Medically Reviewed By
Alan Carter
PharmD Scientific Advisor, Medical Reviewer, and Clinical Pharmacist
Adjunct Faculty, UMKC School of Pharmacy
Summary
As CBD becomes more mainstream, researchers are increasingly interested in CBD’s broader therapeutic application, including its use in treating anxiety, depression, 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.
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:
There are many other mental health disorders that fall within these six categories.
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.
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.”
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.
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.
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).
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:
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.
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.
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:
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.
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.
Unfortunately, the diversity of products on the market today makes it challenging to single out a “top brand.” Instead, look for:
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.
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.
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 oils into the bloodstream.
Alan Carter
PharmD Scientific Advisor, Medical Reviewer, and Clinical Pharmacist
Adjunct Faculty, UMKC School of Pharmacy
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