CBD In Treatment of PTSD, Alzheimer's, Addictions and Mood Disorders

Foreign. I'd like to welcome everybody today's presentation on CBD in the treatment of Alzheimer's, addictions and mood disorders. I'm your host, Dr. Donnelly Snipes. In this class we're going to talk about how we can use CBD in, in the treatment of addiction. CBD and its impact on mental health issues. CBD and its impact on neurodegenerative issues like Alzheimer's and Parkinson's as well as hit a real high level overview of CBD adverse events, toxicity and drug interactions. That is going to be really important because a lot of our clients may decide to try to self medicate with cbd. CBD in addition to other medications. And I'll just foreshadow for you, CBD oil or CBD interacts with just about every medication out there. So we do want to make sure that they're aware of that and hopefully agree to if they're going to try to start taking cbd, do it in a physician supervised capacity. All right. Cannabidiol's promise for treatment of substance use disorder. CBD is short for cannabidiol and recent models implicate major brain circuits involved in reward saliency. So how, how rewarding something is motivation and memory and learned associations in substance abuse. We call those triggers in maintaining addiction. We which may be largely modulated by the endocannabinoid system or the receptors in our brain that respond to cannabinoids. And that includes THC as well as cannabidiol. The endocannabinoid system or ECS modulates dopamine. That's really important to recognize. It also has an effect on noradrenaline and serotonin. But we'll get there. When we talk about addiction though, one of the things that we have seen with addiction, I try to avoid saying we know because we don't really know a whole lot for, for 100% certain. But one of the things that we've seen repeatedly with addiction is that addictive substances and addictive behaviors cause a dopamine surge. The endocannabinoid system is there to try to modulate that dopamine. So, so you don't get those surges quite so much. Alcohol, nicotine and thc, which is not cbd, it is another cannabinoid that's in marijuana. But alcohol, nicotine and THC all increase dopamine levels via nerve terminals modulated by the endocannabinoid system. Important to recognize that when people are using these addictive substances, they, they are activating that endocannabinoid system, the endocannabinoid system, including receptor CB1R which you don't need to know that for the test or anything, but there is a particular receptor in there that represents a necessary contributor towards cellular adaptations in the transition from recreational substance use to a use disorder. So when this CB1R is activated, it causes changes or it facilitates changes in the brain cells in the system that facilitate the move from recreational use to dependence and tolerance and all those other things. The ECS mediated synaptic plasticity may facilitate emotional learning and memory processes in increasing emotional responses to substance related cues. Basically what that's saying is the endocannabinoid system encourages the brain cells to be a little bit more flexible, to be a little bit more receptive and responsive and which facilitates learning when those systems are activated. That kind of primes the brain for learning based on memory. So now they're in this wide open situation. Think about a classroom. You know, when you create a classroom, you want it to create an environment that's conducive to learning. So you do certain things in the classroom and you don't do other things in order to make it so. Most people are comfortable, they're, they have the materials they need to learn, they are not distracted. Same sort of thing goes on in our brain. When our brain has the right environment to learn, it is much more receptive to things. And the endocannabinoid system facilitates that condition in the brain. Antagonism, which means shutting down, locking off, turning off, whatever you want to say. Antagonism of that CB1R receptor reduces alcohol induced sensitization and nicotine relapse. So they're finding that CBD may reduce the people from developing tolerance and sensitization to ethanol and it tends to make them less likely to relapse on nicotine. CBD is non rewarding. It doesn't have the psychogenic properties of thc. That is super important to remember, especially for people who are in recovery, because CBD is not going to get them high. It had acts on other receptors in order to facilitate other processes. It acts on a number of receptor systems including the opioid system, the serotonin system and the cannabinoid system. So when people take CBD they are modulating those symptoms. Systemically administered cbd, which means orally or intravenously by a doctor, I guess, but generally we're talking about oral. Systemically administered CBD regulates mesolimbic dopamine activity. That's important to know and potentially reduces substance induced DYSREGULATION So when people take CBD orally, it keeps them from having that dopamine spike that may occur when they take substances. Because when we take substances, that dopamine system gets disregulated. It just