Obsessive-Compulsive Disorder

25th June 2026

Obsessive-Compulsive Disorder (OCD) affects approximately 2-3% of people worldwide and is recognised as a potentially disabling mental health condition. For many individuals, symptoms can be time-consuming and may significantly impact daily functioning, including work, education, relationships, and overall quality of life.

OCD is more than a preference for order or perfectionism. It is characterised by intrusive, unwanted thoughts (obsessions) and repetitive behaviours or mental rituals (compulsions) performed to reduce distress. While these behaviours may provide temporary relief, they often reinforce the cycle of anxiety over time.

Although many individuals experience some improvement with conventional treatment approaches, some individuals continue to experience residual symptoms such as anxiety, sleep disturbance, and functional impairment despite ongoing care.

In cases where symptoms remain difficult to manage, some patients and clinicians may explore adjunctive strategies alongside standard care. One emerging area of interest is the role of the endocannabinoid system in modulating stress, emotional regulation, and sleep-related processes.

How Cannabinoids Can Help

Preclinical and early clinical research suggests that cannabinoids may influence pathways involved in anxiety, stress response, and sleep regulation. While research in OCD specifically is still limited, the endocannabinoid system is thought to play a role in emotional processing and behavioural regulation. As such, cannabinoids are being investigated as a potential adjunct in certain anxiety-related conditions.

At present, evidence for the use of medical cannabinoids in OCD remains preliminary, and they should not be considered a first-line treatment. Any consideration of cannabinoid-based approaches should be made within a comprehensive treatment plan under the guidance of a qualified healthcare professional.

Mechanisms of Action

Tetrahydrocannabinol (THC)

THC is one of the active compounds found in cannabinoids. It works by interacting with receptors in the brain and nervous system. In some individuals, THC may help promote relaxation and support sleep. Responses to THC can vary from person to person and may depend on the dose used. For this reason, treatment decisions, product selection, and dosing should always be guided by a healthcare professional and reviewed regularly based on individual response.

Cannabidiol (CBD)

CBD is a non-intoxicating compound found in cannabinoids, meaning it does not typically cause a “high.” CBD may help support a sense of calm and reduce anxiety in some individuals. It is thought to work through several pathways in the body and brain, including systems involved in mood, stress response, and natural regulation. In some children, CBD may also support sleep and emotional regulation. However, responses vary between individuals, and not every child will experience the same effects. The way CBD works is still being studied, and treatment should be guided and monitored by a healthcare professional.

Common Conditions Related to Obsessive-Compulsive Disorder [1]

• Anxiety Disorders: OCD frequently co-occurs with other anxiety-related conditions, including generalised anxiety disorder and social anxiety disorder, with overlapping symptoms of chronic worry, hypervigilance, and heightened threat sensitivity.
• Depression: The persistent distress and functional impairments associated with OCD can contribute to depressive symptoms, including low mood, reduced motivation, and anhedonia.
• ADHD: Some individuals with OCD may present with attentional and executive functioning difficulties. When present, these may complicate diagnostic clarity and treatment planning.
• Sleep Disturbances: Sleep problems are commonly reported in OCD and are often linked to intrusive thoughts and ongoing, repetitive thinking at bedtime, which can make it harder to fall asleep and reduce overall sleep quality.
• Body-Focused Repetitive Behaviours: Some individuals may also experience repetitive behaviours such as skin picking or hair pulling. These can occur alongside OCD symptoms or within related conditions that share similar features.

Conventional Treatments

• Cognitive Behavioural Therapy (CBT) with Exposure and Response Prevention (ERP): Considered the first-line psychological treatment for OCD. ERP involves gradual and systematic exposure to feared thoughts, objects, or situations while refraining from compulsive responses, aiming to reduce symptom severity over time [1].
• Selective Serotonin Reuptake Inhibitors (SSRIs): Common side effects may include nausea and vomiting, changes in appetite (either increased or decreased), weight changes, sleep disturbances, agitation or restlessness, confusion, and increased blood pressure. In some cases, SSRIs may also increase the risk of upper gastrointestinal bleeding, particularly when combined with other medications that affect bleeding risk [1].
• Augmentation Strategies: Addition of antipsychotics or other medications when SSRIs alone are insufficient.
• Additional Therapies: Adjunctive psychological interventions such as mindfulness-based approaches, acceptance and commitment therapy and psychiatric support.

Clinical Evidence

Anxiety and Compulsive Symptoms

Research suggests that cannabidiol (CBD) may help reduce anxiety in some people, which can be relevant for individuals with OCD who experience high levels of distress. In controlled studies, CBD has been associated with reduced anxiety symptoms and improved wellbeing [2].

