Psychiatry and Clinical Psychopharmacology 2021;XX(XX)

REVIEW ARTICLE
DOI:10.5152/PCP.2021.0027

The Use of Cannabidiol in Treating Psychiatric Disorders:

A Systematic Review
Alexandru N Pavel1,2 , Radu Paun2 , Valentin P Matei1,2

1
Departmentof Psychiatry, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania; 2Departmentof Psychiatry,
Alexandru Obregia” Psychiatric Hospital, Bucharest, Romania

ABSTRACT
Cannabidiol (CBD) has been used as a pharmacological treatment for psychiatric disorders in many ARTICLE HISTORY
studies, but few of good quality at the moment. Our objective was to assess the effect of CBD in Received: XX XX XXXX
mono/add-on therapy on symptom severity in psychiatric disorders. We performed a systematic Accepted: 30 April, 2021
review of clinical trials and randomized controlled trials that used CBD as treatment for psychiatric
disorders. PRISMA criteria have been used for methodological purposes. Two assessors individually
examined the results based on title and abstract, and decided which papers warranted full read. We KEYWORDS: Anxiety,
included studies in English that measured disease severity as primary outcome. Out of 226 studies cannabidiol, CBD,
returned from the search, 9 warranted full read. There were 4 studies using CBD in schizophrenia, schizophrenia, substance use
3 studies of substance use disorder and 2 studies of social anxiety. CBD has a good safety profile
even in higher doses, but results are inconclusive regarding improvements in disease severity.

INTRODUCTION

Cannabidiol (CBD), a cannabis derivative with low lipase (MAGL), comprise the ECS.13 CBD is one of the many
psychoactive activity, was revealed in 19401 and its cannabinoids isolated from Cannabis sativa.14 Unlike its
structure fully explained in 1963,2 yet its mechanisms of other major component, delta-9-tetrahydrocannabinol
action are still not fully understood. Since the isolation (THC), it does not cause psychotomimetic effects.15 What
of Δ9-tetrahydrocannabinol (THC) as the main compound is more, preclinical studies have proven that CBD may
of cannabis in 1964,3 no further advances were made for present antipsychotic proprieties,16 currently believed to
24 years until the first cannabinoid receptor (CB1) was be through FAAH inhibition.17
discovered.4 Besides the 2 cannabinoid receptors (CB1 and CB2), there
The role of the endocannabinoid system (ECS) in the is the highly intricate endogenous cannabinoid system
human brain is to influence synaptic communication in the human brain which contains other receptors such
between neurons and also to control other processes such as GPR55, GPR18 and GPR119, TRPA, TRPM, TRPC, and
as eating, anxiety, learning and memory, reproduction, PPAR.18 These receptors decrease intracellular levels
metabolism, growth, and development.5 The ECS is known of calcium ions, either indirectly through coupling
to regulate physiological appetite and energy metabolism, with G-proteins or directly through ionic channels. The
by increasing food intake through agonistic effects6 while endpoint of this cascade is the inhibition of release of
affecting appetitive and consummatory aspects.7-9 The neurotransmitters, such as GABA and glutamate. Besides
ECS also has a role in weight gain, independent from its these effects, it has been shown in preclinical studies
effect on appetite,10 by inducing lipogenesis and increasing that it may exhibit neuroprotective effects by inhibiting
insulin resistance. One of the other roles of the ECS is to nitric oxide (NO) production, increasing brain-derived
reduce both neuropathic and inflammatory pain.11,12 neurotrophic factor, and reducing zinc mobilization.20-22
The 2 receptors, the cannabinoid receptor 1 (CB1R) and The ECS has a neuroprotective effect in case of neuronal
cannabinoid receptor 2 (CB2R), together with their primary injury, both in acute (e.g., stroke) and chronic (e.g.,
ligands, anandamide (AEA) and 2-arachidonoylglycerol Alzheimer’s disease) conditions.23 The mechanism behind
(2-AG), and the primary catabolic enzymes for these ligands, this effect is still under debate. It is speculated that the
fatty acid amide hydrolase (FAAH) and monoacylglycerol deposition of beta-amyloid could induce the release of

