Can CBD help treat Anxiety?

By Rosa Holder, BSc

Reviewed by Liran Baram, PhD

What are anxiety disorders

As we all experience occasional anxiety, an anxiety disorder is defined as disproportionate psychological and physiological responses to contextual threat which can severely impair both functioning and quality of life. Symptoms of anxiety may be physical, such as muscle tension, sweating, shaking, nausea, hyperventilation, increased heart rate, blood pressure and palpitations, psychological and behavioural, such as wanting to avoid certain situations, compulsive and repetitive actions, concentration deficits, irritability and dissociation[1]. 

The global prevalence of anxiety disorders at any given time is 7.3% and in a given year is 11.6%, not including anxiety linked to other disorders such as PTSD (post-traumatic stress disorder) or OCD (obsessive compulsive disorder)[2].

Development of anxiety disorders can be partially explained by the genetics we inherit from our parents, in addition to various environmental factors and the interactions between the two[3].

How CBD affects anxiety

The endocannabinoid system (ECS) is critical in regulating anxiety expression, emotional behaviour and fear-conditioned processes [4], meaning the way the body and brain responds to anxiety-provoking stimuli based on previous experience.

CBD is reported to enhance ECS function through interactions with endocannabinoid receptors in a way that reduced feelings of anxiety and its underling mechanisms[5]^,[6]. Furthermore, CBD shares a common mechanism of upregulating the “feel-good” chemical, serotonin, as seen in a selective serotonin reuptake inhibitor (SSRI) that is used in treating anxiety disorders[7].

In the last decade clinical studies have demonstrated the potential therapeutic use of CBD in anxiety disorders. In one such study, from 2011, participants showed significantly reduced anxiety when pre-treated with CBD prior to a simulation public speaking test[8].

A 2015 study demonstrated CBD to be comparable to two anxiolytic treatments (Ipsapirone and Diazepam) in reducing symptoms of social anxiety[9]. In another study, from 2019, daily CBD treatment was demonstrated to decrease anxiety scores (using Hamilton anxiety rating scale) in 79% of patients within the first month of treatment. This lowered anxiety score was maintained for the three-month duration of the study[10].

In addition, a recent online survey revealed that CBD was effective in managing self-perceived symptoms of anxiety and other mental health conditions[11]

Furthermore, CBD can reduce various symptoms of anxiety, such as nausea[12], insomnia and compulsive behaviours[13].

Potential side effects:

There is large therapeutic window, for CBD, meaning a range of doses are effective and safe[14].

Findings generally indicated CBD to be well tolerated and show only minor adverse effects in small portions of the patients[15]^,[16],[17].

The adverse effects appeared less than with existing anxiety medications. However, more studies assessing CBD side effects following chronic administration are needed, as well as studies researching CBD effects on other drugs in cases of coadministration.

Disclaimer

This content is intended only for educational purpose only, and by no means replace for professional medical advice or treatment. Always consult with a medical professional if you are seeking medical advice, diagnosis, or treatment. Particularly if you are taking other drugs to rule out unwanted interactions and side effects.

Sources:

[1] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, VA, American Psychiatric Association.

[2] Baxter, A.J., Scott, K.M., Vos, T. and Whiteford, H.A., 2013. Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychological medicine, 43(5), pp.897-910.

[3] Gross C, Hen R., 2004. Genetic and environmental factors interact to influence anxiety. Neurotox Res.,6(6):493-501.

[4] Lee, T.Y., Hill, M.N. and Lee, F.S., 2016. Developmental regulation of fear learning and anxiety behavior by endocannabinoids. Genes, Brain and Behavior, 15(1), pp.108-124.

[5] Melas, P.A., Scherma, M., Fratta, W., Cifani, C. and Fadda, P., 2021. Cannabidiol as a potential treatment for anxiety and mood disorders: molecular targets and epigenetic insights from preclinical research. International journal of molecular sciences, 22(4), p.1863

[6] Lutz, B., Marsicano, G., Maldonado, R. and Hillard, C.J., 2015. The endocannabinoid system in guarding against fear, anxiety and stress. Nature Reviews Neuroscience, 16(12), pp.705-718.

[7] De Gregorio, D., McLaughlin, R.J., Posa, L., Ochoa-Sanchez, R., Enns, J., Lopez-Canul, M., Aboud, M., Maione, S., Comai, S. and Gobbi, G., 2019. Cannabidiol modulates serotonergic transmission and reverses both allodynia and anxiety-like behavior in a model of neuropathic pain. Pain, 160(1), p.136.

[8] Bergamaschi, M.M., Queiroz, R.H.C., Chagas, M.H.N., De Oliveira, D.C.G., De Martinis, B.S., Kapczinski, F., Quevedo, J., Roesler, R., Schröder, N., Nardi, A.E. and Martín-Santos, R., 2011. Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naive social phobia patients. Neuropsychopharmacology, 36(6), pp.1219-1226.

[9] Blessing, E.M., Steenkamp, M.M., Manzanares, J. and Marmar, C.R., 2015. Cannabidiol as a potential treatment for anxiety disorders. Neurotherapeutics, 12(4), pp.825-836.

[10] Shannon, S., Lewis, N., Lee, H. and Hughes, S., 2019. Cannabidiol in anxiety and sleep: a large case series. The Permanente Journal, 23.

[11] Moltke, J. and Hindocha, C., 2021. Reasons for cannabidiol use: a cross-sectional study of CBD users, focusing on self-perceived stress, anxiety, and sleep problems. Journal of cannabis research, 3(1), pp.1-12.

[12] Rock, E.M., Bolognini, D., Limebeer, C.L., Cascio, M.G., Anavi‐Goffer, S., Fletcher, P.J., Mechoulam, R., Pertwee, R.G. and Parker, L.A., 2012. Cannabidiol, a non‐psychotropic component of cannabis, attenuates vomiting and nausea‐like behaviour via indirect agonism of 5‐HT1A somatodendritic autoreceptors in the dorsal raphe nucleus. British journal of pharmacology, 165(8), pp.2620-2634.

[13] Blessing, E.M., Steenkamp, M.M., Manzanares, J. and Marmar, C.R., 2015. Cannabidiol as a potential treatment for anxiety disorders. Neurotherapeutics, 12(4), pp.825-836.

[14] Blessing, E.M., 2015. Cannabidiol as a potential treatment for anxiety disorders. 12(4), pp.825-836.

[15] Shannon, S., 2019. Cannabidiol in anxiety and sleep: a large case series. 23.

[16] Berger, M., Li, E. and Amminger, G.P., 2020. Treatment of social anxiety disorder and attenuated psychotic symptoms with cannabidiol. BMJ Case Reports CP, 13(10), p.e235307.

[17] Moltke, J. and Hindocha, C., 2021. Reasons for cannabidiol use: a cross-sectional study of CBD users, focusing on self-perceived stress, anxiety, and sleep problems. Journal of cannabis research, 3(1), pp.1-12.