Anxiety

CBD And Anxiety: What You Need To Know (And Ask) Before Taking CBD

By Anna McGeehan
Nik Shuliahin

Curious how CBD can help treat anxiety? Medical researchers certainly are.

As CBD becomes more mainstream, researchers are increasingly interested in CBD’s broader therapeutic application, including its use in treating anxiety and panic attacks.

Anxiety disorders are the most prevalent mental health conditions in the United States, and mounting anecdotal and clinical evidence is revealing CBD’s anxiolytic properties.

While it’s easy to zero in on CBD’s immense potential, it’s also important to remember that CBD research is relatively new and medical studies are hamstrung by federal regulations, cost barriers, and restrictions on clinical testing.

This guide will help shed light on what we currently know about CBD and anxiety and offer findings from peer-reviewed journals. It will also present common side effects associated with CBD, highlight the patchwork of laws across the country, and present some key takeaways to help you make an informed decision about using CBD as a treatment for anxiety.

What Are The Different Types of Anxiety Disorders?

The American Psychiatry Association (APA) defines anxiety disorders as excessive anticipation of a future concern, exhibited through muscle tension, increased heart rate, irritability, avoidance behaviors, etc.

The APA and the National Institute of Mental Health identify six types of anxiety disorders:

Generalized Anxiety Disorder:

  • Affects approximately 2 percent of the US population.
  • Characterized by persistent worry about job responsibilities, health, and minor matters such as chores.
  • Interferes with daily life in the form of restlessness, irritability, fatigue, difficulty concentrating, muscle tension, or sleep disruption.

Panic Disorder:

  • Affects 2 to 3 percent of the US population.
  • Characterized by recurrent, overwhelming physical and psychological distress.
  • Symptoms include increased heart rate, trembling, numbness, dizziness, chest pain, smothering sensation, and a fear of losing control.
  • A panic attack can be so severe that a sufferer might think they are having a heart attack.

Phobias:

  • Affects between 7 and 9 of the US population.
  • Defined as excessive fear of an object, situation, or activity that is generally not harmful. Fear is often disproportionate to the situation.
  • There are several types of phobias, including:
    • Agoraphobia: Fear of being in situations where escape may be difficult or help might not be available. Affects 2 percent of the US population.
    • Social Phobia or Social Anxiety: Fear of being embarrassed, humiliated, or rejected in social situations. Affects 7 percent of the US population.
    • Separation Anxiety: Fear of separation from loved ones. Affects 1 to 2 percent of the US population.

There are many other mental health disorders that fall within these six categories.

What Does the Research Say About CBD and Anxiety?

Researchers first discovered CBD’s anxiolytic properties  in the 1980s when evaluating how to control the psychoactive effects of high-dose THC treatments in human subjects.

Since then, many studies have revealed CBD’s anti anxiety, antipsychotic, antiemetic, anti inflammatory properties, as well as a range of other potential health benefits.

There are a few important caveats though.

First, few clinical studies involve human subjects, and even fewer include children. Second, some studies are either limited to acute dosing or administer CBD in very high doses, making it hard to extrapolate findings to the general population. Third, like any medication, CBD does not work the same for everyone, particularly for patients taking other medications.

With these limitations in mind, here is what we have found about CBD’s anti anxiety properties.

General Anxiety

Early preclinical studies tested CBD’s anxiolytic effects on lab rats using models that replicated rodents’ aversion to open space. These studies concluded that CBD had positive anxiolytic effects at low and intermediate doses but not at high doses.

Subsequent neuroimaging studies confirm CBD’s anxiolytic effects on cerebral blood flow and serotonin receptors. A 2004 study involving ten healthy adults found that CBD “significantly decreased subjective anxiety and increased mental sedation.” A 2018 study similarly concluded that “CBD has the ability to reduce psychotic, anxiety and withdrawal symptoms,” but “further studies should include larger randomized controlled samples.”

Additional meta-analyses and literature reviews reiterate these findings across a body of clinical and preclinical trials.

A 2015 meta-analysis of 49 studies found CBD to have minimal sedative effects and an “excellent” safety profile, though further study is needed to determine if “chronic, in addition to acute CBD dosing, is anxiolytic in humans.”

A 2018 literature review found “converging evidence that acute CBD treatment is anxiolytic in both animals and humans,” making CBD a “potential candidate for testing as a pharmacological adjunct to psychological therapies.”

Panic Disorders

Studies looking more specifically at panic disorders report similar anxiolytic effects.