Broader research reviews suggest that cannabinoids may have calming effects in some neuropsychiatric conditions, but evidence specifically for OCD is still limited and in early stages [3]. Some observational studies report changes in symptoms and quality of life in people with OCD or OCD-like symptoms who use cannabis-based products, but these findings cannot confirm cause and effect [4,5].

Intrusive Thoughts and Rumination

At present, there is no strong clinical evidence from controlled studies showing that cannabinoids directly reduce core OCD symptoms such as intrusive thoughts or compulsions [1,6].

However, early clinical observations and reviews suggest that cannabinoids may influence the broader stress and anxiety systems that are often associated with OCD symptom severity. A case report and literature review describe improvements in OCD symptoms in individual cases, although these findings are limited and cannot be generalised to broader clinical populations [7].

Another study also found that acute administration of CBD was associated with short-term reductions in obsessive-compulsive symptoms under experimental conditions, but these effects were temporary and do not establish long-term treatment efficacy [2].

Overall, any potential benefit is currently understood as being more related to reducing anxiety and distress, rather than directly modifying the underlying OCD cycle [1,6].

Sleep Quality and Night-Time Anxiety

Some research suggests that cannabinoid-based treatments may help improve sleep quality and reduce the time it takes to fall asleep, particularly in people experiencing anxiety or related neuropsychiatric symptoms [3].

Some studies also include combined THC and CBD formulations, which have been associated with improvements in sleep onset and overall sleep quality in broader clinical populations. However, responses can vary between individuals, and effects depend on the specific formulation used [3].

This may be relevant in OCD, as sleep difficulties are common and often linked to heightened anxiety and difficulty switching off at night [1].

Improved sleep may indirectly support daily functioning, emotional resilience, and engagement in psychological therapies such as CBT with Exposure and Response Prevention (ERP). These findings are based on broader research and have not yet been specifically confirmed in OCD populations [3,5].

Benefits of Cannabinoids

• Support for Anxiety and Stress Symptoms: Early research suggests that cannabinoids may help reduce anxiety and stress in some individuals, which can indirectly reduce the distress associated with obsessive thoughts and compulsive urges [2,3].
• Favourable Tolerability in Some Individuals: CBD in particular is generally well tolerated in research settings, although side effects can still occur and may vary depending on dose, product type, and individual response. Compared with some standard medications, it does not typically produce emotional blunting or appetite suppression, but it is not side-effect free [3].
• Sleep Support: Some studies suggest that cannabinoid-based treatments may help improve sleep quality and reduce time to fall asleep, particularly in individuals with anxiety-related symptoms [3]. Improved sleep may indirectly support emotional regulation and daytime functioning in OCD [1].
• Multi-Symptom Support (Indirect): Cannabinoids may influence several symptom domains such as anxiety, stress response, and sleep. However, current evidence suggests these effects are indirect and vary between individuals rather than targeting OCD symptoms directly [6,1].
• Complementary to Psychological Therapy: By potentially reducing anxiety and improving sleep, cannabinoids may help some individuals feel more able to engage in psychological treatments such as CBT with Exposure and Response Prevention (ERP). They are not a replacement for these therapies but may be considered as part of a broader treatment plan in some cases [1].

Side effects of CBD

CBD is generally well-tolerated, with most adverse effects being mild to moderate. These may include diarrhea, nausea, appetite changes, somnolence, and fatigue. Elevations in liver enzymes may occur, particularly when used with valproate or other medications metabolised by the liver. Serious adverse effects are rare. Baseline and periodic liver function monitoring is recommended, especially in patients with hepatic impairment or those receiving hepatotoxic medications.

Drug Interactions

CBD may interact with other medications, and some medications may also affect CBD levels in the body. These interactions can occur through shared liver enzyme pathways, including CYP3A4 and CYP2C9.

As a result, levels of either CBD or certain medications may increase or decrease, which may affect therapeutic response and the risk of side effects. This may be particularly relevant for certain cardiovascular, psychiatric, and anticonvulsant medications.

The extent of interaction varies depending on the specific medication, cannabinoid formulation, and individual patient metabolism.

