CBD for Anxiety | CBDnerds
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The anti-anxiety effect of CBD is well supported within the scientific literature. With research interest growing rapidly, many more clinical studies are on the way investigating the use of CBD in anxiety-disorders and beyond.
There has been over 4 decades of scientific research on the anti-anxiety effects of CBD – including both animal studies and human clinical trials.
Both animal research and human clinical studies have shown that CBD can significantly reduce anxiety for those with certain anxiety disorders and for individuals in the general population.
CBD for Anxiety (March 2021)
Can you use CBD for anxiety? Decades of research have been done investigating the anxiolytic or anxiety-reducing effects of CBD. From scientific surveys to clinical studies, here’s the science behind all of it.
Cannabidiol (CBD) is growing in popularity as a natural option for treating a wide range of ailments – including anxiety. As a naturally occurring cannabinoid found within the cannabis plant, many have turned to CBD in hopes it will help with a number of health conditions, from stress to pain.
Research into the use of CBD for anxiety treatment extends back to as early as the 1970s with great strides still being made today.
Anxiety is generally defined as a feeling of unease – including those of worry, fear, and apprehension – and can be triggered by a wide variety of events and scenarios. These can be as simple as writing an exam or meeting new people.
Stress occurs when we encounter these threatening or unfamiliar situations (these can be both real or perceived), and anxiety is the natural reaction to that stress.1
Anxiety symptoms can vary drastically from person to person, but typical physical symptoms can include:
- General restlessness
- Feelings of fear and worry
- Nausea, dizziness, and/or headaches
- Trouble concentrating
- Rapid breathing and/or chest pains
- Increased heart rate
- Excessive sweating
- Difficulty falling asleep
Everyone experiences feelings of mild anxiety at some point in their lives. Typically, these feelings will fade once the stressful situation triggering them is resolved.
But when these feelings become constant, too hard to control or begin affecting your daily life, it can indicate an anxiety disorder.
Different Types of Anxiety Disorders
Anxiety can be the main symptom of many different complex disorders and can be caused by a combination of varying conditions:
- Substance abuse
- Childhood experiences
- Panic disorders
The most current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) – which serves as the principal authority for psychiatric diagnoses in many parts of the world – lists 7 different anxiety disorders.
Anxiety can, however, exist as a major symptom of many other disorders as well, such as obsessive-compulsive disorders and trauma and stressor-related disorders.
The 7 anxiety disorders include:2
Generalized Anxiety Disorder (GAD)
Individuals with GAD experience excessive anxiety surrounding multiple things within their personal health, everyday life, work, or social environment. This occurs on most days for at least 6 months.
Separation Anxiety Disorder
People with separation anxiety disorder experience extreme anxiety and fears about being separated from the people they are attached to.
A fairly rare disorder, selective mutism occurs when someone fails to speak in certain social situations even though they have normal language skills.
Sometimes this inability to speak may be tied to extreme shyness, fears of social embarrassment, or compulsive traits.
Also called “simple phobias,” people with specific phobias develop intense anxiety or fear of certain objects, animals, or situations. This includes the fear of heights, blood, needles, spiders, etc.
Broadly, agoraphobia is defined as a fear of places and situations where help may not be available if things go wrong, causing the individual to panic, feel trapped and/or helpless. People diagnosed with agoraphobia have an intense fear of 2 or more of the following situations:
- Using public transportation
- Being in open spaces
- Being in enclosed spaces
- Standing in line or being in a crowd
- Being outside of the home alone
Social Anxiety Disorder
Individuals with social anxiety disorder have an intense fear of performative situations where they may be judged or evaluated by others. This can manifest in the workplace, school, or even personal environments.
People with panic disorder have reoccurring panic attacks. These are periods of intense fear that come on quickly and often without warning. They may be triggered by certain situations or objects.
Apart from feeling intense anxiety during a panic attack, these individuals often experience anxiety and worry surrounding when the next attack might happen. They may feel the need to avoid certain places, objects, or situations that can trigger an attack which can greatly interfere with their everyday life.
What Do We Know About the Types of Anxiety Disorder?
Not only are various forms and causes of anxiety complex, but the biology behind anxiety disorders is also not well understood.
Most research indicates that extreme anxiety likely arises due to changes in brain chemistry, particularly in areas of the brain that process emotions and fear. These changes affect how the brain controls the production and release of neurotransmitters – the chemical messengers that help neurons communicate with each other.3
A person’s brain chemistry is influenced by their innate genetics as well as their general experiences throughout life, marked significantly by physical and psychological trauma.
Currently, most anxiety-related disorders are treated using psychological therapies (e.g. cognitive behavioral therapy) and/or medications (e.g. serotonin reuptake inhibitors such as Prozac and Zoloft).
Can CBD Help?
Regardless of the cause or severity of your anxiety, CBD may be a good option for easing some of those symptoms.
