Psychiatry | Mount Sinai Today

How to Talk to Your Child About COVID-19

Updated on Jun 30, 2022 | Children's Health, COVID-19, Mental Health, Psychiatry, Your Health

Discussing difficult topics with children can be uncomfortable and this pandemic is no exception. Aliza Pressman, PhD, co-Founding Director and Director of Clinical Programming for the Mount Sinai Parenting Center, shares information parents and guardians can use as they care for children during the time of COVID-19.

Should I let my children watch the news?

If you want to give age-appropriate information to your kids, I recommend reading articles from reputable sources—either to them or with them—and then talking about the information. You may want to stick with resources that do not show images as it can be hard for children—and adults—to get images out of their minds.

We don’t want our children to see difficult images that we cannot control. For that reason, I would recommend turning off the news completely in front of younger children. In fact, older children and teenagers don’t really need those images either. Ideally, you should set aside time to watch the news to when you are alone or with other adults. This will also help manage your own stress because you will be limiting the amount of time you spend taking in this information.

I would discourage people of all ages from watching the news too much. Having the news on 24/7 heightens stress in the household and sends the message that you’re scared to turn the news off because you’re afraid you’ll miss something.

How do I help my child understand why they cannot see their friends and loved ones?

It can be hard for children to be unable to visit friends and loved ones, like grandparents, who they might be accustomed to seeing regularly. Try to empathize with your child and help them come up with proactive ways to connect with grandparents or other loved ones whom they cannot see.

This is the time to take advantage of social media and digital devices to empower your child to forge a connection with someone when they are not in the same room. Help turn sadness into productive action by encouraging your child to write letters, send notes, call, and video chat. These are beautiful ways to connect and show children that there is something they can do to help a person they love feel better.

If your child doesn’t have someone to connect with, there are organizations that can help you reach out, write letters, and draw pictures for elderly and vulnerable people who are currently isolated.

Should I tell my child if a loved one is seriously ill?

No matter how old your child is, it’s important to be honest and give your child the information needed. How you explain the situation depends on the child’s age.

For younger children, if a close family member is ill and you know how that illness is progressing, you can tell your child that the person tested positive for COVID-19. Explain the care that person is receiving and that you need to support them from afar.

If the person is very ill and you do not know what the outcome will be, it’s okay to express that to your child. Explain that the person is receiving great care and that you will keep in touch to see how things are going. You do not want to tell your child that everything is fine and then, all of a sudden, the person’s condition deteriorates.

On the other hand, if the person is asymptomatic and has tested positive, you don’t necessarily need to tell your children.

What if I or my partner becomes ill?

If you or your partner are sick, you need to tell your child what is going on. Explain that COVID-19 is very contagious. Explain that, in order to keep their body healthy and their parent’s body healthy, you will need to be separated for 14 days. You can make a calendar as a visual reminder of how long you will be apart. This can work well for the whole family as even adults can benefit from being able to check off each day of quarantine as it passes.

When you explain anything to children, be sure to check in first. See what they know already and then you can see where to begin with the explanation.

Dr. Pressman is the host of parenting podcast Raising Good Humans. Recently, she and Mariel Benjamin, LCSW, from The Mount Sinai Parenting Center, answered questions from health care providers and staff on the front lines to help support their parenting curing COVID-19. Additionally, The Mount Sinai Parenting Center maintains a COVID-19 resources page for parents, caregivers, and health care workers.

COVID-19: Coping and Resiliency Skills

Mar 31, 2020 | COVID-19, Mental Health, Psychiatry, Your Health

As the outbreak of COVID-19 spreads throughout the greater New York area, people are adjusting to radical changes in their daily life. Businesses are closed, people are working from home—if they are able to work at all—and kids are trying to learn at home. It’s a stressful time for everybody. Rachel Yehuda, PhD, Professor of Psychiatry and Neuroscience at the Icahn School of Medicine at Mount Sinai, offers this advice about resiliency skills and coping with the COVID-19 crisis.

It’s hard not to get overwhelmed by the news. Should you limit the amount of news you watch?

There’s a part of me that wants to keep up with every update. I try to limit my exposure because much of the news is repetitive and some of it is sensationalized. I was out west in mid-March for a brief trip, and saw pictures on the news of empty shopping shelves here in New York. I was pretty worried until I got home that there might be shortages. Of course when I did return, I realized that the situation wasn’t quite as bad as portrayed. People did panic-shop, but the shelves were also getting restocked. So my worry in that case was exaggerated.