Corresponding author: Valentin P Matei, e-mail: [email protected]

Cite this article as: N Pavel A, Paun R, P Matei V. The use of cannabidiol in treating psychiatric disorders: A systematic review. Psychiatr
Clin Psychopharmacol. 2021; XX: 1-7.
 Pavel et al.

endocannabinoids, thus creating an imbalance between its Terms]) AND (psychiatry and psychology category[MeSH
neuroprotective effects (mediated by action on CB1R) and Terms])” and “CBD AND psychiatry” on Web of Science,
proinflammatory effects (mediated by action on CB2R). and in ClinicalTrials.gov, due to differences in search
The ECS has also been linked to movement disorders, via input format and applied filters for English language,
its inhibitory effects on the CB1R, which is abundant in the Randomized Controlled Trials and Clinical Trials. The
basal ganglia.24 It is ventured that an imbalance in the ECS PubMed search yielded 81 results between 1975 and 2020.
could be responsible for the movement deficit in Parkinson’s The ClinicalTrials.gov database returned 86 studies, with
disease, Huntington’s disease, Gilles de la Tourette’s 28 completed studies, out of which 9 presented results. The
syndrome, tardive dyskinesia, and dystonia.6 There is Web of Science All Databases search returned 59 clinical
also an endocannabinoid hypothesis in the etiology of trials during the same time period.
schizophrenia which postulates that overactivity of the We included in the systematic review only the studies
ECS could lead to an increase in dopamine and lowering that assessed the effect of CBD as monotherapy or
in glutamate, which leads to the development of positive add-on therapy on disease severity as primary outcome in
symptoms.25 psychiatric disorders, and only studies published in English.
CBD has been proposed as a pharmacological intervention for All studies were screened by title and abstract in order to
epilepsy, anxiety disorders, psychotic disorders, dementia, further select the studies that met the eligibility criteria.
and other psychiatric diseases and neurodegenerative After the screening process, all the remaining articles
disorders.26 were reviewed and the following data were extracted:
Initial evidence of the effect of CBD on anxiety came from author, year of publication, psychiatric disorder, sample
studies on healthy volunteers that presented increased size, drugs administered and dosage, and primary outcome
anxiety after the use of THC,27 and studies that showed measure used.
increased use of cannabis in persons with anxiety as a form
of “self-medication,”28 which lead to believe that there RESULTS
are both anxiogenic and anxiolytic compounds in cannabis.
Yet, the mechanisms behind these effects are not fully There were a total of 226 studies screened for eligibility
understood. (see selection diagram for detailed process). Of the 81
There is growing interest in expanding treatment options studies from PubMed, 73 were excluded because they did
where no new drugs with novel mechanisms of action not use only CBD in the intervention group (there was a
have been introduced. Several studies suggest that CBD combination of CBD and THC), did not address psychiatric
could be efficient in treating certain psychiatric disorders. patients (but healthy volunteers or neurologic patients),
Therefore, the purpose of our systematic review is to or did not measure disease severity as primary outcome.
assess the effect of CBD as a pharmacological intervention Only 9 studies were read in full, out of which 4 were
in psychiatric disorders and its impact on disease severity. schizophrenia trials,17,30-32 3 addressed substance use
disorders,33,34 and 2 addressed anxiety disorders35,36 (see
MATERIALS AND METHODS Table 1 for details about each study included).
Out of all 9 completed studies with results presented
The present systematic review was conducted in line with from ClinicalTrials.gov, 8 were excluded on the grounds of
the PRISMA guidelines and reporting criteria.29 being doubles, not including psychiatric patients, or not
We searched multiple databases (PubMed—MEDLINE, using CBD alone in the intervention group. Only 1 study
ClinicalTrials.gov, Web of Science All Databases) for was included for full read and it addressed patients with
articles that focused on the use of CBD as monotherapy cannabis use disorder.37
or add-on therapy in psychiatric patients. In MEDLINE, All the Web of Science results were doubles of the PubMed
we performed a search using the phrasing “(CBD [MeSH results and none were included for full read. In total there
were 9 studies warranting full read. The full diagram of
study selection is presented in Figure 1.
MAIN POINTS
• CBD is safe to use, even in higher doses, in patients with DISCUSSION
psychiatric disorders such as schizophrenia, substance use
disorders, and anxiety disorders.
• The efficacy of CBD on disease severity is doubtful at the CBD in Schizophrenia
moment due to a low number of high-quality studies and
lack of common ground regarding mean dose to be used and All the studies included examined the effect of CBD on
means of administration. patients with schizophrenia or schizophrenia spectrum
• CBD could be useful in treating some symptoms of disorders. Only one of the studies had a case–control
psychiatric disorders due to its effects on the ECS, but its
effect on disease severity is limited.
design,32 the rest being randomized controlled trials. The
case control study evaluated the potential effect of CBD in