CBD products can influence our body’s endocannabinoid system (ECS) – a neuromodulatory system that plays a role in regulating a wide variety of physical and mental health processes such as memory, learning, mood, pain management, and inflammation.4,5
Our bodies naturally produce endocannabinoids which interact with endocannabinoid receptors on different cells including neurons.
The most abundant receptor, CB1, can be found across the central nervous system which includes parts of the brain that control emotions and anxiety – such as the prefrontal cortex.3,6
The second major endocannabinoid receptor, CB2, can also be found in the central nervous system but is primarily found in the immune system. Endocannabinoids can also interact with several other receptors including the serotonin receptor (5-HT1A receptor) and the TRPV1 receptor.7
Cannabinoids from cannabis plants (such as marijuana and hemp), including CBD, can naturally mimic certain endocannabinoids and can modulate the way various endocannabinoid receptors work.
While the details are yet to be fully understood, researchers have gathered some insight into how CBD could be influencing each receptor and what could potentially be happening.
Specifically, CBD has been shown to decrease and/or change the activity of both CB1 and CB2 receptors.8,9
CBD has also been shown to stimulate the serotonin receptor (5-HT1A) at low concentrations and promote the activity of TRPV1 at higher concentrations. Both of these mechanisms are thought to be anxiolytic and may be contributing to CBD’s anti-anxiety effects.10,11
Furthermore, CBD has also been shown to prevent enzymes from breaking down anandamide, the natural endocannabinoid, which is an important activator of the CB1 receptor.12
What Does the Research Say – Preclinical Studies
A lot of the initial research on the anti-anxiety effects of CBD were done in animal models using behavioral tests.
In a landmark 1990 study, researchers tested whether 2.5, 5, 10, or 20 mg/kg doses of CBD affected how rats would perform in an elevated plus-maze.13 Elevated plus mazes are commonly used by researchers to study anxiety-related disorders such as PTSD.
These mazes contain different open and closed sections. Anxious animals typically spend less time in open sections and more time in closed or protected sections where they are less likely to be attacked by potential predators.
At low doses (2.5, 5, and 10 mg/kg), the rats appeared more exploratory and were more likely to enter open spaces in the maze – indicating reduced anxiety.
These effects were similar to a 2 mg/kg dose of diazepam – also marketed as Valium – a well-known drug used to create calming effects and treat anxiety in humans.
Since then, the anti-anxiety effects of CBD have been broadly confirmed in 30 other animal studies using a variety of behavioral tests. All of them have shown that while high doses (~ 100 mg/kg) were ineffective, lower doses (~ 10 mg/kg) had anti-anxiety effects.7,14
Some animal studies also indicated that CBD has similar effects in reducing stress, fight-or-flight, and compulsive behaviors.
Because of this, CBD is also being investigated for use in treating certain phobias and PTSD.15
What Does the Research Say – Clinical Studies
The anti-anxiety effects of CBD seen in animals have served as a guide for human research and many clinical studies have since been completed.
In as early as the 70s and 80s, researchers have found in double-blind studies that CBD can be used to reduce the anxiety-triggering effects of THC – a major cannabinoid in cannabis that has psychoactive effects.15,16
More recent studies have further examined the use of CBD in treating various forms of anxiety.
In a 1993 study, where a double-blind, placebo-controlled, simulated public speaking test was conducted, researchers found that participants who took 300 mg CBD prior to a 4-minute public speaking challenge reported feeling less anxious afterward – as compared to the placebo group.
This effect was comparable to known anti-anxiety medications used in the study (e.g., 10 mg of diazepam, 5 mg of ipsapirone).17
Another double-blind placebo-controlled public speaking study in 2019 further confirmed the anti-anxiety effects of CBD in everyday individuals.
Participants were asked to take either a placebo, 150, 300, or 600 mg of CBD before taking a simulated public speaking test.18
Those in the placebo group reported significantly higher anxiety both during the speech and after the speech. Participants who took 300 mg of CBD reported significantly lower anxiety.
However, at 150 and 600 mg doses of CBD, researchers found no significant difference from placebo. This suggests that finding a moderate dosage may be important for achieving anti-anxiety effects.
Anxiety and Sleep
A 2019 open-label study on 72 patients with a diagnosis of anxiety or sleep disorders, provided the participants with a range of 25 to 175 mg of CBD per day across a 3-month time frame.19
After just 1 month, the majority of patients (79.2%) reported reduced anxiety. Only a few adverse effects were reported by 3 participants such as dry eyes, mild sedation, and fatigue.
Pediatric Anxiety and PTSD
A case study from the University of Colorado’s School of Medicine found that CBD was useful in reducing anxiety caused by PTSD for a 10-year-old girl.20
After rounds of ineffective pharmacotherapy and adverse effects from medication, the patient was administered CBD instead. Starting with 25 mg of CBD a day for 4 months, and then moving to a CBD spray (~6-12 mg per spray) as needed after month 4.
Using a standardized screen for child anxiety-related disorders, the medical team found that CBD reduced the patient's score from 34 to 18. A score of 25 or higher typically indicates a childhood anxiety disorder.