On the other hand, it is a good idea to check in a couple times a day to get the latest reports. Let’s face it, a pandemic is a scary thing to be a part of, and there are important updates that we need in real time. The important news is information about what we can do or should be doing. We need to make sure we get our news from reputable sources, like the World Health Organization. Some news outlets have an agenda that they are trying to promote, and I don’t think that’s helpful or healthy to engage in because it may increase distress. But, even if you’re getting news from reputable sources, you don’t need it 24/7.

It’s hard to avoid if you’re home.

True, but it’s also a time when you can do other things at home other than having the TV on. It’s a time that you can read, write, do something creative, meditate, or try a recipe you’ve wanted to try. You can spend time playing with your children, writing letters, or get organized, even clean out your closet.

Think of something you can do at home that will make you feel productive, and that you’ve accomplished something at the end of the day. Put the focus on enhancing your home experience as opposed to what you can’t do in the outside world.

It’s also a really good time to check in on friends, neighbors and particularly, older folks. Now is the time to catch up with other people, perhaps there’s someone you haven’t had a chance to talk to. Or maybe there’s an older person who’s shut in and isolated and needs help. It’s a healthy and healing thing to think about other people, rather than focus exclusively on yourself.

Some people are reporting that they are learning a new “coronavirus skill or art.” Think about the things you have always wanted to do, but never had the time. Arts and crafts. Watercolors. Play a musical instrument.

Does sticking to a daily routine help keep you on track?

For some people it’s very good. For children, in particular, the structure of a routine is very grounding. But there is also something liberating about a guilty pleasure of going off routine. If you always wake up really early to commute to work, there is nothing wrong with giving yourself a treat of an extra hour of sleep to make up for some of the negative aspects of not being able to go out and do whatever you want. So I wouldn’t rigidly advocate it for everyone. If you feel lost without a structure, like you are wasting the day or failing to be industrious or productive, a schedule can be important. But for people who find themselves over-scheduled, there is something about putting the world on mute and listening to one’s needs that can promote a sense of well-being.

The key is to be mindful about it. We are being given an opportunity to connect with something inside of ourselves that hasn’t been nurtured. We have been given more time. Sleep an extra hour, or skip a meal if you want. Do something you don’t ordinarily get to do. It’s a chance to embrace possibilities outside the box. We’re in a serious situation, but we can try to make the most of it and squeeze something positive out of it.

The people who are going to do the best are those who find special moments, special meaning, and special opportunities during this time. During the past couple days, I’ve gotten texts from people just asking “How are you doing? I’ve been thinking about you.” It’s wonderful to get those messages and connect when, otherwise, we might not have had time. And we’ll come out the other end of this changed in some way—maybe for the better.

Can you talk a bit about resiliency skills?

Optimism is certainly a big resiliency skill. Being able to look at the positive side of things is very important. I believe spiritual mindfulness is key; understanding what is in your control and what is not. And taking whatever control you can take, acting on it, and not feeling victimized. And knowing that this will all pass, and maybe good things will come from it in the future. This is hard to do while people are getting sick and dying, and when people are losing their jobs and faced with economic hardship. Grieving losses in real time is an important key to resilience in the future. Realistically assessing and starting to think about what will need to happen in the weeks to come if one has lost one’s job is also important.

Not feeling helpless, but trying to act is also an important way to build resilience. I am reminded of 9/11. At this time we want to behave in a way that when we look back, we will be proud of what we did during this pandemic—individually and as a society. If you bear that in mind, you won’t have disappointed yourself, and that is an important key to resilience.

Doing things for others—altruism—is also key. If you help others, even if there’s a certain amount of risk to yourself, you’ll feel good about yourself when all is said and done. Certainly health care workers on the front lines are expressing altruism each day. People are scared right now. Even people I know who are always positive are worried about getting sick, or even worse, being a carrier and getting someone even more vulnerable at risk. You should be careful if being helpful means posing a risk to yourself or to others. Yet there are many ways to contribute without leaving the house. We can show up each day in our lives—for ourselves and other people—and ask what can we do today to help. That’s resilience.

Five Things to Know About Esketamine

Mar 9, 2020 | Psychiatry

Dr. Murrough recently launched a TRD Program, featuring esketamine as a treatment option. He is a leader in clinical research in this area, such as the ongoing multi-center clinical trial known as ELEKT-D, which compares the safety and effectiveness of ketamine vs. electroconvulsive therapy.