2
 Table 1.  Studies Included in the Review
Primary Outcome
Author/Year Psychiatric Disorder Duration Sample Size CBD Dosage Monotherapy/Add-On Comparator Risk of Bias45
Measure
Zuardi et al. 2006 Treatment-resistant 5 weeks 3 40-1280 mg per Monotherapy None (case–control BPRS -
Schizophrenia day design)
Lewke et al. 2012 Schizophrenia 4 weeks 39 200-800 mg/day Monotherapy Amisulpride BPRS and PANSS Low
McGuire et al. 2017 Schizophrenia 6 weeks 88 1000 mg/day Add-on Placebo PANSS, SANS, CGI, Low
BACS
Boggs et al. 2018 Schizophrenia 6 weeks 36 600 mg/day Add-on Placebo MCCB, PANSS High
Morgan et al. 2013 Tobacco addiction 1 week 24 400 μg aerosol Monotherapy Placebo Number of High
solution/day cigarettes
smoked per week
Hurd et al. 2019 Heroin use disorder 1 week 42 400 or 800 mg/day Monotherapy Placebo VAS-C/VAS-A High
Hill 2017 Cannabis use disorder 6 weeks 10 Up to 800 mg/day Monotherapy Placebo Self-report High
Cannabis Use
Crippa et al. 2011 Social anxiety 140 min 10 Single 400 mg Monotherapy Placebo VAMS High
dose
Bergamaschi et al. 2011 Social anxiety 2.30 min 36 Single 600 mg Monotherapy Placebo and VAMS, SSPS-N High
dose healthy controls
BPRS, brief psychiatric rating scale; PANSS, positive and negative symptoms scale; SANS, scale for the assessment of negative symptoms; CGI, clinical global impression scale; BACS, brief
assessment of cognition in schizophrenia; MCCB, matrics consensus cognitive battery; VAS-C/A, visual analog scale for craving/anxiety; VAMS, visual analog mood scale; SSPS-N, negative
self-statement scale.
Psychiatry and Clinical Psychopharmacology

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 Pavel et al.

were significant improvements (P = .019) after 8 weeks in

the CBD group on the PANSS positive symptoms subscale.
What is more, the CBD group showed improved motor
speed but not executive functioning, thus showing some
benefits of CBD on cognition. One important finding by
McGuire et al. was the presence of improvements in CGI-S
and CGI-I in the CBD group, meaning that even though the
improvements according to scale scores were modest, they
were clinically meaningful.

It seems that CBD is safe to use in schizophrenia patients

but the results are mixed when assessing its effects on
disease severity. The results are even more difficult to
interpret in the case of studies where clinicians declared
improvements in severity even though the objective scales
showed no change.
More so, the later improvements in positive symptoms
shown in some studies warrants replication due to possible
confounding factors. Improvements could be due to longer
duration of antipsychotic treatment or the natural course
of illness. On the other hand, the neuromodulation effect
induced by CBD through the ECS may only become apparent
Figure 1.  Acneiform lesions after melatonin usage. after a longer period of time.

