Can CBD Cause Psychosis? Is That A Crazy Question?

Lots of people are interested in trying one of the CBD products that have hit the market in recent years. Quite a few, though, aren’t sure what makes CBD different from the THC that makes weed users high.

That’s why they may worry about CBD’s potential side effects, particularly since marijuana has been shown to occasionally trigger the symptoms of psychotic behavior.

There’s nothing to worry about. CBD (cannabidiol) and THC (tetrahydrocannabinol) are very similar plant compounds, and they’re both found in hemp — the plant that CBD is sourced from — and cannabis. But the two compounds, known as cannabinoids, act very differently in the body.

THC does the bulk of its work in the brain, where it makes people high and may cause rare but serious negative side effects. Cannabidiol, however, delivers the majority of its apparent benefits throughout the rest of the body, doesn’t cause intoxication, and only rarely causes side effects, none of them severe.

Any concern about a link between CBD and psychosis is misplaced.

The THC in weed can occasionally make some users experience hostility, disorganized thinking, paranoia, and other signs of serious mental illnesses like psychosis. But many experts say those are just temporary episodes, not evidence that THC can cause psychosis or other mental health conditions.

And some believe there’s even more to the story. They say that existing evidence simply shows that those with psychosis or schizophrenia are more likely to use marijuana, possibly trying to self-medicate. They say there’s no proof that weed causes psychosis.

The few anecdotal stories about CBD users exhibiting psychotic symptoms don’t stand up under scrutiny. It turns out the users had either taken CBD containing more THC than legally allowed, or consumed such enormous amounts of CBD that the small amount of THC in cannabidiol built up to the point where it caused problematic side effects.

There’s complete agreement on the primary question we’re considering, though. CBD doesn’t cause any of the symptoms associated with psychosis, and certainly can’t cause serious mental illness.

Want to learn more? Or curious about why there’s THC in CBD products? We have the answers.

What’s in Extracted CBD?

CBD and THC are more than 100 cannabinoids found in both hemp and cannabis plants, and they’re the two most important. Hemp contains lots of CBD and very little THC, while cannabis is loaded with THC and has very little CBD content. That’s why the non-intoxicating cannabidiol used to create CBD products is extracted from hemp plants and not cannabis plants.

However, even the most efficient (and expensive) extraction process available, known as supercritical CO₂ extraction, isn’t perfect. When CBD is taken from hemp plants, other plant compounds come along — including terpenes, other cannabinoids, and hemp’s small amount of THC, which is not enough to get anyone high under normal circumstances.

Here are the specifics for those interested. Governments that have legalised the sale of CBD products dramatically limit the products’ THC content. In the UK and some other countries, there can be no more than 0.2% THC in the products; the limit is 0.3% in the US and many other nations. That compares with the 25-30% THC content found in very potent weed strains.

Those numbers don’t lie. Even if taking extremely high doses of cannabidiol, its 0.2 or 0.3% THC content won’t come close to altering their perceptions or thoughts — and most certainly can’t cause psychosis in any responsible user (and for that matter, almost any irresponsible user).

In one of the extremely rare cases of psychosis said to be linked to cannabidiol cited in our introduction, the user had taken a dose of CBD hundreds of times higher than normal and way above the very high amount that studies show safe for consumption without side effects. That’s how the THC in their system apparently built to problematic levels.

(For comparison, there’s alcohol in the small bottles of pure vanilla extract used in baking. Most recipes call for about ¼ teaspoon of vanilla, so you could make 48 recipes with a standard-sized bottle. ¼ teaspoon of vanilla, or even an entire bottle, won’t get you drunk — but if you start downing bottle after bottle, you could eventually get there and suffer ill effects.)

Can You Buy CBD Without Any THC Content?

When shopping for CBD products, you’ll notice there are usually three versions to choose from: full-spectrum, broad-spectrum, and CBD isolate.

Full-spectrum products contain the extracted cannabidiol we’ve been discussing; they contain all of hemp’s plant compounds, including the low level of THC. That’s a good thing, because the compounds work together in an “entourage effect” to maximize CBD’s apparent medical benefits.

For those who want to limit their THC consumption even further (they may be allergic to the cannabinoid or may be afraid of flunking a cannabis drug test), broad-spectrum has been processed further to remove the THC content (although traces may remain). CBD isolate has had all other plant compounds, including all traces of THC, removed.