In March 2019, intranasal esketamine—a form of ketamine marketed as SPRAVATO™ CIII Nasal Spray*—was approved by the U.S. Food and Drug Administration (FDA) to treat patients with treatment-resistant depression (TRD). James Murrough, MD, PhD, Director of Mount Sinai’s Depression and Anxiety Center for Discovery and Treatment, was deeply involved in the research that led to esketamine’s FDA approval. In November 2019, he launched a TRD Program at the Icahn School of Medicine at Mount Sinai, featuring esketamine as a treatment option. Below, Dr. Murrough breaks down the top five things to know about esketamine based on his experience over the past decade.

1. What it is. Esketamine is a potent variant of the drug ketamine, which has been used for 50 years in medical settings as an FDA-approved anesthetic. Ketamine is used off-label to treat depression, typically via intravenous infusion; esketamine, on the other hand, is administered at registered centers via nasal spray and is now FDA-approved for the treatment of TRD in conjunction with an oral antidepressant. It is classified as a controlled substance, and is not available for use outside of approved treatment centers. Prescription of esketamine is restricted through a specialized FDA-regulated program designed to minimize potential risks associated with a medication, known as a Risk Evaluation and Mitigation Strategy (REMS) program.

2. How it works. Via a series of complex biological processes, esketamine enhances the activity of glutamate in brain regions that are important for mood. (Glutamate is the principal neurotransmitter that excites cells in the brain and throughout the central nervous system.) This alteration in glutamate signaling is thought to increase neuroplasticity to 1) allow the brain to cope more effectively with stress, and 2) reverse depression-related brain changes. Because impaired neuroplasticity is linked to depression, the patient’s symptoms improve as the neuroplasticity increases, enhancing resiliency and enabling the patient to create new, more positive thoughts and behaviors.

3. How it’s administered. Esketamine takes five to ten minutes to administer via nasal spray, but patients remain under supervision for two hours for monitoring and are unable to drive for the rest of the day. The antidepressant effects may occur within days in some patients, in contrast to other antidepressants that typically require at least four to six weeks for effectiveness. As stated in the esketamine prescribing information, the treatment course begins with an acute induction phase that involves administering the nasal spray two times a week for four weeks. The first dose of this induction phase is 56 mg; however, the dose may be increased to 84 mg at subsequent visits depending on the patient’s reaction. If the patient exhibits evidence of the therapeutic benefit at the end of induction phase, the patient enters the maintenance phase of treatment. For this phase, dosing frequency should be decided on a case-by-case basis to determine the least frequent amount that still maintains clinical improvement.

4. Side effects. The most common side effects of esketamine are dissociation, dizziness, nausea, sedation, vertigo, hypoesthesia, anxiety, lethargy, increased blood pressure, vomiting, and feeling drunk. Additional data is being collected on an ongoing basis, and will likely uncover insights about potential longer-term side effects associated with continuous treatment.

5. The evidence. Years of research beginning in the late 1990s culminated in esketamine being developed and then approved in 2019 as the first mechanistically novel, non-monoaminergic antidepressant for patients with TRD. Early academic studies showed that even single doses of intravenous ketamine led to rapid and robust antidepressant effects in patients with TRD, with short-term responses rates generally between 60 and 70 percent. Subsequently, FDA registration trials testing the antidepressant effects of esketamine in TRD were comprised of three short-term trials, one randomized withdrawal trial, and one open-label longer-term safety study. FDA approval was granted based on two positive efficacy studies (one short-term and the randomized withdrawal trial), together with an acceptable safety profile. Meta-analytic studies using all available data confirm that treatment with esketamine leads to a significant beneficial effect in patients with TRD.

Dr. Murrough an Associate Professor of Psychiatry and Neuroscience at the Icahn School of Medicine at Mount Sinai. He is currently a site investigator on the ongoing multi-center clinical trial known as ELEKT-D, which compares the safety and effectiveness of ketamine vs. electroconvulsive therapy. He is actively involved in clinical research aimed at discovering safe, effective antidepressants with novel mechanisms of action.

*Mount Sinai was involved in the research that led to the development of this new treatment method for treatment-resistant depression and receives financial remuneration from the manufacturer of SPRAVATO. Mount Sinai’s Dean is a co-inventor of patents related to this new treatment method and as such receives remuneration through Mount Sinai from the manufacturer. For more information about these financial interests and Mount Sinai’s leadership role in SPRAVATO, please visit bit.ly/esketamine-development. (Dr. Murrough does not have a financial interest in SPRAVATO.)

