Updated on April 10, 2023
As millions of individuals who suffer from it know firsthand, anxiety presents as conditions of unfulfilled opportunities and painful psychological experiences. Although there are cognitive and pharmaceutical interventions that provide symptom relief for many, efficacy is not universal and tolerability can be a hindrance to adherence even when symptoms are alleviated. As such, many patients continue to seek alternatives to standard therapies. In light of a growing body of evidence, physicians and their patients are now increasingly finding success with promising new approach: cannabidiol therapy.
Cannabidiol (CBD) is derived from cannabis, and, like other cannabinoid class chemicals, such as tetrahydrocannabinol (THC), behaves as a potent neurotransmitter in the brain with both excitatory and inhibitory capabilities. In the case of THC, the consequent neurotransmission can cause psychoactive effects and, as a result, THC is most commonly used recreationally.
Some individuals are hesitant to consider CBD as a legitimate anxiety aid due to its association with illicit cannabis use and the mistaken assumption they will experience psychoactive effects, such as those produced by THC. But, although CBD is a major constituent of cannabis, it is widely recognized to not cause psychoactive effects and is therefore of little recreational value.
Furthermore, CBD causes none of the side effects traditionally associated with cannabis use, such as exaggerated appetite, hypersomnia, or spiraling paranoia. On the contrary, CBD’s side effect profile, while mild, includes symptoms like decreased appetite and insomnia. More serious side effects of recreational cannabis use—such as its potential role in the onset of schizophrenia—are also notably absent from tests regarding CBD and anxiety when used therapeutically.
Due largely to its anecdotally-supported efficacy and high tolerability, individuals are already turning to CBD—via their doctors or otherwise—to cope with anxiety. Indeed, a survey of more than 2,400 CBD users conducted in 2017 found that approximately 30 percent of respondents were leveraging the link between CBD and anxiety. Significantly, the survey also found that respondents were using CBD to manage multiple symptoms at once; on average, respondents addressed 2.67 different symptoms with CBD. And the results suggest CBD is highly effective; 36 percent of the respondents reported that CBD manages their condition “very well by itself,” whereas only 4.3 percent reported that CBD was insufficient to manage their symptoms on its own and that additional medications were required.
For individuals desiring to supplement their current anti-anxiety therapies, CBD use in anxiety is a promising new field that could open new avenues for symptom management.
The basis for linking CBD and anxiety is well-established within the scientific literature, despite lagging public perceptions regarding cannabinoid therapeutics. Of particular interest is a research review published in the August 2018 issue of Epidemiology and Psychiatric Sciences, which supports CBD as an effective therapy for anxiety.
Authored by Drs Mandolini and Lazzaretti of the University of Milan’s Department of Neurosciences and Mental Health, the review goes beyond confirming the evidence of efficacy and contends that physicians should begin implementing CBD therapy into their clinical practices sooner rather than later.
To make this point, the authors draw on a plethora of research findings in clinical trials, animal studies, and in vitro experiments published over decades of scientific exploration of CBD. According to the paper, the synthesis of the scientific literature strongly supports using CBD to manage certain forms of anxiety.
Although CBD is effective for managing many types of anxiety, the review cites several studies indicating that CBD might be exceptionally effective at helping with social anxiety via its vasodilatory effect in certain brain regions. By selectively increasing the blood flow to structures of the brain responsible for processing fear and anxiety emotions, like the amygdala, CBD is hypothesized to increase their function and consequently manage anxiety.
CBD might also slightly reduce blood flow in areas responsible for recalling traumatic memories. Mandolini believes this is made possible by CBD’s ability to bind to the 5HT1A serotonin receptor in the brain. The reduction in anxiety caused by CBD therapy supports the cognitive processes that anxiety typically hampers; individuals with this type of anxiety often have racing thoughts, subjective blankness of thought, and difficulty maintaining attention on external stimuli.
These cognitive impairments can significantly interfere with functionality, diminishing quality of life and potentially increasing symptoms of comorbid mood disorders. As such, addressing the cognitive effects of anxiety is necessary for many patients to recover. Unfortunately, anxiety therapies like benzodiazepines might actively weaken or slow cognitive processes owing to their inhibitory effects.
In one of the studies cited by Mandolini on CBD and anxiety, doses of 600 mg of CBD were found to manage or nearly eliminate the cognitive impairment associated with public speaking anxiety, resulting in cognitive function equivalent to healthy controls. In the study, a group of subjects who experienced social anxiety when performing public speaking was split into two groups. One group was administered CBD therapy, whereas the other received a placebo.
