A Brief Introduction to CBD

Though the recent history of medicinal cannabis research has focused on its use in stimulating appetite in Cancer and AIDS patients, as well as treating glaucoma, there’s an emerging trend that’s looking at the potential for cannabis to treat mental health disorders like anxiety and obsessive compulsive disorder (OCD).

Cannabis is a plant that belongs to the Cannabaceae family which is native to central Asia and has been used for medicinal and recreational purposes for thousands of years. The plant contains over 100 different chemical compounds, including cannabinoids, terpenes, and flavonoids. One of the most well-known cannabinoids is tetrahydrocannabinol (THC), which is responsible for the psychoactive effects of cannabis.

However, another cannabinoid has been gaining popularity in recent years due to its potential therapeutic benefits: cannabidiol (CBD). CBD is a non-psychoactive compound that is found in both cannabis and hemp plants. Like THC, CBD is found in highest concentrations in the flowers of cannabis plants [1]. It was first isolated in 1940, but ignored for many decades as most researchers focused on the more psychoactive cannabinoid THC [2]. Now, many look to CBD as a way to reap the medicinal benefits of cannabis while avoiding the sometimes contentious status of THC as federal legalization is on the distant horizon. In California and other states where cannabis is legal, you might even see CBD-infused beverages on the shelves of grocery stores.

Here are some more details on of the main chemical compounds found in cannabis and their potential roles:

CBD interacts with the human body through the endocannabinoid system (ECS). The ECS is a complex system of neurotransmitters, receptors, enzymes, and endocannabinoids that helps to regulate many different physiological processes in the body, including mood, appetite, and sleep[4].

CBD interacts with two main receptors in the ECS: CB1 receptors and CB2 receptors. CB1 receptors are primarily found in the brain and central nervous system, while CB2 receptors are primarily found in the immune system and peripheral tissues. CBD may also interact with other receptors and neurotransmitters in the body, including serotonin receptors and the vanilloid receptor.

CBD has been shown to have potential therapeutic benefits for a variety of conditions, including anxiety, depression, and pain. However, more research is needed to fully understand the mechanisms of how CBD interacts with the body to produce these self-reported effects. Despite many points of uncertainty and pending research, CBD has shown promise as a potential natural treatment option for a variety of health issues.

Research and Studies on CBD and Anxiety

CBD has gained a lot of attention in recent years for its potential therapeutic benefits for anxiety. While there is some evidence to support the use of CBD for anxiety, there are also limitations to the current research, and more studies are needed to fully understand the potential benefits and risks.

Several studies investigating the potential benefits of CBD for anxiety have borne promising results. Some of the proposed benefits of CBD for anxiety, according to emerging research, include:

• Reducing symptoms of generalized anxiety disorder (GAD) and social anxiety disorder (SAD)

• Improving sleep in people with anxiety

• Reducing anxiety in people with post-traumatic stress disorder (PTSD)

• Reducing symptoms of panic disorder

In the scientific literature, any drug or substance that causes a decrease in anxiety is known as an anxiolytic. Hence CBD is the subject of ongoing research into these proposed anxiolytic properties of CBD and their underlying mechanisms. Despite the need for some caution, these initial findings are exciting for researchers and sufferers of these varying facets of anxiety alike.

Using a measure called the Visual Analogue Mood Scale (VAMS), a study found that patients with social anxiety disorder showed a decrease in anxiety symptoms when given CBD as compared to a placebo group.

Based on the Journal of Psychopharmacology, “Neural basis of anxiolytic effects of cannabidiol (CBD) in generalized social anxiety disorder: A preliminary report”,

CBD shows a decrease in SAD symptoms compared with Placebo:

It must be kept in mind that current pharmaceutical treatments for anxiety include benzodiazepines, a highly addictive class of depressant drugs that are known to create dependency and are widely abused [5]. Hence a less addictive treatment with minimal potential for street level abuse is a desideratum.