Partnering With the Community to Bring Mental Health Services to Those in Need

Updated on Jun 30, 2022 | Psychiatry

Sabina Lim, MD, MPH, Vice President and Chief of Strategy for Behavioral Health at Mount Sinai Health System, and Joan Bell, LCSW, Clinical Director of The Mount Sinai Hospital’s Psychiatry Ambulatory Services. Photo by Richard Vernon.

On Saturdays during the month of February, a group of organizations that support the homeless known as the Rescue Alliance, including Salvation Army, The Bowery Mission, Hope For New York, and New York City Relief, host an annual service event called Don’t Walk By. Volunteers canvass the streets and subway lines of Manhattan to introduce themselves to those in need, and invite them to dinner at a host site where they are offered a hot meal, a backpack filled with supplies for the winter (socks, blanket, etc.), basic medical care, psychological support, behavioral health referrals, connections to support services, and a safe and warm place to unwind. In 2019 and 2020, clinicians from across the Mount Sinai Health System have participated by providing brief counseling, crisis intervention, and coordination of care to mental health and addiction services.

On February 1, Hillary Perlman, LCSW, Manager of the Mount Sinai Morningside Psychiatric Mobile Crisis Team, Kay Hua, MD, a psychiatry resident at Mount Sinai Morningside and Mount Sinai West, and Laura Diamond, LMHC, EdM, MA, Counseling Supervisor for the inpatient detox/rehab program at Mount Sinai West, provided mental health counseling and opioid/substance use counseling and referrals in downtown Manhattan. The volunteers helped individuals identify which services they wanted to utilize while they were at the event and advocated for them throughout the process. They also distributed naloxone kits to those interested and provided instructions on how to use them.

Hillary Perlman, LCSW, Manager of the Mount Sinai Morningside Psychiatric Mobile Crisis Team, Kay Hua, MD, a psychiatry resident at Mount Sinai Morningside and Mount Sinai West, and Laura Diamond, LMHC, EdM, MA, Counseling Supervisor for the inpatient detox/rehab program at Mount Sinai West. Photo by Richard Vernon.

“We were honored to be a part of such an important event,” said Ms. Diamond. “It’s inspiring to see different organizations come together to help the community that we are all a part of and to bridge the gap to care and support. This is our community, so this is exactly where we should be. A simple conversation with someone can provide us with enough information to easily connect individuals to life-saving services. For the most part, many of the participants were simply looking for someone to talk to, and it was extremely gratifying for each of us to be that person.”

On February 22, Sabina Lim, MD, MPH, Vice President and Chief of Strategy for Behavioral Health at Mount Sinai Health System; Joan Bell, LCSW, Clinical Director of The Mount Sinai Hospital’s Psychiatry Ambulatory Services; and Anita Kennedy, CRPA, CMA, Peer Engagement Specialist at the Addiction Institute of Mount Sinai at Mount Sinai Beth Israel, provided mental health and opioid/substance use counseling and referrals, distributed more than 50 naloxone kits, and trained 57 people on their use.

Ciarra Leocadio, a REACH patient navigator/outreach worker, provided overdose prevention education and naloxone distribution.

Several volunteers attended from Mount Sinai’s Respectful and Equitable Access to Comprehensive Healthcare (REACH) Program, which provides a patient-centered, harm reduction approach to primary care for persons who use alcohol and other drugs, and for individuals living with hepatitis C. Martha Giardina, RN, a REACH nurse, Katherine Dunham, a REACH patient navigator/outreach worker, and Ciarra Leocadio, a REACH patient navigator/outreach worker, provided overdose prevention education and naloxone distribution. “The work of the REACH Program would not be possible without our strong connection to our community partners; we were grateful to be part of this event and are inspired by the commitment to help those in need of mental health and addiction services,” said Jeffrey Weiss, PhD, MS, Director of REACH and Associate Professor of Medicine.

“I am so proud of and grateful to the Mount Sinai Behavioral Health team who have volunteered at this important community event,” said Dr. Lim. “As clinicians, it is important for us not to wait for people to come in, but to go out into the communities we serve to make the connections. I am also so impressed by and thankful to the Rescue Alliance agencies for organizing this event and for the incredible work they do every day for the homeless.”

Inventing New Ways to Deliver Mental Health Care to the Community

Updated on Jun 30, 2022 | Psychiatry

Due to the team’s consistent engagement and follow-up, 98 percent of patients involved with MOT intervention have shown up for their first appointment.