Following therapy administration, the subjects performed a public speaking simulation as their anxiety levels and cognitive functioning were measured before, during, and after the simulation. In terms of the overall reduction of anxiety levels in comparison to healthy controls, subjects who took CBD scored nearly 50 percent lower on the Changes In Visual Analogue Mood Scale (VAMS) anxiety assessment instrument than the group with anxiety who received placebo. The VAMS measures both the intensity of the subjective experience of anxiety and the cognitive impairment that accompanies high levels of anxiety. Likewise, the general discomfort score of subjects who took CBD was 10 percent lower than in the placebo group.
Significantly, the CBD therapy group returned to normal levels of arousal as rapidly as healthy controls, while the placebo control group did not return to the lower level of arousal experienced by the other groups in the time points measured by the researchers.
The authors point out this unique therapeutic effect—causing patients to recover more quickly from episodes that cause anxiety even in healthy people—has a plethora of applications for anxiety; post-stimulus anxiety is a major detractor of patient quality of life and is a primary feature in post-traumatic stress disorder. Furthermore, pre-stimulus anxiety—like the anxiety caused by drug withdrawal—might also be effectively managed by CBD.
Studies consistently show the effects of CBD can be extraordinary for individuals who struggle with anxiety. So how does CBD generate such dramatic effects in the brain? Unlike other neurotransmitters responsible for regulating arousal in the brain like GABA (gamma-aminobutyric acid), cannabidiol exhibits both excitatory and inhibitory effects on the neurons it binds to.
The downstream impact of this mixed effect profile is a subtle inhibition of anxiety without the psychoactive effects of cannabis consumption or other anxiolytics like benzodiazepines. Likewise, CBD isn’t fatal in overdoses, meaning that CBD and anxiety might be a safer pairing than addressing anxiety with benzodiazepines, which can cause death via respiratory depression.
Importantly, CBD also lacks the addictive potential of benzodiazepines. Although benzodiazepines present a significant risk for abuse and addiction, CBD has no recognized recreational features nor is it physically habit-forming. This is a critical point because many physicians hesitate to prescribe benzodiazepines to patients and insist on short-term therapy to reduce the possibility of abuse and addiction, which means benzodiazepines can’t be used as a long-term solution for anxiety symptoms.
When benzodiazepines are used on a long-term basis, tolerance and physical dependence can build and patients might experience uncomfortable withdrawal symptoms, including rebound anxiety, when they try to reduce their dose or discontinue the drug. In some cases, withdrawal symptoms are severe and can include seizures, dysphoria, psychosis, and mania. CBD has no such shortcomings.
The side effects of benzodiazepines are also formidable in comparison to CBD. When individuals take benzodiazepines to address their anxiety, they often become transiently cognitively impaired while under the effects of the drug, potentially interfering with social and professional functioning. Users are advised to avoid driving and might find their ability to sustain attention is impaired, along with reaction speed.
Additionally, reduced inhibitions can cause someone taking benzodiazepines at therapeutic doses to engage in risky or undesirable behaviors. Because benzodiazepines also inhibit short-term memory consolidation, a person taking them might also struggle to remember their daily events. In some cases, benzodiazepines can cause depression or excessive emotional numbing, which can be particularly dangerous for those struggling with a comorbid mood disorder. CBD, on the other hand, is not associated with any of these phenomena.
Benzodiazepines aren’t the only class of anxiolytic drugs that CBD outperforms. Selective serotonin reuptake inhibitors (SSRIs) are frequently prescribed to address anxiety and used on a long-term basis. These medications, although effective for many, are known for their diverse set of side effects, which include sexual dysfunction, tremors, fatigue, and weight gain. Some individuals even experience additional anxiety when taking SSRIs and many need to try more than one SSRI before finding one to which their symptoms respond.
This often results in a lengthy process of trial and error, as the effects of the medication might not be observed for weeks. In contrast, CBD has no serum concentration build-up period beyond the initial period after dosing, nor does it have the substantial side effect profile of SSRIs. Additionally, although SSRIs are not addictive, some patients build mild physical dependency as the result of their effect on neurotransmitter behavior.
Upon terminating SSRI use, those taking them might experience SSRI discontinuation syndrome for several days or weeks, resulting in symptoms such as malaise, anxiety, nausea, and insomnia. There is no documented discontinuation syndrome associated with CBD and anxiety, nor does its short course of action give reason to suspect there is one that is yet undiscovered.
Dr. Mandolini’s review concludes by stating the present hypotheses regarding CBD’s mechanism of action should offer confidence in its potential to manage anxiety. Large randomly controlled clinical trials will soon be conducted to shed light on the details of how CBD therapy should be implemented to address symptoms. However, clinicians already have an abundance of clues from the extant literature. Likewise, their patients who need a novel anxiety aid today can try CBD therapy on their own using the information compiled by Dr. Mandolini and others. Should those individuals who become early adopters of the CBD and anxiety pairing, they might finally move beyond the limits of anxiety while avoiding the shortcomings of conventional therapies.
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