goes wide open. And CBD seems to modulate that a little bit. Treatment with CBD blocked the rewarding effects of morphine and heroin and prevented drug and stress induced reinstatement of conditioned plain place preference lasting up to two weeks post administration. So that's really interesting. Now, condition, place preference, why do we care about this? When somebody receives a reward, receives a stimulus, gets that dopamine rush in a particular place, that place becomes associated with pleasure. In substance abuse counseling, we talk about this as, you know, a trigger. Being in that place, being in a bar, or if you, you know, use heroin when you're at home, you know, being at home could be a trigger. And when people were given cbd, it seemed to block those memories and reduce the preference for certain places that are associated with use, which is really awesome. So it kind of reduces those urges a little bit. And it lasted up to two weeks post administration. CBD reduces a lot of different things. And as always in this presentation, all of the hyperlinks will take you to the articles that I got this information from. Just to keep it clean. I do the hyperlinks. But CBD reduces in most people the overall level of alcohol intake. The motivation for ethanol, it's key, keeping them from becoming tolerant to it. But it also kind of takes some of the rewarding effects out of it. Since it's modulating that dopamine release, it reduces anxiety and impulsivity, which is helpful not only in alcoholism, but a whole host of other mood, mental health, and even neurodegenerative disorders. Alcohol related stetosis and fibrosis in the liver is also reduced because CBD reduces lipid accumulation, so reduces that fatty liver, it stimulates autophagy. So the liver, the body, starts eating, consuming, getting rid of whatever you want to say, bad cells, and it modulates inflammation. We know that alcoholism causes inflammation in the liver, and CBD helps modulate or reduce some of that inflammation. Now, this isn't a pass where somebody can take CBD and then drink all they want. I don't want them to start thinking that way because the addicted brain will go there. But it is interesting to notice that CBD may be able to help reverse a little bit some of the liver damage done by the intake of alcohol. CBD also reduces oxidative stress by inducing death of activated hepatic stellate cells. This is again something you're seeing that autophagy oxidative stress is when you have byproducts and residual residues of things that have processes that have happened in your body and they can build up and be toxic, which is why the stress part and CBD actually causes some of these cells that have gone a little wonky to be consumed to be gotten rid of. It also reduces alcohol related brain damage preventing neuronal loss by its antioxidant and immunomodulatory properties. Okay. When people drink, one cause of brain damage is due to lack of enough thiamine because alcohol blocks thiamine uptake and results in weirnicky Courseicoff syndrome. CBD doesn't seem to help with that. So that's one issue. But the other issue is that the ingestion of alcohol leads to systemic inflammation. And CBD because of its anti inflammatory properties does seem to reduce the inflammation and reduce the the damage to the brain cells because of its antioxidant and anti inflammatory processes. CBD and stimulant disorders. CBD has reversed toxicity and seizures induced by cocaine. Not saying again this is not like taking naltrexone or something that with opioids that is an automatic reversal. But they have found that it has helped heal the body some. When somebody has used cocaine and had had toxicity or seizures it reverses behavioral sensitization induced by amphetamines and it reduces motivation to self administer cocaine and method. We're speculating again that CBD's function in modulating that dopamine and keeping it from, you know, going wide open is what reduces motivation to self administer because the high is just not so good. It's just like eh. CBD also increased the extinction of cocaine and amphetamine induced conditioned place preference. Just like I said on the last slide or the slide before because it is reducing the rewarding reward salience of those places and of those things. Then when it's administered then by administering that you're also reducing the trigger salience. You're reducing the urges to go there. Mechanisms involved in the protective effects of CBD on addiction to psychostimulant drugs include prevention of drug induced neuro adaptations. Hopefully it's preventing by addressing that that receptor, it's preventing that neuroplasticity that encourages people to move to problematic use. It encourages somehow they don't know how exactly, but it does encourage the eraser of a barrent drug memories. So it helps with some of those. For some people they say it helps with their drug dreams that they have elimination of cognitive deficits induced by psychostimulant drugs. So it helps the brain become a little bit healthier and alleviation of mental disorders that are comorbid with, with psychostimulant abuse. You'll learn in a little while that CBD interacts on