As part of the state’s ongoing effort to further innovate in behavioral health care and develop more effective alternatives to emergency rooms, the New York State Office of Mental Health (OMH) asked Mount Sinai Morningside (formerly known as Mount Sinai St. Luke’s) to lead the Upper Manhattan Behavioral Health Crisis Response Pilot. This pilot aimed to improve the response times of existing mental health mobile crisis teams (MCTs) and to better ensure follow-up outpatient care. MCTs go out into the community to do clinical in-person assessments for people experiencing a behavioral health crisis, and provide short-term follow-up post-crisis. The goal of the pilot was to reduce response time for individuals served by the Mount Sinai Morningside MCT (increasing the likelihood of face-to-face contact), and also to create a network of outpatient mental health providers committed to providing timely outpatient appointments. Ultimately, the pilot aimed to develop a model of response and post-crisis connections to outpatient care that can be replicated throughout New York City.

The Mount Sinai Morningside team more than exceeded their goals. They reduced response time from 24-48 hours to just two hours, which led to a more than 10 percent increase in face-to-face contact with patients, and ultimately higher outpatient appointment acceptance and attendance rates. Mount Sinai’s success led to the expansion of the pilot into a New York City-wide pilot during the second and third years, and to include Mount Sinai Beth Israel and several other hospitals in New York City. In addition, the Mount Sinai Morningside MCT expanded their geographic catchment area for crisis response.

A data-driven evolution: The mobile outreach team
Part of the charge of the pilot was to develop deep quantitative and qualitative understanding of the nature of behavioral health crises. The data showed that only approximately half of patients who reached out were in a true state of crisis. The other half were at risk of a future crisis because they were disconnected to outpatient treatment or had difficulty getting access to treatment. Early in the test, the team realized they could use MCT resources more efficiently by creating an offshoot mobile outreach team (MOT) to handle the non-crisis cases. This would enable the MCT to reach the patients in crisis more quickly and efficiently, and the MOT could focus on the patients who didn’t require urgent or emergent care. The MOT’s purpose was to proactively try to prevent crises, rather than rapidly respond to crises. And the primary way to try to prevent crises was to engage meaningfully and connect patients to outpatient care.

While the MCT consists of social workers, the MOT is made up of a social worker and a credentialed peer counselor. “This combination is unique,” said Kristina Monti, PhD, LCSW, Director of Special Projects for the Psychiatric ER at Mount Sinai Morningside and Mount Sinai West. “It’s unique to the intervention itself in that it’s providing a transition of care, and it’s focused not so much on crisis intervention but on engagement.”

How it works
The MOT’s social worker, Sara Kluge, LCSW, screens the referrals from various sources within Mount Sinai Morningside and Mount Sinai West (inpatient and outpatient psychiatric services). Once screened, she and the peer counselor, Antonio Muñoz-Hilliard, have their first meeting with the patient, often on the inpatient unit. During this meeting, a rapport is established through supportive engagement; potential barriers to psychiatric stability are identified; and patients are provided with psychoeducation/planning regarding follow-up appointments. “We’ve had a very high engagement rate—in the first year, 97 percent of patients we met with agreed to the service,” Ms. Kluge said.

Within 24 hours after this initial meeting, the two reach out to the patient to arrange a second meeting. This meeting takes place in the community, often in the patient’s home. In this setting, Sara and Antonio work to remove barriers such as transportation to appointments, ambivalence about mental health treatment, and basic needs. This sets the MOT apart from other programs—both the effort to tailor a unique approach for all individuals, and a standard of reaching out to patients within one day of discharge.

The third meeting is the “warm hand-off,” where the team meets the patient at the clinic and helps with paperwork. Due to the team’s consistent engagement and follow-up, 98 percent of patients involved with MOT intervention have shown up for this first appointment. The first clinic visit can often feel daunting. “Some of the patients are only 18 or so, and this is their first time filling out this type of paperwork,” said Sara. “I’ve had patients who would have left if I hadn’t been there to help them through it. Having someone sit and walk them through the process has really increased the likelihood of them attending that next appointment.”