treatment-resistant schizophrenia. Although the study had CBD in Substance Use Disorders
negative results, it emphasized the good tolerability and
safety profiles of high-dose CBD (max 1280 mg/day). There were 3 studies assessing the use of CBD in substance
use disorders.33,34,37 The use of CBD in these disorders
One17 study focused on the effect of CBD on levels of AEA, is due to the involvement of the ECS in the reward and
an endocannabinoid transmitter, believed to be involved reinforcement circuits of the brain,39 which is common
in modulation of pain, mood, and cognition.38 This study ground with substance use disorders. CBD has been
aimed to alleviate psychotic symptoms in patients with shown34 to significantly reduce the number of cigarettes
schizophrenia and schizophreniform psychosis by raising smoked in individuals with tobacco addiction, but at the
AEA signaling through administration of CBD (200-800 mg/ same time had no impact on cigarette craving. Thus,
day), using amisulpride (200-800 mg/day) as comparator. the mechanism behind its possible efficiency remains
Both groups had less severe symptoms at 28 days, as unclear.34 It is speculated that, from a neurobiological
measured by PANSS, but the study could not prove non- point of view, its effects are directly related to the action
inferiority of the CBD group (P = .27). Their results suggest of CBD on the CB1R. Another piece of evidence comes from
that CBD could be an effective alternative to improve preclinical studies on rats where it has been shown that
psychotic symptoms, with good tolerance and safety inhibiting FAAH by CBD administration17 causes a decrease
profile, although sample size and follow-up duration were in the reinforcing and neurochemical effects of nicotine.40
rather small, warranting replication studies with larger Smoking reduction could occur due to modulation of
sample sizes. salience cues determined by CBD, also shown in preclinical
studies.41 Further clinical studies designed to evaluate
Two studies used CBD as adjunctive therapy30,31 in
the effect of CBD on cigarette addiction,34 as performed
patients with schizophrenia, with conflicting results. Boggs
in the case of CBD for heroin addiction,33 are required
et al.31 showed that both the CBD (600 mg/day) and the
to assess these preclinical findings. Hurd  et  al.33 found
placebo group showed a decrease in PANSS scores over a
that administering either 400  mg or 800  mg/day of CBD
period of 6 weeks but concluded that the improvement was
significantly reduced heroin craving compared to placebo.
not attributable to CBD. The same results were observed for
Craving was slightly lower in the 800  mg/day group but
cognitive improvement. Furthermore, a post-hoc analysis
the intragroup differences did not reach statistical
revealed that only the placebo group showed cognitive
significance. After 1 week since the last CBD dose, craving
improvements over time, despite the similar baseline
was significantly reduced in the 800  mg group while at
cognitive functioning. In comparison, McGuire et al.30 showed
the same time increased in the control group. Challenged
no statistically significant improvements in PANSS total,
with video drug cues, all groups showed an increase in
general, or negative scores in the CBD (1000 mg/day) group
anxiety compared to baseline assessment; furthermore,
compared to placebo at study endpoint (8 weeks), but there

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 Psychiatry and Clinical Psychopharmacology