opioid, serotonin, dopamine and norepinephrine systems. So it is, it is impactful for just about everything in the DSM iv. Not everything, but just about cannabis and mental health disorders. Anxiety, social anxiety, depression, especially depression related to anxiety. When somebody's just stressed out for so long, they start to develop this sense of hopelessness and helplessness. All of those have shown extreme promise for treatment with cbd. CBD has many additional targets within and beyond the endocannabinoid system. It's not just that one System. It also activates 5ht, which you remember are serotonin receptors, adreno receptors. So that's your norepinephrine system and your mu. Opioid receptors, those are your pain receptors, your heroin opioid related receptors. CBD interestingly, has the opposite effect of THC in the prefrontal cortex, which is where we have our higher order thinking and our impulse control. And in the amygdala. When people take thc, a lot of times it increases their respiration, it increases their heart rate, and it activates their amygdala, it activates their stress response system. CBD seems to have the opposite effect, which is interesting when we get down in a few minutes to talking about the implications of treatment of PTSD with cbd. CBD, either as a monotherapy or added to regular antipsychotic medication, improved symptoms in patients with schizophrenia with promising effects, especially in early stages of the illness. In terms of garden grown marijuana, again, it's really important to recognize that, that THC is a major component of your garden grown cannabis. It's really, there are special seeds, special plants, special whatever you call them, hybrids that you get theoretically to produce hemp, which is where the CBD oil is extracted from. So garden grown cannabis may not have the same effects because it does have those higher levels of thc. Now remember, some illnesses, some conditions actually respond better to thc, but we weren't talking about that in this particular presentation, so I left those out. But do think about the fact that CBD and THC have some opposing psychological effects. In one study, I didn't find a whole lot of studies on CBD and PTSD, but in one study, 91% of patients experienced a decrease in PTSD symptom severity as evidenced by lower scores on the PCL5 at 8 weeks post treatment as opposed to their initial baseline. Well, that's pretty encouraging. Again, we want to look at where is this coming from since the pt. Since PTSD does involve hyperactivation of that amygdala and it does involve a lot of those other the serotonin system and other things, it seems like the endocannabinoid system, specifically CBD helps modulate that and kind of get it back to normal. I've used the analogy repeatedly of a warm bath. And when people are really anxious, angry, stressed out, hyper vigilant, it's running like running hot water wide open. And when they're super calm, it's like running cold water wide open. And it seems like the CBD gets in there and kind of monkeys with it. So it's an adequate, not too much is getting through, but enough is getting through. Alzheimer's and dementia Cannabidiol or CBD is a phytocannabinoid which is helpful as an antioxidant to reduce oxidative stress, an anti inflammatory and an agonist of dopamine and serotonin. Remember antioxidants we talk about all the time. We want antioxidants to prevent aging, we want antioxidants to help help fight cancer. We, we want anti antioxidants to help prevent the degeneration of neural pathways and development of Alzheimer's and dementia. So antioxidants not only in food but also in CBD are really helpful at reducing oxidative stress. Anti means getting rid of and oxidant means those ox that oxidative stress. We already talked some about CBD's anti inflammatory properties. And then remember agonist means increasing dopamine and serotonin so it increases the dopamine and serotonin systems. Alzheimer's and Parkinson's are both characterized by inflammation systemically and oxidative stress. CBD is also helpful in patients with epilepsy, restless legs and multiple sclerosis. Now with restless legs that has a lot to do with dopamine imbalances. With epilepsy and multiple sclerosis. The CBD generally is used in epilepsy for seizures and in multiple sclerosis for tremors. CBD as opposed to THC did not negatively alter cardiovascular parameters, body temperature, psychomotor or psychological functions. Nor did it induce a catalepsy or a trance like or seizure like state like THC does in some people. It doesn't put them into this zone. It really doesn't have much of a psychogenic effect at all. Based on his pharmacology, CBD may be useful not only in Alzheimer's and dementia, but also in other mental health and behavioral conditions that have symptoms such as agitation, self injury, anxiety, aggression, like autism spectrum disorders, for example. So based on its pharmacology, CBD may be useful for reducing agitation, anxiety, psychosis, aggression, depression, pain, plaque formation in the brain, and oxidative stress. All of those things we work with to some level every day. Now, CBD is not typically strong enough, if you want to use