An empathetic perspective
As a peer counselor, Antonio has real-life experience and therefore can engage with the patient on a level that a social worker can’t. He has been a peer counselor for 12 years, and Mount Sinai hired him for the MOT. He provides tools for recovery, serves as a model of sustained wellness in order to provide hope, and aims to help patients focus on the whole picture of their lives. “Sometimes we have to look at what’s happening in the life of the individual to promote a trauma-informed way of relating,” he said. “I like to look at it not from the perspective of what’s wrong, but what happened. If they lost their job, failed at school, ended a relationship, got evicted, are suffering from physical health problems—all these things affect the way that we take care of ourselves and how we view crisis. The focus should not be on what we want to avoid doing, but to encourage a move to who and where we want to be.”

A successful proof of concept
The MOT has an 86 percent retention rate of patients returning to the next appointment and continuing clinic treatment. Providers feel the MOT is a vital part of successful continuity of care. “There are several examples in which MOT involvement has been so essential for transition to our clinic. MOT does such a good job of connecting to patients and using patient-centered interventions,” said Joyce Thomashefsky, LCSW, a Mount Sinai West inpatient social worker. “I feel most comfortable with discharge plans when MOT is involved, as I can see more patients are showing for their appointments,” added Hafina Allen, LCSW, a Mount Sinai Morningside inpatient social worker.

Patients also know who they can go to if they have problems in the future, due to the rapport they have built with the MOT. “MOT saved my life that day,” said one patient. “I was hurting myself and I felt comfortable telling them that when they visited me at home.”

What Are the Benefits of CBD?

Updated on Jun 30, 2022 | Mental Health, Psychiatry, Your Health

Interest in cannabidiol (CBD) has increased dramatically in recent years. Available in oils, lotions, and vaping fluid, the substance has been touted as a cure-all for various ailments including anxiety, arthritis, and insomnia. While its growing reputation is impressive, is CBD just an alternative medicine fad or can it really help?

For the past decade, Yasmin Hurd, PhD, Director of the Addiction Institute of Mount Sinai, has been at the forefront of CBD research. Below, she breaks down the three things you should know before adding the substance to your routine.

What is CBD and what can it treat?

CBD is one of more than 100 substances known as cannabinoids found in the Cannabis plant. There are two main cannabinoids, CBD and THC (tetrahydrocannabinol). CBD does not cause a high, unlike THC, which is the main psychoactive ingredient in cannabis (including marijuana and hashish).

Although you can find many advertisements touting CBD’s medicinal uses, the U.S. Food and Drug Administration (FDA) has not approved CBD to treat any disorders in adults. The only FDA approval for CBD is for the treatment of two rare and severe forms of childhood epilepsy. However, CBD has been investigated for the treatment of anxiety, cannabis and opioid use disorder, Crohn’s disease, diabetes, epilepsy, pain, Huntington’s disease, sleep disorders, Parkinson’s disease, and schizophrenia/psychosis.

If there is no FDA approval, what evidence supports CBD use?

In limited clinical trials, CBD was found to help reduce social anxiety, post-traumatic stress disorder, and craving in those with an opioid addiction. However, most of these clinical studies involved a small number of participants. For a more conclusive verdict, larger, more sophisticated trials are needed.

Fortunately, more extensive research is in the works. In May 2019, my team published study results from a clinical trial showing that CBD reduced craving and anxiety in individuals with a history of heroin abuse. This suggests that it may play a role in helping to break the cycle of addiction. We are now starting larger studies.

Is CBD safe? If I decide to use it, should I tell my doctor?

Yes and yes. A consistent finding in clinical studies is that CBD is safe. However, it is not FDA-approved and researchers are still investigating its use. Because of this, it is critical that your doctor is aware of your CBD use. Making your doctor aware will help to avoid any potential for CBD to interact with medications you may be taking. Even if you do not take regular medications, you should keep a log of your daily activity, including any changes in your physical state, mood, and sleep following use.

Additionally, because CBD is not regulated by the FDA, you should be careful about the source of your CBD. Many products sold as “pure CBD” contain THC and other ingredients that can be harmful, such as lead, mold, or synthetic cannabinoids, which can cause paranoia, hallucinations, or other psychotic symptoms. For a safer, higher-quality product, look for CBD that has a certificate of analysis—this indicates that the product has been thoroughly checked for contaminants and allows you to view its THC and CBD levels.

Photo Of Yasmin Hurd Yasmin Hurd, PhD, is the Ward-Coleman Chair of Translational Neuroscience and the Director of the Addiction Institute at Mount Sinai. She is currently the principal investigator on a clinical trial of CBD for treating opioid use disorder, a neuroimaging study of CBD’s effects on the human brain, and a study looking at neurodevelopmental effects of cannabis and its epigenetic regulation.