Clinical Trial: CBD Dosing Reduces Anxiety and Tremor in Parkinson’s Patients
Sao Carlos, Brazil: Cannabidiol administration is associated with both decreased anxiety and tremor amplitude in patients with Parkinson’s disease (PD), according to clinical trial data published in the Journal of Psychopharmacology.
A team of Brazilian researchers assessed the efficacy of a 300mg dose of CBD in patients with PD in a randomized, placebo-controlled model. Acute CBD administration was associated with a statistically significant reduction in experimentally-induced anxiety and tremor.
A previous trial similarly reported that CBD was anxiolytic at doses of 300mg in healthy volunteers, but that it was not so at higher (600mg) and lower doses (150mg).
Observational trial data has previously reported that inhaled cannabis is associated with improvements in multiple PD symptoms, including tremor, rigidity, and bradykinsea.
Full text of the study, “Effects of acute cannabidiol administration on anxiety and tremors induced by a simulated public speaking test in patients with Parkinson’s disease,” appears in the Journal of Psychopharmacology. Additional information on cannabinoids and PD is available from NORML.
CBD for Parkinson’s Disease
Parkinson’s disease is a neurodegenerative disorder that progressively causes neurons to die. One function of neurons is to create a neurotransmitter called dopamine, a chemical messenger responsible for sending messages between neural cells in the brain. Parkinson’s disease primarily affects dopamine-producing neurons in an area of the brain called the substantia nigra, causing critically low levels of dopamine that negatively affect motor function.
The result of this is a gradual loss of motor control, with symptoms starting gradually, usually with a noticeable tremor in just one hand. However, people with Parkinson’s disease also often exhibit emotional and behavioral changes, including sleeping problems and depression. Taken together, this makes Parkinson’s a debilitating disease that affects the patient, but also those around them.
The cause of Parkinson’s disease is still unknown and there is no cure for it.
Symptoms of Parkinson’s Disease
People with Parkinson’s typically start experiencing symptoms in the later stages of the disease, after a significant number of neurons have been damaged or lost. Symptoms develop slowly over multiple years, and they differ from person to person. Because symptoms often differ from one person to the next, not all symptoms listed below are necessary for a Parkinson’s diagnosis. Younger people in particular may only exhibit one or two of these symptoms, especially in the earlier stages of the disease.
While a variety of other symptoms may occur, the primary motor symptoms of Parkinson’s disease include:
Tremors that tend to occur at rest, is usually slow and rhythmic, occurring first in the hand, foot, leg, jaw, chin, mouth, or tongue—and eventually spreading across the body
A sensation of internal tremors, which are not necessarily visible to others.
Rigidity including tightness or stiffness of the limbs or torso
Bradykinesia, or “slow movement,” a reduced or mask-like expression of the face, blinking less frequently
Difficulties with fine motor coordination
Postural instability including an inability to maintain a steady, upright posture, or to prevent a fall, that becomes more pronounced in the later stages of the disease, this symptom causes
Walking or gait difficulties that may begin as a small change in the way the arm swings while walking and evolving into a slow, small, shuffling gait, rapid small steps, or freezing episodes in which the feet appear to be glued to the floor
While they are less noticeable—and often overlooked because of the disease being a movement disorder—there are also many associated non-motor symptoms of Parkinson’s. Disturbances in the sense of smell, eye and vision issues, sleep problems, depression, anxiety, pain, psychosis, fatigue, cognitive changes, weight loss, lightheadedness, sweating, melanoma, personality changes, and gastrointestinal, urinary, and sexual issues can all occur in patients of Parkinson’s disease.
Parkinson’s Disease Medications & Treatment
There is no cure for Parkinson’s disease. Because symptoms don’t exhibit themselves until the later stages of the disease, early diagnosis is difficult—but scientists continue to search for ways to identify the early onset of Parkinson’s. While no treatment options currently available can slow or halt the progress of Parkinson’s disease, there are treatments available to improve its symptoms.
Almost all Parkinson’s patients will eventually require medication to treat their motor symptoms. Several classes of medications are available, and often patients will be prescribed various strengths, formulations, and combinations of medications to improve their symptoms. These include:
Levodopa works by being converted to dopamine in the brain. Side-effects include nausea, usually requiring it to be taken with carbidopa. If symptoms return between doses (OFF periods) an infison of levodopa that is administered through a tube called duopa, a powder form of levodopa which can be inhaled, or the new medication istradefylline (Nourianz) may be prescribed. Levodopa treatments are often delayed as long as possible as its effects wear off over time and it eventually stops working, causing the patient to develop movement problems called “motor fluctuations”.
Safinamide (Xadago) is prescribed when patients taking levodopa and carbidopa have a breakthrough of Parkinson’s symptoms that were previously under control. Side effects include trouble falling or staying asleep, nausea, falls, and uncontrolled, involuntary movements.
Dopamine agonists that imitate the action of dopamine in the brain to treat the motor symptoms of Parkinson’s disease. Examples include pramipexole, rot ropinirole and igotine that can be taken on their own or with levodopa. Side effects can include nausea, orthostatichypotension, hallucinations, somnolence, and impulse control disorders.
The most common non-pharmaceutical interventions include lifestyle changes that can help slow disease progression and make symptoms more manageable. These include eating a healthy diet and a proper exercise program to help maximize the potential of medications, increase energy, and promote general health and well-being in Parkinson’s patients.