that word, to really help a lot with sleep. Unless the person is having difficulty sleeping because of their anxiety or agitation, it may help there. Now, I didn't specifically research CBD and, you know, sleep or CBD and insomnia, but it may be helpful as an adjunctive to what the person is currently doing. Again, CBD interacts as does thc. Cannabinoids interact with a whole host of medications. So it's really important to stress with your patients if they are going to try it, because some are just determined that they want to try that and get off prescriptions or whatever that they do need medical consultation. Other things that CBD does, it helps with pain. Obviously, inflammation is an underlying cause for pain in a lot of people. Autoimmune disease diseases cause systemic inflammation in the body. So when people have something like Crohn's disease or fibromyalgia or even diabetes is associated with systemic inflammation. Depression, interestingly enough, is correlated with systemic inflammation. And I have a video on the YouTube channel on Leaky gut and gut health that helps explain, you know, how depression and stress actually can lead to systemic inflammation and vice versa, how systemic inflammation can lead to depression and stress. Asthma, now that's not typically associated with mental health issues, so to speak, but when people are asthmatic, some people have anxiety. I know my daughter, when she was little, she had breathing problems and she was terrified to go very far away from home. She was terrified to go out hiking and do fun things because she was afraid she would have an asthma attack. So there is a certain amount of agoraphobia or anxiety that can be associated with asthma, especially bad asthma. But that aside, if somebody has asthma, they found that CBD is an exceptionally potent bronchodilator. So it does help open up those bronchioles so people can breathe easier. And osteoporosis, interestingly enough, that's not really associated with inflammation. But I didn't have another slide to put it on. As people get older, especially women, as we get older and our estrogen levels change, we become more susceptible to osteoporosis. Cannabidiol, CBD as well as some other cannabinoids stimulate bone growth and may be able to help prevent osteoporosis. So that's something to look at again. Why do we care for a mental health from a mental health perspective? Well, because osteoporosis can be painful. Bone broken bones, broken hips from osteoporosis can be painful and debilitating. And as we if we feel ourselves getting more fragile, it tends to impair our self efficacy and and impair our mood and our outlook. To answer your question, Robert, all CBD mixtures are not created equal. CBD is not regulated by the FDA with the exception. There is one drug that is used to treat seizures in epilepsy that has been FDA approved. But anything you get over the counter is not regulated by the fda. It is also not supposed to make any claims about being able to cure or treat any diseases. Additionally, if you get it your CBD oil from Acme.com and you get get it on in June and then you order again in August from acme.com same manufacturer, same place, same even same size jar, you may not get the same potency of cbd. There's also a lot of variation between producers in the actual potency of the CBD in the tincture that you're getting or the oil or whatever method you're getting it in. So no, all CBD products are definitely not created equal. And you can't even guarantee that you're getting the same dosage even if you get it from the same supplier every single time. Do be aware of that. It's just like all of the workout supplements and stuff that are on the market. There's a lot of loosey goosiness which is is very frustrating and it can be very scary. Additionally, the dosage for cbd, when you go to one manufacturer, they may recommend XYZ dosage. You go to another manufacturer, they may recommend something, you know, five, ten times higher. So the recommended dosage is all over the place or the recommended serving size, they can't call it a dosage is all over the place which also means you don't know what potency. In many of these studies they were very careful to either not say or give a range of the dosage that they used because you know, we don't really know yet. Since Cannabino Cannabidiol is so new on the market, we don't really know what the appropriate and helpful and therapeutic dosage is yet. Which is again why you need to get a naturopath or somebody who is very familiar with CBD involved in the process if somebody is going to be taking it. So what are some of the adverse effects in toxicity? And I note here that all of these symptoms can be seen in people when they take CBD at doses higher than recommended for human consumption. But like I said, the potency is a little bit loosey goosey, you know, between suppliers and the recommended serving size varies dramatically between suppliers. So the dose that is, quote, recommended for human consumption really hasn't been all that well established yet. But the FDA has weighed in a little bit. But when people take too much, they can have developmental toxicity. So it can impair physical