participants receiving CBD at 800 mg/day had the lowest CONCLUSION

baseline-adjusted increase in anxiety. While there was no
difference in cognitive performance between the groups, Despite the general interest in CBD treatment of psychiatric
statistically significant benefits for physiological measures diseases, there is an extremely low number of quality
were present in the CBD group, with lower heart-rates, studies in this domain. CBD has been proven to be safe to
temperature, and salivary cortisol levels when exposed use even in higher doses in social phobia, schizophrenia,
to drug cues, compared to placebo. This shows promising and substance use disorders, as monotherapy or add-on
results for the use of CBD in reducing drug-cue-induced therapy, but the evidence regarding its effects on disease
craving and anxiety in opioid use disorder, and could be severity is contradictory. It seems that the use of CBD
an important addition to currently available addiction in psychiatric disorders is still a gray area and there is
medication. uncertainty regarding its efficacy in this field.
One completed trial for the use of CBD in cannabis use
disorder was identified,37 rendering negative results. The Ethics Committee Approval: XXX.
use of 800  mg/day CBD did not decrease the number of Informed Consent: XXX.
cannabis inhalations per day while the placebo group
Peer Review: XXX.
showed significantly reduced daily consumption. The
Author Contributions: XXX. Q1
results from this study cannot be used to draw firm
conclusions in regard to the use of CBD in cannabis use Acknowledgments: Not applicable.
disorder due to its low patient number (N = 9) and fewer Conflicts of Interest: Authors declare no conflicts of
inhalations of cannabis per day present at baseline in the interest.
placebo group. Financial Disclosure: There was no funding for the writing
CBD could be used to reduce symptoms of anxiety related to and designing of this study.
substance abuse (both in abstinent and currently dependent
patients) and the number of drug administrations. These
effects seem to be different depending on the type of REFERENCES
substance the person is addicted to and the phase in
1. Adams R, Hunt M, Clark JH. Structure of cannabidiol, a
which it is administered, with better results in presently
product isolated from the marihuana extract of
abstinent patients compared to active users. There were Minnesota wild hemp. I. J Am Chem Soc. 1940;62:196-
no severe side effects in this trial. 200. [CrossRef]
2. Mechoulam  R, Shvo  Y. Hashish—I. Tetrahedron.
CBD in Anxiety Disorders 1963;19:2073-2078. [CrossRef]
Both studies assessing single-dose administration of CBD in 3. Gaoni Y, Mechoulam R. Isolation, structure, and partial
anxiety disorders focused on its effects on social anxiety.35,36 synthesis of an active constituent of hashish. J Am Chem
Soc. 1964;86:1646-1647. [CrossRef]
Participants who received CBD in 400 mg and 600 mg/day
4. Devane  WA, Dysarz  FA, Johnson  MR, Melvin  LS,
reported significantly lower levels of subjective anxiety Howlett  AC. Determination and characterization of a
compared to controls. This anxiolytic effect has been cannabinoid receptor in rat brain. Mol Pharmacol.
shown in fMRI studies to be related to reduced activity 1988;34:605-613.
in limbic and paralimbic brain areas, both known to be 5. Skaper  SD, Di Marzo  V. Endocannabinoids in nervous
associated with anxiety.42,43 From the neurobiological system health and disease: the big picture in a nutshell.
perspective, CBD could exert its anxiogenic effects through Philos Trans R Soc B Biol Sci. 2012;367:3193-3200.
5-HT1A receptor agonism.44 Due its safety and tolerability, [CrossRef]
CBD could be considered a viable option for treating social 6. Sierra  H, Cordova  M, Chen  C-SJ, Rajadhyaksha  M.
Confocal imaging–guided laser ablation of basal cell
phobia, with current results demanding further research
carcinomas: an ex vivo study. J Invest Dermatol.
for its use in other anxiety disorders as well. 2015;135:612-615. [CrossRef]
7. Chaperon F, Soubrié P, Puech AJ, Thiébot MH. Involvement
Limitations of central cannabinoid (CB 1 ) receptors in the
Our review depicts the current results of using CBD for establishment of place conditioning in rats.
reducing disease severity in psychiatric diseases. One Psychopharmacology. 1998;135:324-332. [CrossRef]
possible limitation is the language barrier, in including 8. Thornton-Jones  ZD, Vickers  SP, Clifton  PG. The
cannabinoid CB1 receptor antagonist SR141716A reduces
only papers written in English. The limited data available
appetitive and consummatory responses for food.
should also raise caution in interpreting the results. Psychopharmacol (Berl). 2005;179:452-460. [CrossRef]
Moreover, there were studies assessed as having a high 9. Hungund BL. Endocannabinoid system: a newer molecular
risk of bias. This warrants improvements in study design target for the treatment of alcohol-related behaviors.
and methodology to be used in future studies in order to World J Pharmacol. 2012;1:44. [CrossRef]
increase the validity of results.