Be aware, though, that removing THC and other compounds from extracted cannabidiol lowers or eliminates the entourage effect. Broad-spectrum and isolate products still deliver most of the CBD’s purported benefits, but full-spectrum products will always be the most effective.

The Effects of THC and CBD

It may seem odd that two cannabinoids that have the same molecules behave so differently inside the body, but one small difference between them makes all the difference. The atoms in CBD and THC are arranged differently; that gives them different chemical properties and causes them to interact with different protein structures in the body.

First, a bit of background. A large majority of the body’s most important functions, ranging from thinking and immunity to pain, sleep, and inflammation, are governed by a full-body network called the endocannabinoid system (ECS). The ECS is a collection of receptors (the protein structures we just mentioned) and chemical messengers that shuttle between them.

There are two key groups of ECS receptors. CB1 receptors are primarily found in the brain and nervous system, and they control most brain operations like thought, memory, pain, and sleep. CB2 receptors are mostly located elsewhere in the body and govern functions like inflammation and immunity.

The ECS is where THC and CBD do their work. They’re both very similar to the chemical messengers known as endocannabinoids, which are produced inside the body and carry instructions between ECS receptors. That similarity allows THC and CBD to interact with the receptors and deliver their own instructions or interfere with the ones being sent.

That brings us to the slight structural difference between THC and CBD, which causes the two cannabinoids to act differently and provide different effects. THC binds to the CB1 receptors in the ECS, allowing it to affect brain operations in ways that make users high. CBD interacts primarily with CB2 receptors, so it doesn’t have a major impact on brain processing.

The difference also explains why THC and CBD don’t appear to deliver all of the same health and wellness benefits, but that’s a subject for a different article. Here, we’re focused mainly on issues like psychosis and mental illness, so let’s go there next.

THC, CBD, and Psychosis

Psychosis is an “umbrella” diagnosis describing a collection of symptoms that show a patient’s thoughts aren’t strongly tied to reality. Delusions, hallucinations, an inability to effectively focus thoughts, and unreasonable hostility are signs of this mental disorder.

As you’ve probably guessed, psychosis symptoms are triggered in the brain, where the bulk of the endocannabinoid system’s CB1 receptors are located. Many are in the amygdala, the part of the brain where emotions associated with psychosis are triggered. Research suggests that THC increases activity in the amygdala and may overstimulate it, causing psychosis symptoms.

Why are those delusional and possibly imaginary perceptions experienced by only a small number of weed users? Research has found that the marijuana’s potency and the user’s genetics appear to play large roles — and one study claims that women’s higher oestrogen levels may make significantly them more sensitive to THC’s effects and put them more at risk.

Another theory is also worth considering. Even though the link between THC and the occasional appearance of psychosis symptoms is unquestioned, one prominent expert believes there’s more to the story.

Dr. Nora Volkow, director of the US National Institute on Drug Abuse, says research shows only that people suffering from schizophrenia are likely to be marijuana users, not that the drug causes psychosis and other serious issues. She says studies also show that those vulnerable to serious mental illnesses are more likely to experience psychotic episodes after smoking weed.

Some believe those who are vulnerable are more likely to use cannabis as a way to self-medicate, and one study has shown that people with a genetic risk of psychosis who use cannabis have a six times greater risk of becoming schizophrenic, while those not at risk have virtually no chance of developing the disorder.

Whatever the causality may be, and whether psychotic episodes are more common now that marijuana use is more common (there are conflicting opinions on that as well), that doesn’t change the fact that using CBD doesn’t cause psychosis.

We’ve already discussed one of the reasons why: the extremely small THC content in cannabidiol. Here’s the other: CBD doesn’t interact with CB1 receptors in the brain to any large extent, so it’s not even “playing in the playground” where THC might cause symptoms associated with psychosis, schizophrenia, or other serious mental illnesses.

In fact, there’s some evidence that administration of CBD may help ease psychotic symptoms triggered by THC use. And a few studies show that cannabidiol may even reduce the risk of those episodes in weed smokers. That evidence is from preliminary studies, and much more research must be done to gain clarity on those possibilities.

One thing remains certain, though: people using CBD products don’t have to worry about serious, unwanted side effects like psychosis.

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