and psychological development if they are still growing. Embryo fetal mortality and we're going to talk about that a little bit more in a minute. But it actually prevents or inhibits implantation of the embryo and it can cause birth defects, central nervous system inhibition. So and that's the same as a lot of your depressants. It can cause slowed reaction time, slow breathing, slower heart rate to a very bad place. Neurotoxicity, too much of a good thing. Even though it theoretically helps regulate a lot of different systems in the brain. If you take too much, just like anything else, it can be toxic hepatocellular, which means liver injuries and abnormalities. We need to be aware that yes, it can help heal the liver, but in doses that are too big, it can also overwhelm the liver and cause problems itself. Spermatogenesis reduction. So the development or creation of sperm is reduced. So that's sperm count is going to go down. Male reproductive system alterations and it goes into, you know, the size and weight of testes and other things. If you want to read about it, the articles in your class, hypotension, so low blood pressure, diarrhea, vomiting and fatigue, that however, you know, I'm putting that out there. So you know that cbd, yes, it's natural, but, but it also can be harmful. Just like a lot of other natural things that are out there. There are a lot of positive effects if used appropriately. And it's important to just be aware and be cognizant of this. And yes, Logan, the seizure medicine is epidiolex CBD adverse effects Cannabis and CBD use is rising among pregnant women. In one study, an estimated 4 to 20% of 18 to 24 year old pregnant women Were using some form of cannabis products. Now that included THC as well as cbd. But that's a, that's a lot of pregnant women. CBD inhibits embryo implantation and placenta development. Remember, they need the placenta to get the nutrients in order to develop appropriately. And prenatal cannabinoid exposure, not just CBD but to any of the cannabinoids, potentiates the harmful effects of alcohol, increasing the risk of the development of fetal alcohol spectrum disorders and craniofacial malformations and eye defects. Really important to recognize that not only is CBD potentially harmful to a fetus and cannabinoids potentially harmful to a fetus, we know that alcohol is potentially very harmful to a fetus. When you put them together, they potentiate each other. So it's, I mean it's even more powerful than like one plus one is two, it's like one plus one is six. Really important that pregnant women are not drinking, definitely not drinking and using CBD or cannabinoids or cannabis marijuana concurrently and preferably not using cannabinoids either. So let's go down to drug reactions and there's a lot of them. Remember I told you that CBD interacts with just about every drug on the market. Well, here you go. Let's go through this laundry list and talk about why we care. The first one is sort of a easy go by guide, but it doesn't cover all of them. However, any of your clients who are taking drugs that have a grapefruit warning on them, like busperone or a lot of the antipsychotics, those drugs are metabolized by CYP2D6, which is inhibited by CBD. So if they're taking that medication, then the metabolization of those drugs may not go the way it's supposed to, which means in most cases the drug levels are going to build up to toxic levels in the system way too quickly. So it's really important if there's a grapefruit warning on their drugs not to take cbd. That's, you know, just one of those rules. But that warning is not on a lot of medications. Steroids and corticosteroids are used for things like asthma, arthritis and other inflammatory cond. We need to ask people, are they taking steroids or corticosteroids. When my daughter used to get sick, she had, she was born with lung problems and so every time she would get sick it would go to her chest and she would either develop bronchitis or pneumonia just like that, and she would have to be on a nebulizer in order to reduce the inflammation in her. In her lungs. And sometimes she would even have to take oral steroids if it got that bad. Why do I bring that up? Because some of our clients may be, you know, not taking any drugs at all, you know, any medications at all, taking cbd, and then they get sick and they get prescribed steroids or corticosteroids. It's important for them to recognize that, oh, this new medication I'm taking might interact with the CBD that I'm already taking. They need to let their prescribing physician or physicians know if they're taking it. Statins, these are the drugs that people take for cholesterol. Most people I know, unfortunately, who are over the age of about 50 are on some level of statins. And, you know, we could argue whether they need to be or not. Statins also have some interesting effects on mood, just as a side side effect. But if somebody is taking statins, CBD will interact with those. CBD interacts with calcium channel blockers. Those are the medications you take for high blood pressure. Certainly don't want to be monkeying around with that. Remember, CBD can, in high enough doses, can cause