A study found that the acute administration of CBD in mice that encountered a snake decreased the same panic-related behaviors.

Social Anxiety Disorder

A meta-analysis of 34 studies concluded that a high-dose oral CBD treatment (between 150 and 600 mg per day) resulted in therapeutic effects for patients with social anxiety disorder, but also caused mental sedation.

A 2011 study evaluated the effects of CBD on 24 social anxiety patients when giving a public presentation. Patients that received 600 mg of CBD showed a significant reduction in anxiety, cognitive impairment, and speech discomfort compared to the placebo group.

Is There a General Takeaway From This Body of Research?

Data suggest that CBD has powerful anxiolytic properties in both human and animal subjects, but researchers are unsure how much CBD to take (localized low-dose versus systemic high-dose) and for how long (acute versus chronic dosing).

Are There Any Side Effects?

At this stage in CBD research, it’s hard to conclusively list CBD’s side effects since so many studies use animal subjects instead of humans. Researchers point out that the same CBD dose will likely cause larger side effects in rats and mice than humans.

With that in mind, side effects from pre-clinical and clinical trials include:

  • Changes in eating behavior, specifically a reduction in sucrose preference
  • Changes in sleep behavior
  • Gastrointestinal upset
  • Weight loss
  • Lethargy

What Are The Current Legal Restrictions?

The prevalence and ease of purchasing CBD might make it seem like it’s legal in all 50 states. However, the regulatory framework is quite complicated.

At the federal level, cannabis and cannabis extracts such as CBD are classified as a Schedule I drug under the Controlled Substances Act (CSA) (21 U.S.C. § 811 and 812), the same classification as heroin and ecstasy.

At the same time, hemp is generally legal under federal rules, and language in the 2018 farm bill would further lift restrictions as long as the THC content is negligible.

State rules complicate matters even more. According to NORML, a marijuana advocacy group, all but three states have some law permitting hemp and marijuana or CBD products, in direct conflict with federal law.

Idaho, South Dakota, and Kansas are the last states to completely prohibit cannabis products. A proposal for medical marijuana recently failed to be placed on the ballot in Idaho this November. 47 other states and the District of Columbia have some law supporting either recreational or medical cannabis or industrial hemp.

[ Read more about state laws around hemp and CBD ]

With this confusing overlay, legal experts recommend against taking CBD products across state lines and, if purchasing online, verifying that the CBD product was produced in a state where CBD or cannabis are legal.

What Else Do I Need To Know?

Reviewing the seemingly endless number of CBD products can be daunting. Keep these questions in mind when reviewing your options or talking with your doctor:

Is CBD Addictive?

Unlike THC, CBD does not appear to have addictive properties. The world’s leading research organizations have reported no evidence of abuse potential or public health problems.

How Does CBD Interact With Other Medications?

While researchers have isolated CBD’s side effects in clinical studies, much less is known about how CBD interacts with other medications. Always consult a doctor and disclose any medications before taking CBD.

What Are the Best CBD Brands?

Unfortunately, the diversity of products on the market today makes it challenging to single out a “top brand.” Instead, look for:

  • Purity: Clinical trials typically administer CBD in its purest form. You may encounter less controlled products on the market.
  • Ingredients: Verify that the CBD products specifically contain CBD, not just “cannabinoids.” Otherwise, you could just be consuming compounds extracted from miscellaneous plant parts such as the stem.
  • Reporting Standards: Select companies located in states that legalized recreational and medical cannabis, since they tend to have stricter standards.
  • Third-Party Testing: Research companies that contract with third-party accreditors, certify the ingredients, and post their results online.

Remember that CBD is entirely unregulated and the FDA does not certify companies’ health claims. The FDA has sent warning letters to at least six CBD companies for misleading or mislabeled products.

[ Learn more about CBD products ]

How Much CBD Should I Take?

In the absence of federal guidelines, consult a doctor to determine your optimal dose.

Clinical studies typically administer between 100 and 600 mg of CBD per day with minimal side effects. Some research suggests starting with 0.5 mg per pound of body weight per day, divided into three separate doses.

Is There a Best Way To Take CBD?

Consumption will depend on your preference and your doctor’s recommendations. Consuming pure cannabidiol oil orally or sublingually is the most direct way to administer CBD into the bloodstream.

Medically Reviewed By

Alan Carter
PharmD Scientific Advisor, Medical Reviewer, and Clinical Pharmacist
Adjunct Faculty, UMKC School of Pharmacy

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