CBD And Anxiety
Anxiety and anxiety-related disorders are the most common form of mental illness in the United States. It is estimated that over 30% of US adults experience anxiety-related disorders at some point in their lives . Today’s standard treatment options often have either insufficient responses or are accompanied by unwanted side effects .
The increasing availability of cannabis-derived compounds as a result of decriminalization has led to expanding exploratory interest into these natural chemicals for a variety of therapeutic benefits. Unlike THC, CBD does not produce intoxicating effects. Many studies suggest that CBD may play a role in the management of anxiety by way of its pharmacologic activity within the Endocannabinoid system . With mounting clinical, preclinical, and anecdotal evidence of CBD’s potential anxiolytic (anxiety-reducing) properties, let’s take a closer look at what the literature currently has to say with regards to CBD and anxiety, and why CBD may be suited as a key therapeutic player in this arena.
Table of Contents
Anxiety is an emotional response that is occurs from a perceived potential threat. As a natural component to human survival, it is adaptive in nature, meaning the response is appropriate to perceived threat or stimuli. Anxiety becomes maladaptive when it expresses under non-threatening or benign stimuli. This can lead develop into anxiety-related disorders. 
Per the Statistical Manual of Mental Disorders (5th Edition), anxiety disorders are grouped into General Anxiety Disorder (GAD), Panic Disorder (PD), Social Anxiety Disorder (SAD), Specific Phobia (SP) – with PTSD and OCD grouped in with “anxiety-related” disorders.
Untreated, these anxiety-related disorders are often associated with a diminished quality of life, physical and mental impairment, relationship issues, and general poor health .
There have been a plethora animal studies showcasing the effectiveness of CBD on anxiety, but for this summary we will focus primarily on human studies.
In a 2011 human, double-blind study published in Neuropsychopharmacology, 24 subjects with generalized Social Anxiety Disorder (SAD) were selected to receive CBD or placebo before a public speaking test. Examining various measures of mood, self-assessment, as well as physiological measure, it was summarized that CBD had a positive effect on the anxiety caused by public speaking.
“Pretreatment of SAD patients with CBD significantly reduced anxiety, cognitive impairment, and discomfort in their speech performance (S) and significantly decreased alert in their anticipatory speech (A). The cognitive impairment, discomfort, and alert of SAD patients that received CBD had similar results to the [healthy group] during the SPST [public speaking test]. These preliminary results indicate that a single dose of CBD can reduce the anxiety-enhancing effect provoked by SPST in SAD patients, indicating that this cannabinoid inhibits the fear of speaking in public, one of the main symptoms of the disorder” .
In a 2019 randomized, double-blind human study published in Frontiers in Psychology, 37 Japanese adolescents with Social Anxiety Disorder (SAD) and Avoidant Personality Disorder were studied over a four-week period. This study built on the above findings to explore CBDs effects on teenagers, and for a longer period rather than a single dose. This study found a significant reduction in SAD symptoms across the four-week intervention .
In a 2015 review published in The American Society for Experimental Neurotherapeutics the authors reviewed 49 preclinical, clinical, or epidemiological studies related to CBD and anxiety and found that, “Preclinical evidence conclusively demonstrates CBD’s efficacy in reducing anxiety behaviors relevant to multiple disorders, including PTSD, GAD, PD, OCD, and SAD, with a notable lack of anxiogenic effects…. Human experimental findings support preclinical findings, and also suggest a lack of anxiogenic effects, minimal sedative effects, and an excellent safety profile” .
A 2015 case study observed the effects of CBD on one 10 year old girl with severe PTSD and other anxiety-related symptoms. By the time CBD was introduced, she had been previously unresponsive to a multitude of other treatments. After 5 months of receiving 25mg CBD per day, her symptoms and quality of life drastically improved. The case study found that for this patient 12-25mg CBD provided relief of all key symptoms with minimal side effects .
In 2019 a retrospective case study was performed at a psychiatric clinic where 72 psychiatric patients expressing anxiety or poor sleep were given 25mg CBD per day for at least one month of active treatment. The CBD was administered in tandem to normal psychiatric treatments. While it should be noted that there was no control group, 79% of patients saw significant improvement in anxiety-related symptoms .