hypotension. So if you're taking medication for your blood pressure to reduce it, then you take CBD with it. Guess what? Your blood pressure may go through the floor. Antihistamines, interestingly enough, HIV antivirals and immune modulators. Because the CBD is in and of itself a immune system modulator. Sometimes it works with, sometimes it works against the HIV drugs. And, you know, depending on what cocktail the person is on, is really important to know the interactions. I'll put all three of these together. Benzodiazepines, which are your anti anxiety medications. Antipsychotics, which is like your. Your Seroquel and your Haldol, and antidepressant medications and herbs, including things like St. John's Wort, all interact with the GABA system, the serotonin system, and. Or the dopamine system. Your antipsychotics typically are responsible for reducing dopamine levels. So if somebody is taking cbd, which increases dopamine, you're kind of working against yourself here. Antidepressant medications increase serotonin and potentially dopamine and or norepinephrine. CBD potentially also increases all three of those. And so you may put people into a position where they are at risk of things like serotonin syndrome. Serotonin syndrome is deadly. If people get too much serotonin, it spikes their body temperature and results in tremors, vomiting, potentially loss of consciousness. A lot of really bad stuff. And it can happen after just one dose. It's not something that has to. That they have to do, you know, for a week or two weeks or months at a time. Sometimes we see, when we talk about serotonin syndrome, a lot of times we're taught. Talking about. When we're talking about serotonin and serotonin syndrome. We're also talking about when people take it with antidepressants, when they take two different antidepressants together, or they take antidepressants and opioids, which actually both increase serotonin, or they take antidepressants. And this is a favorite one of the teenagers, dextromethorphan, which is a cough suppressant. A lot of teenagers for a while don't know if they're still doing it, were taking mega doses of dextromethorphan rectally in order to increase the rate of absorption. And the dextromethorphan actually increases serotonin levels. And they were. Some of them were getting so much they were developing serotonin syndrome. So serotonin is really nothing to monkey around with if you don't know what you're doing. Like I said, herbs. We're looking at 5ht as well, 5htp as well as St John's wort. Anticonvulsants like Klonopin or clonazepam, beta blockers. Another thing that is used for blood pressure, proton pump inhibitors, which are things like Zantac. And there's one that begins with a P, and I can't think of it right now, but you take it for stomach acid and even oral diabetic medications. Any of these, all of these interact with cbd and it will affect the amount of. Circulate that circ. Amount of that medication circulating in your system, or the absorbability or availability of it. In some cases it reduces and in other cases it increases. The point is to know what. What the interactions are. Now, one interesting place you can go is to drugs.com and they have an interaction checker, see if I can get it to come up. Um, Okay, so to answer somebody else's question, as well as to show you how the drug interaction thing works, you put in the medication or medications that the person is taking, and then it'll tell you drug interactions. For this one, it says statins and cannabidiol. Cannabidiol may cause liver problems. And using it with other medications that also affect the liver, such as statins, may increase the risk of liver damage. So that's what that's all about. So that you just go to drugs.com or search for drugs.com drug interaction checker. And I've, I've used it with a lot of my clients to help them understand the side effects of some of the medications they're taking as well as to check for side effects of the medications they're taking with other things like herbs, over the counter drugs, even alcohol. CBD is showing promise as an alternative or adjunctive treatment for a variety of things ranging from Alzheimer's and addiction to Parkinson's and schizophrenia. I mean if you go to pubmed and I'll go there in a minute, you, you're going to find tons of articles in your classroom. I think I have, in the additional resources section, I think I have about 17 articles that I cited in, in this presentation. There's just a plethora of information and I'm really excited that this is coming out. But right now they still don't. Good recommendations for dosing. And even if they did, if you're getting the CBD over the counter, you can't guarantee that you're actually getting that dosage of CBD in that formulation. CBD does not have the psychogenic effects that THC does. However, THC has been found to be more effective at addressing certain issues over the counter. CBD is non standardized, so dosages even from the same manufacturer but in different lots may have different potencies. CBD interacts with most medications so it's vital to consult a physician prior to using it. The dosages, like I said, of CBD in the literature varied