Social Anxiety Disorder
In a 2011 double-blind, placebo-controlled, simulated public speaking study, patients with social anxiety disorder were provided with either a placebo or 600 mg of CBD 1.5 hours before completing a 4-minute public speaking challenge.21
Those who took the CBD reported significantly less anxiety, cognitive impairment, and discomfort during their speech performance.
In a separate 2019 study, researchers used a similar double-blind placebo-controlled model to study how useful CBD could be in treating social anxiety outside the laboratory.
Teenagers with social anxiety disorder took either a placebo or 300 mg of CBD oil for 4 weeks. Questionnaires administered before and after the treatment showed that the CBD group had significantly reduced feelings of anxiety whereas the placebo group showed no significant changes.22
Furthermore, no participants reported any significant health complaints from using the CBD oil in a follow-up meeting.
Ongoing Clinical Trials
Apart from completed studies, there are also many ongoing trials that hope to further investigate the use of CBD as a treatment for anxiety disorders.
A study in the Netherlands is currently looking at whether a weekly dose of 300 mg of CBD administered orally for 8 weeks could help individuals with phobia-related anxiety disorders.23
An ongoing phase 3 clinical trial in Canada is working to determine the possible use of CBD oil capsules (containing 200-800 mg of CBD) to treat generalized anxiety disorder, social anxiety disorder, panic disorder, and agoraphobia.
In the U.S., an open-label phase 2 clinical trial is taking place to examine whether a dose of 30 mg a day of CBD taken under the tongue for 4 weeks could help with anxiety and sleep.
Trying CBD for Anxiety
Decades of animal studies and clinical trials support the use of CBD for anxiety – particularly when used at a moderate dosage. Many studies have indicated that the anti-anxiety effects of CBD tend to decline at higher concentrations.
As with using CBD for any health reasons, it’s best to begin with a low dosage and only move up as needed.
Studies done to date on the use of CBD in treating anxiety-like responses have all found CBD to be safe and generally well-tolerated with little to no differences from taking a placebo in terms of unwanted anxiety, sedation, positive psychotic symptoms, or intoxication.24
However, at higher concentrations, it can also cause a wide range of side effects.
Some of these can include:25
- Dry mouth
- Low blood pressure
- Changes in appetite or weight
Furthermore, there are additional considerations to make when CBD is taken alongside other medications. CBD can interfere with how other drugs are metabolized and processed within the body, possibly causing adverse drug reactions.24
CBD has been reported to interfere with antiretrovirals, antidepressants, antipsychotics, and opioids.
Significant research has already been done in both animal studies and human clinical trials indicating the benefits of using CBD for anxiety. With further research on the way, it’s clear that CBD will play a large role in how various anxiety disorders may be treated in the future.
Likewise, CBD’s strong safety profile also makes it a great option for anxiety treatment.
However, as noted, CBD can interfere with certain antipsychotics and antidepressants commonly prescribed for anxiety, making it best to consult a medical practitioner before incorporating CBD into your treatment regimen.
Not to mention, different consumption methods have been found to be more effective for anxiety than others. For example, smoking or vaping CBD allows the cannabinoid to enter the bloodstream quicker rather than CBD gummies or oils. So, if you're finding CBD oils aren't effective for your anxiety, it may be worth checking other consumption methods out.
7 Wright, Madison, Patricia D. Ciano, and Bruna Brands. “Use of cannabidiol for the treatment of anxiety: A short synthesis of pre-clinical and clinical evidence.” 5.3 (2020): 191-196.
10 Campos, Alline Cristina, and Francisco Silveira Guimarães. “Involvement of 5HT1A receptors in the anxiolytic-like effects of cannabidiol injected into the dorsolateral periaqueductal gray of rats.” Psychopharmacology. 199.2 (2008): 223-230.
11 Lee, Jonathan L. C. et al. “Cannabidiol regulation of emotion and emotional memory processing: Relevance for treating anxiety-related and substance abuse disorders.” British Journal of Pharmacology. 174.9 (2017): 3242-3256.
12 Bisogno, T. et al. “Molecular targets for cannabidiol and its synthetic analogues: Effect on vanilloid VR1 receptors and on the cellular uptake and enzymatic hydrolysis of anandamide.” British Journal of Pharmacology. 134.4 (2001): 845-852.
20 Shannon, Scott, and Janet Opila-Lehman. “Effectiveness of cananbidiol oil for pediatric anxiety and insomnia as part of posttraumatic stress disorder: A case report.” The Permanente Journal. 20 (2016): 16-005.
21 Zuardi, Antonio Waldo, and José Alexandre S. Crippa. “Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naïve social phobia patients.” Neuropsychopharmacology. 36.6 (2011): 1219-1226.
23 Van der Flier, Febe E. et al. “Cannabidiol enhancement of exposure therapy in treatment refractory patients with phobias: Study protocol of a randomized controlled trial.” BMC Psychiatry. 19.1 (2019): 69.