5
 Pavel et al.

10. Greenberg  I, Kuehnle  J, Mendelson  JH, Bernstein  JG. 25. Laviolette  SR, Grace AA. The roles of cannabinoid and
Effects of marihuana use on body weight and caloric dopamine receptor systems in neural emotional learning
intake in humans. Psychopharmacol (Berl). 1976;49:79- circuits: implications for schizophrenia and addiction.
84. [CrossRef] Cell Mol Life Sci. 2006;63:1597-1613. [CrossRef]
11. Guindon  J, De Léan  A, Beaulieu  P. Local interactions 26. Huestis  MA, Solimini  R, Pichini  S  et  al. Cannabidiol
between anandamide, an endocannabinoid, and adverse effects and toxicity. Curr Neuropharmacol.
ibuprofen, a nonsteroidal anti-inflammatory drug, in 2019;17:974-989. [CrossRef]
acute and inflammatory pain. Pain. 2006;121:85-93. 27. Crippa  JA, Zuardi AW, Martín-Santos  R  et  al. Cannabis
[CrossRef] and anxiety: a critical review of the evidence. Hum
12. Guindon J, LoVerme J, De Léan A, Piomelli D, Beaulieu P. Psychopharmacol. 2009;24:515-523. [CrossRef]
Synergistic antinociceptive effects of anandamide, an 28. Buckner  JD, Schmidt  NB, Lang  AR  et  al. Specificity of
endocannabinoid, and nonsteroidal anti-inflammatory social anxiety disorder as a risk factor for alcohol and
drugs in peripheral tissue: a role for endogenous fatty- cannabis dependence. J Psychiatr Res. 2008;42:230-239.
acid ethanolamides? Eur J Pharmacol. 2006;550:68-77. [CrossRef]
[CrossRef] 29. Liberati  A, Altman  DG, Tetzlaff  J  et  al. The PRISMA
13. Mechoulam  R, Parker  LA. The endocannabinoid system statement for reporting systematic reviews and meta-
and the brain. Annu Rev Psychol. 2013;64:21-47. analyses of studies that evaluate health care
[CrossRef] interventions: explanation and elaboration. PLOS Med.
14. ElSohly  MA, Radwan  MM, Gul  W, Chandra  S, Galal  A. 2009;6:e1000100. [CrossRef]
Phytochemistry of cannabis sativa L. In: progress in the 30. McGuire P, Robson P, Cubala WJ et al. Cannabidiol (CBD)
chemistry of organic natural products [internet]. 2017. as an adjunctive therapy in schizophrenia: a multicenter
Berlin; Springer:1-36. randomized controlled trial. Am J Psychiatry.
15. Zuardi  AW, Guimarães  FS, Moreira  AC. Effect of 2018;175:225-231. [CrossRef]
cannabidiol on plasma prolactin, growth hormone and 31. Boggs DL, Surti T, Gupta A et al. The effects of cannabidiol
cortisol in human volunteers. Braz J Med Biol Res. (CBD) on cognition and symptoms in outpatients with
1993;26:213-217. chronic schizophrenia a randomized placebo controlled
16. Gomes FV, Llorente R, Del Bel EA et al. Decreased glial trial. Psychopharmacol (Berl). 2018;235:1923-1932.
reactivity could be involved in the antipsychotic-like [CrossRef]
effect of cannabidiol. Schizophr Res. 2015 May;164:155- 32. Zuardi  AW, Hallak  JEC, Dursun  SM  et  al. Cannabidiol
163. [CrossRef] monotherapy for treatment-resistant schizophrenia. J
17. Leweke  FM, Piomelli  D, Pahlisch  F  et  al. Cannabidiol Psychopharmacol. 2006;20:683-686. [CrossRef]
enhances anandamide signaling and alleviates psychotic 33. Hurd YL, Spriggs S, Alishayev J et al. Cannabidiol for the
symptoms of schizophrenia. Transl Psychiatry. reduction of cue-induced craving and anxiety in drug-
2012;2:e94-e94. [CrossRef] abstinent individuals With heroin use disorder: a double-
18. Dewey WL. Cannabinoid pharmacology. J Ethnopharmacol. blind randomized placebo-controlled trial. Am J
1987;20:293-294. [CrossRef] Psychiatry. 2019;176:911-922. [CrossRef]
19. Zou  S, Kumar  U. Cannabinoid receptors and the 34. Morgan  CJA, Das  RK, Joye  A, Curran  HV, Kamboj  SK.
endocannabinoid system: signaling and function in the Cannabidiol reduces cigarette consumption in tobacco
central nervous system. Int J Mol Sci. 2018;19:833. smokers: preliminary findings. Addict Behav.
[CrossRef] 2013;38:2433-2436. [CrossRef]
20. Kim SH, Won SJ, Mao XO, Jin K, Greenberg DA. Molecular 35. Bergamaschi  MM, Queiroz  RHC, Chagas  MHN  et  al.
mechanisms of cannabinoid protection from neuronal Cannabidiol reduces the anxiety induced by simulated
excitotoxicity. Mol Pharmacol. 2006;69:691-696. public speaking in treatment-naïve social phobia
[CrossRef] patients. Neuropsychopharmacology. 2011;36:1219-
21. Khaspekov  LG, Brenz Verca  MS, Frumkina  LE  et  al. 1226. [CrossRef]
Involvement of brain-derived neurotrophic factor in 36. Crippa JAS, Derenusson GN, Ferrari TB et al. Neural basis
cannabinoid receptor-dependent protection against of anxiolytic effects of cannabidiol (CBD) in generalized
excitotoxicity. Eur J Neurosci. 2004;19:1691-1698. social anxiety disorder: a preliminary report. J
[CrossRef] Psychopharmacol. 2011;25:121-130. [CrossRef]
22. Sánchez-Blázquez  P, Rodríguez-Muñoz  M, Vicente- 37. Hill  K. Cannabidiol pharmacotherapy for adults With
Sánchez A, Garzón  J. Cannabinoid receptors couple to cannabis use disorder. Full Text View ClinicalTrials.gov
NMDA receptors to reduce the production of NO and the 2016:1-20.
mobilization of zinc induced by glutamate. Antioxid 38. Di Marzo  V, Petrosino  S. Endocannabinoids and the
Redox Signal. 2013;19:1766-1782. [CrossRef] regulation of their levels in health and disease. Curr
23. Ramos  JA, González  S, Sagredo  O, Gómez-Ruiz  M, Opin Lipidol. 2007;18(2):129-140. [CrossRef]
Fernández-Ruiz  J. Therapeutic potential of the 39. Serrano  A, Parsons  LH. Endocannabinoid influence in
endocannabinoid system in the brain. Mini Rev Med drug reinforcement, dependence and addiction-related
Chem. 2005;5:609-617. [CrossRef] behaviors. Pharmacol Ther. 2011;132:215-241. [CrossRef]
24. Sañudo-Peña  MC, Tsou  K, Walker  JM. Motor actions of 40. González  S, Grazia Cascio  M, Fernández-Ruiz  J  et  al.
cannabinoids in the basal ganglia output nuclei. Life Sci. Changes in endocannabinoid contents in the brain of rats
1999;65703-713. [CrossRef] chronically exposed to nicotine, ethanol or cocaine.
Brain Res. 2002;954(1):73-81. [CrossRef]