widely. Currently there are a couple of CBD based medications that are FDA approved for the treatment of seizure disorder. Finally, remember that CBD oils may also have traces of THC, generally not over 0.3%. Y' all know one of my favorite things is PubMed and I can never remember the long address for it. You just type in PubMed. Cannabidiol and. We'll just do and ptsd. And I guess I stumped it because it took a long time. You can go over here and you can shorten the window so you only see stuff from the last two years. I always have free full text checked because I like to read the actual article, not just the abstract. And you can set additional filters like species. I always have mine checked on humans because I'm not as interested in what it did to the Rats. But then all of these you can, you can look at. Somebody asked about cannabidiol and insomnia. So let's see. Proof of concept there. So then going with just the abstract, that one hasn't been done yet. They're talking about what they will do. Results. 72 adults had primary concerns of anxiety and poor sleep. Anxiety scores decreased in 57 patients and sleep scores improved within the first month in 48 patients, but fluctuated over time. And CBD was well tolerated in all but three patients. So theoretically this may be something that comes out as a newer intervention that is less harmful to the brain than antihistamines and some of the barbiturates that are currently available for insomnia. Something to keep your eye on now. All right, let's look at, Let's look for that. See if I can find anything on the FDA on cbd. Yeah, yeah. Potential harm of cbd. The FDA really doesn't like cbd. They want to tell you about all the scary stuff. So right now, like I said in the research, the dosage a lot of times wasn't even noted, but other times it was. There was a very wide spectrum of what they were offering for it. No, the research studies that we looked at or that I looked at did not talk about CBD. Isolate. Full spectrum or broad spectrum. We can look at those real quick. Let's see. It appears all of those have THC removed. But in the full spectrum and broad spectrum they have some of the other cannabinoids that exist in the marijuana plant in there. And you know, THC is the psychoactive one. So if that's what a lot of the drug tests measure for. But each one of the cannabinoids has its own independent properties and usefulness and things. So I can see why some people would look for a broad spectrum CBD in order to get as much benefit and antioxidant and anti inflammatory effects as possible without the thc. But you notice neither NIDA nor SAMSA had anything about that on them. What is. Interestingly, it appears this article on the National Institute of Drug Abuse is quite positive about the potential promise of cannabidiol for therapeutic use. So I'll put that in here for you guys to read in depth. Let me answer your question, Logan. It. Let's see. Yes, I would say, Logan, the. I mean anything with dextromethorphan that is being taken in addition to CBD can have a potentiation effect and the triple, triple Cs themselves or dextromethorphan alone can cause can in high enough doses can lead to serotonin syndrome. So it is. That is one of those things that can be really scary. Oops. No. Oh hush. Here is a video I did do on serotonin syndrome. If you're in Florida and you need medical error prevention, you can get CEUS for it. But if you don't care about that, then you know, just watch the video. If you're interested in learning more about serotonin syndrome and what the symptoms are, Are there any other questions? I've really enjoyed all your questions about cbd. I am still learning about it obviously along with you guys. But I was I really enjoyed going through the research. And yes I saw somebody else commenting. I'm not sure where you're seeing the ads at. There shouldn't be any ads during the during the class, but unfortunately Google is creepy aware of what you do. I swear sometimes they just hear what I'm saying and I'm not even looking online and I start getting fed ads about it. So you probably will start seeing some ads about CBD Oil. One thing you can do if if you want to, there are some free open source ad blocker programs. My husband has them on his computer because he really hates ads to no end. But you can also install those if ads bother you. I usually just kind of ignore them, but they are distracting for some people. Alrighty everybody. If you have any other questions, please feel free to email me@support.com otherwise I will see you Thursday. Oh and just so you all know, we will be doing a. CEU cruise the weekend before Valentine's Day in 2021. So if you need those face to face CEUs, consider pre registering so we can so we can get the group rate. Between writing notes, filing insurance claims and scheduling with clients, it can be hard to stay organized. That's why I recommend TherapyNotes. Their easy to use platform lets you manage your practice securely and efficiently. Visit therapynotes.com to get two free months of therapy notes by just using the promo code CEU or when you sign up for a free trial@theapynotes.com. 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