Physical, occupational and speech therapies can help with walking and gait issues, fine motor skills, and speech and language issues that may arise with Parkinson’s disease while deep brain stimulation (DBS) may improve symptoms in certain patients.
CBD for Parkinson’s Disease
Research & Scientific Evidence
A handful of studies have investigated the effects of cannabidiol (CBD) to treat Parkinson’s disease and symptom management. However, the main body of evidence showing that CBD has promise as an effective treatment for this disease lies in studies relating to adjunct actions and complications from the disease including oxidative stress, neural inflammation and neurodegeneration.
One such study is from 2011 in which researchers published the findings of the journal Psychopharmacology. Because of many neurodegenerative disorders involving cognitive deficits, they assessed whether the anti-inflammatory, and neuroprotective effects of CBD could be useful in the treatment of memory impairment associated to these diseases.
Using an animal model of cognitive impairment induced by iron overload, they tested the effects of CBD in memory-impaired rats in both a single dose as well as continued use. In the first experimental condition, the researchers administering a single dose of either 5.0 mg/kg or 10.0 mg/kg of CBD immediately after a training session of the novel object recognition task. They continued a daily intraperitoneal CBD injection for 14 days to examine chronic use and performed object recognition training 24 hours after the last dose and a retention tests 24 hours after training.
They found that a single dose of 10.0 mg/kg of CBD recovered memory while repeated CBD administration of either CBD dose improved recognition memory. They concluded that the evidence suggests that CBD shows potential for the treatment of cognitive decline associated with neurodegenerative disorders.
21 Parkinson’s disease patients without dementia or comorbid psychiatric conditions were assigned to three groups of seven subjects each. The control group was treated with a placebo, the first experimental group with 75 mg/day of CBD and the second experimental group with 300 mg/day of CBD. Participants were assessed in respect to motor and general symptoms, well-being and quality of life, and possible neuroprotective effects one week before and again, during the last week of treatment.
Although they didn’t find a statistically significant different between the group for motor and general symptom outcomes or neuroprotective effects, they did find that the patients treated with 300 mg/day of CBD had a significant improvement in their quality of life. However, the researchers also noted that studies with larger samples and specific objectives are required before definitive conclusions can be drawn.
In contrast, the latest research from 2020 suggests that CBD can help with motor symptoms, specifically tremors. In the Journal of Psychopharmacology, researchers published the results from their study aimed at evaluating the impact of a single dose of 300 mg CBD on anxiety measures and tremors induced by a Simulated Public Speaking Test (SPST) in individuals with Parkinson’s disease. They found that a single dose of 300 mg CBD not only decreased anxiety in patients with Parkinson’s disease but that there was also decreased tremor amplitude in an anxiety-provoking situation.
In a 2015 study published in Toxicology in Vitro, scientists investigated the potential neurorestorative effects of CBD and the pathways that mediate it for the treatment of Parkinson’s disease.
They used rat neurons treated with a neurotoxin that is known to induce Parkinson’s disease in vivo and presents with neuroinflammation, excitotoxicity, mitochondrial dysfunction and reduced neurotrophic support. Cell viability, neuritogenesis (the process of forming of new neurites), neural growth factor (NGF) and neuronal protein expression, and the involvement of NGF receptors after CBD exposure were measured.
The data indicated that CBD has neuroprotective effects on neural cells that involves neuritogenesis, NGF receptors as well as an increased expression of axonal and synaptic proteins leading them to conclude that the neuroprotective effects of CBD might be beneficial in Parkinson’s disease.
Anecdotal Evidence – using CBD oil for Parkinson’s
The scientific evidence seems to indicate that CBD has the potential to improve quality of life for patients with Parkinson’s disease in addition to reducing neuroinflammation and oxidative stress as well as induce neurogenesis and neuritogenesis that can potentially slow or even reverse disease progression. Anecdotal evidence also shows that CBD may improve Parkinson’s disease symptoms in some patients but it would seem that many people find a greater relief and reduction in motor symptoms when using cannabis. In fact, according to this study, while only 4.3% of a self-report survey of patients with Parkinson’s disease used cannabis, it ranked among the most effective complimentary and alternative therapies listed.
CBD as a complementary treatment for Parkinson’s
CBD can also play a role as a complementary therapy to help reduce many of the symptoms associated with the pharmaceutical treatments usually prescribed to patients with Parkinson’s disease. CBD can help alleviate gastrointestinal issues like nausea from side effects of levodopa and safinamide. Likewise, CBD has specifically been shown to help improve complex sleep-related behaviors associated with rapid eye movement sleep behavior disorder as well as psychosis in Parkinson’s disease patients.
The anti-inflammatory, anti-oxidative, neuroprotective and neuroregenaritive effects of CBD can all prove to make it a promising treatment for Parkinson’s disease, for both symptom reduction as well as even potentially slowing down disease progression. In addition, the data shows that CBD is also effective at improving overall quality of life. However, it would seem that high dosages of 300 mg/day produced the best effects, probably due to CBD being a pleiotropic drug that produces different effects through multiple molecular pathways at different dosages. As always, speak to your treating physician before using CBD to monitor dosage, symptom severity, and other clinical parameters. In addition, CBD is contraindicated with use with certain medications, so they can ensure that your CBD treatment is both safe and effective.
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