While the exact pathophysiology of anxiety-related disorders is not known, evidence suggests that the key neurotransmitters involved in adaptive or maladaptive anxiety responses are Dopamine (DA), Norepinephrine (NE), y-aminobutyric acid (GABA), and Serotonin (5-HT) . Current medications on the market for anxiety and depression are designed to act on and modulate activities in these channels .
CBD and the Endocannabinoid System have been highly suggested to play a critical role in modulating activity involved in the anxiety response, making them a well-suited candidate for area of study for anti-anxiety drug development .
The first relevant interaction is that while CBD has a low affinity (binding ability) with the CB1 receptor, it has an indirect effect by way of inhibiting the enzyme-breakdown of native neurotransmitter, anandamide (AEA, known as the “bliss molecule”). This inhibition allows for AEA to say in the system longer and provide benefit . Evidence from preclinical studies suggests that anandamide has “acute anxiolytic effects and also regulates learned fear by dampening its expression, enhancing its extinction and disrupting its reconsolidation” .
CBD is also known to be a modest agonist (activator) of human 5HTa receptor, similar to Serotonin – further suggesting CBD as an “interesting and useful potential beyond the realm of the cannabinoid receptors” .
Some studies have tested for the effects of CBD across a range of dosages within a single study and shown that CBD seems to have a “biphasic” effect on anxiety. This means that the benefit presents as an inverted U shape, where the lowest and highest doses produced little to no effect on public-speaking-induced anxiety, and a significant decrease in anxiety was observed at the middle-ground dosage.
A 2019 placebo-controlled human study published in the Brazilian Journal of Psychology; the goal was to investigate the notion that CBD expressed a bell-shaped response curve across varying CBD dosages. In the trial, 57 healthy male subjects were observed giving a simulated public speaking test before and after administration of varying dosages of CBD. The study concluded that acute doses of CBD can decrease anxiety. This study was also important because it tested for a variety of levels of CBD dosage across the study . In the words of the authors,
“Our findings confirm the anxiolytic-like properties of CBD and are consonant with results of animal studies describing bell-shaped dose-response curves. Optimal therapeutic doses of CBD should be rigorously determined so that research findings can be adequately translated into clinical practice. 
There has been a vast body of positive research studying the effects of CBD in animal studies, but there is still more work to be done in the realm of human clinical trials before certain findings can be refined. This is in part due to the prohibition on Cannabis, and CBD’s evolving legal status (though federally legal under the 2018 Farm Bill). The studies that have been done show great promise, but due to factors such as small sample sizes, or varying dosage amounts across studies, and lack of long-term studies, the generalizability of certain findings is limited. Thus, things like identifying the correct and specific therapeutic dose for a given ailment remains to be polished.
In this regard CBD is still considered to be in an exploratory phase from the user perspective. It is legal on the market and boasts a relatively positive safety profile, so many individuals are exploring the potential benefits on their own.
CBD is known to have a favorable safety profile and being generally well tolerated. Some possible mild side effects side effects can include dry mouth, diarrhea, drowsiness at high concentrations, or changes in appetite 
CBD is not addictive and thus lacks abuse potential. Many prescription drugs affect the release of dopamine in the brain’s pleasure center that can cause one to become dependent on the drug over time. CBD is not shown to trigger dopamine release, or show addictive qualities in the available literature.
Additionally, there can be certain drug interactions when CBD is combined with other medications such as blood thinners. Be sure to consult with your health care provider before trying CBD if you are taking other prescription medications to ensure that you are informed and safe!
The suggested method of ingestion to potentially alleviate the symptoms of anxiety is to receive it orally via sublingual absorption, or via digestion.
Exactly how much CBD is right for each person varies, but the general rule of thumb is to start low and slow – at around 10mg per dose. Starting low ensures an optimal experience so that you can see how it works in your system, and then feel comfortable working up from there.
If you are taking other prescription medications, it is best to consult with your doctor to ensure there are no potential drug interactions.
Interested in learning more about CBD? Check out these other articles:
- What is CBD and What Are the Benefits?
- Full Spectrum vs Broad Spectrum vs CBD Isolate
- Difference between Hemp and Marijuana
- Introduction to the Endocannabinoid System
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