat everything from seizures to asthma to gastroesophageal reflux disease (GERD).
Like all things related to cannabinoid medicine, there isn’t a whole lot of research, but small studies are promising, he says. And anecdotally, he treats hundreds of patients for this exact problem, and sees so many of them benefitting. “We improve behaviors like agitation and calling out, they sleep better, and often we’re able to either reduce or completely take people off antipsychotics,” Dr. Pearson says.
When Karen Van Dyke learned about the potential for CBD to help with dementia-related psychosis, she talked with a doctor about how it might help her aunt. Her dementia had progressed, and she was increasingly anxious and experiencing sundowners, a word used to describe the agitation, confusion, and aggression that can hit people with dementia in the afternoon and evening. Van Dyke didn’t want to put her on medication that would have certain side effects—“what was most important to her was her dignity,” she says.
She knew cannabinoids might be a solution, but didn’t know many details. So, she brought her aunt to see a nurse who specializes in cannabis medicine. Soon, her relative was taking a tincture with a combination of CBD and THC every morning and another every evening.
“I was an absolute convert when I saw what it did for Auntie,” Van Dyke says. Her confusion subsided substantially—she no longer frantically asked for her purse, or for her husband who had passed 30 years prior, and was able to calmly hold a conversation. Her aunt was 102 when she started taking the tinctures and lived for just a few more years, but Van Dyke says she would have started her on it much sooner if she knew how well it would work. The only side effect she noticed was that her aunt seemed to be sleeping a little more than normal, so her nurse suggested reducing the dosage a bit. Which did the trick.
Van Dyke, who calls herself a “warrior princess for the elders,” uses her experience to run her company, which helps elderly people and their families find the best senior care housing options for them. After seeing how cannabinoids helped her aunt, she now tells all of her clients to ask their doctors about them as a treatment option. She says there may be barriers if your loved one is in a large care facility, but some smaller homes may be OK with it. Her aunt was living at home, so it made things easier.
What Are the First Steps to Take?
It’s important to remember that cannabinoids are chemical substances, and should be treated like any other medication you take. “A physician should be involved. We don’t really want loved ones trying to manage that stuff on their own,” Dr. Pearson says. Drug interactions can be really serious, and patients with dementia tend to be on multiple medications. It’s imperative to make sure a doctor is involved in any decisions about medications, even if it’s not something you’re buying at a pharmacy.
The tricky thing is that there are not a lot of physicians out there who feel comfortable recommending and overseeing cannabinoid medicine—especially for patients with dementia. “There are a lot of medical cannabis doctors in the U.S., but not a lot who are using it in dementia patients, so it is kind of specialized,” Dr. Pearson says. Being board-certified in the U.S. as well as Canada, he often does virtual consultations with people stateside and gives advice on what to buy at a dispensary and how to take it.
If a caregiver is looking for options to treat dementia with psychosis, the first step is to speak with their physician and ask about using cannabinoids, Dr. Pearson says. It may fall on deaf ears. If your doctor isn’t comfortable recommending a doctor who can work with you on this, you can search for doctors on the Society of Cannabis Clinicians website. You can also check if your state has a list of medical cannabis doctors (this will vary depending on the laws in your state).