Conclusion

For individuals with OCD who continue to experience significant anxiety, sleep difficulties, or functional impairment despite standard psychological and pharmacological treatment, medical cannabinoids may be considered as a carefully supervised adjunctive option in selected cases. Current research suggests that cannabinoid-based treatments, particularly CBD-containing formulations, may help reduce anxiety and support sleep in some individuals; however, evidence specifically in obsessive-compulsive disorder remains limited and continues to evolve. Cannabinoids are not a replacement for first-line treatments such as psychological therapy (including CBT with Exposure and Response Prevention) and pharmacological interventions, which remain the foundation of OCD care. Instead, they may be considered in selected cases as part of an integrated, specialist-guided approach aimed at supporting overall symptom burden, functioning, and quality of life.

How to Access AKOS BIO Cannabinoid Therapy

If you are interested in exploring cannabinoid-based treatment as part of your therapeutic plan, discuss this option with your treating healthcare provider. They can help determine whether cannabinoid therapy may be appropriate for your individual circumstances.

Alternatively, if you would like to explore AKOS BIO’s pharmaceutical-grade cannabinoid products, you can book a consultation with an independent prescribing healthcare practitioner via the AKOS BIO website.

AKOS BIO provides pharmaceutical-grade cannabinoid products and educational resources to support patients and healthcare professionals. Prescribing decisions are made independently by qualified healthcare practitioners.

In South Africa, AKOS BIO doctors will apply for your Section 21 licence (SAHPRA) on your behalf if medical cannabis is appropriate for your condition. The permit is valid for six months and can be renewed if treatment is effective.

For more information or to book a consultation:

Website: www.akos-bio.com

WhatsApp: 066 269 1108

References

[1] Brock, H., Rizvi, A., & Hany, M. (2026). Obsessive-Compulsive Disorder. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK553162/

[2] Kayser, R. R., Haney, M., Raskin, M., Arout, C., & Simpson, H. B. (2020). Acute effects of cannabinoids on symptoms of obsessive‐compulsive disorder: A human laboratory study. Depression and Anxiety, 37(8), 801–811. https://doi.org/10.1002/da.23032

[3] Rice, L. J., Cannon, L., Dadlani, N., Cheung, M. M. Y., Einfeld, S. L., Efron, D., Dossetor, D. R., & Elliott, E. J. (2024). Efficacy of cannabinoids in neurodevelopmental and neuropsychiatric disorders among children and adolescents: A systematic review. European Child & Adolescent Psychiatry, 33(2), 505–526. https://doi.org/10.1007/s00787-023-02169-w

[4] Lynskey, M. T., Athanasiou-Fragkouli, A., Schlag, A. K., & Nutt, D. J. (2025). Medicinal Cannabis Use Among People with Obsessive Compulsive Disorder: Changes in Quality of Life After Three Months. Psychoactives, 4(2), 16. https://doi.org/10.3390/psychoactives4020016

[5] Nicolini, H., Martínez-Magaña, J. J., Genis-Mendoza, A. D., Villatoro Velázquez, J. A., Camarena, B., Fleiz Bautista, C., Bustos-Gamiño, M., Aguilar García, A., Lanzagorta, N., & Medina-Mora, M. E. (2021). Cannabis Use in People With Obsessive-Compulsive Symptomatology: Results From a Mexican Epidemiological Sample. Frontiers in Psychiatry, 12, 664228. https://doi.org/10.3389/fpsyt.2021.664228

[6] Kayser, R. R., Snorrason, I., Haney, M., Lee, F. S., & Simpson, H. B. (2019). The Endocannabinoid System: A New Treatment Target for Obsessive Compulsive Disorder? Cannabis & Cannabinoid Research, 4(2), 77–87. https://doi.org/10.1089/can.2018.0049

[7] Szejko, N., Fremer, C., & Müller-Vahl, K. R. (2020). Cannabis Improves Obsessive-Compulsive Disorder—Case Report and Review of the Literature. Frontiers in Psychiatry, 11, 681. https://doi.org/10.3389/fpsyt.2020.00681

[8] Blessing, E. M., Steenkamp, M. M., Manzanares, J., & Marmar, C. R. (2015). Cannabidiol as a potential treatment for anxiety disorders. Neurotherapeutics, 12(4), 825–836. https://doi.org/10.1007/s13311-015-0387-1

[9] Kuhathasan, N., Dufort, A., MacKillop, J., Gottschalk, R., Minuzzi, L., & Frey, B. N. (2019). The use of cannabinoids for sleep: A critical review on clinical trials. Experimental and Clinical Psychopharmacology, 27(4), 383–401. https://doi.org/10.1037/pha0000285

[10] Shannon, S., Lewis, N., Lee, H., & Hughes, S. (2019). Cannabidiol in anxiety and sleep: A large case series. The Permanente Journal, 23, 18–041. https://doi.org/10.7812/TPP/18-041