6
 Psychiatry and Clinical Psychopharmacology

41. Ren Y, Whittard J, Higuera-Matas A, Morris C V., Hurd YL. 43. Fusar-Poli  P, Crippa  JA, Bhattacharyya  S  et  al. Distinct
Cannabidiol, a nonpsychotropic component of cannabis, effects of Δ9-tetrahydrocannabinol and cannabidiol on
inhibits cue-induced heroin seeking and normalizes neural activation During emotional processing. Arch Gen
discrete mesolimbic neuronal disturbances. J Neurosci. Psychiatry. 2009;66:95-105. [CrossRef]
2009;29:14764-14769. [CrossRef] 44. Russo  EB, Burnett  A, Hall  B, Parker  KK. Agonistic
42. Fusar-Poli P, Allen P, Bhattacharyya S et al. Modulation properties of cannabidiol at 5-HT1A receptors.
of effective connectivity during emotional processing by Neurochem Res. 2005;30:1037-1043. [CrossRef]
Δ9-tetrahydrocannabinol and cannabidiol. Int J 45. Sterne  JAC, Savović  J, Page  MJ  et  al. RoB 2: a revised
Neuropsychopharmacol. 2010;13:421-432. [CrossRef] tool for assessing risk of bias in randomised trials. BMJ.
2019;366:l4898. [CrossRef]

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Q1 Please provide the text for these sections.