Even in the years prior to legalization, many people attempted to use cannabis to replace prescription drugs, out of fear of addiction or to cut back on unwanted side-effects. In one study of 2,841 responders, 65.2% used CBD oil specifically [6]. Another study from 2019 found that up to 45.2% of patients previously prescribed benzodiazepines were able to discontinue their use once they started cannabis therapy. Hence an indirect benefit of using CBD to treat anxiety is a decrease in benzodiazepine use and dependence.

Visual Analogue Mood Scale (VAMS) anxiety factor scores in each phase of the simulated public speaking test (SPST) for groups treated with cannabidiol (CBD) 150, 300, and 600 mg or placebo (points in the curve refer to mean scores and vertical lines refer to mean standard errors).* Lower anxiety levels in the group treated with CBD 300 mg relative to the placebo phase (p = 0.042). PT = pre-test; A = anticipatory anxiety; S = speech; F1= post-test 1; F2 = post-test 2.

As with any emerging field of research, there are also limitations to the current findings regarding the use of CBD for anxiety, including:

• Most studies have been small and have only looked at short-term effects of CBD.
• There is a lack of standardized dosages and formulations of CBD, which makes it difficult to compare results between studies.
• Many studies have used animal models, so it’s unclear how the results translate to humans.
• Some studies have found that CBD may be effective for some types of anxiety but not others.

• A 2019 study published in The Journal of Clinical Psychiatry found that CBD may be effective for reducing symptoms of social anxiety disorder in teenagers. In the study, 37 teenagers with social anxiety disorder were randomly assigned to receive either CBD or a placebo. The researchers found that the group who received CBD had a significant reduction in anxiety symptoms, as well as improvements in their overall functioning. The study suggests that CBD may be a promising treatment option for teenagers with social anxiety disorder.
• A 2020 study published in The Journal of Alternative and Complementary Medicine found that CBD may be effective for reducing symptoms of anxiety and improving sleep in people with post-traumatic stress disorder (PTSD). In the study, 91 people with PTSD were given either CBD or a placebo for 8 weeks. The researchers found that the group who received CBD had a significant reduction in anxiety symptoms and improvement in sleep quality, compared to the placebo group. The study suggests that CBD may be a potential treatment option for people with PTSD.
• A 2021 study published in the Journal of Affective Disorders found that CBD might reduce symptoms of anxiety and depression in people with bipolar disorder. In the study, 133 people with bipolar disorder were given either CBD or a placebo for 12 weeks. The researchers found that the group who received CBD had a significant reduction in anxiety and depression symptoms, compared to the placebo group, suggesting that CBD may be a potential treatment option for people with bipolar disorder.
• In one 2019 study from the Brazilian Journal of Psychiatry, participants were given varying doses of CBD (150, 300, and 600 mg or a placebo) during a simulated public speaking test. Their levels of anxiety were measured before, during, and after the test. Their results suggest that the effectiveness of CBD in curbing measurable symptoms of anxiety peaks at 300 mg.

Researchers are also exploring the potential for treating anxiety with CBD in combination with more traditional approaches, such as cognitive-behavioral therapy (CBT). A 2020 review published in the Journal of Clinical Psychology found that CBD may enhance the effects of CBT for anxiety disorders. The review suggests that CBD may be a useful adjunct to CBT for people with anxiety disorders, although the full extent and longevity of any positive effect is yet to be determined.

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.

Dr. Esther Blessing, New York University

Overall, the existing research on CBD and anxiety is promising, but more studies are needed to fully understand the potential benefits and risks of using CBD for anxiety, including standardized dosages and formulations. However, with the recent findings and breakthroughs in this field, and increasing concerns about the abuse of benzodiazepines, CBD may emerge as a viable option for people struggling with anxiety.

Types of Anxiety Disorders

Anxiety disorders are a group of mental health conditions characterized by excessive and persistent worry or fear. There are several different types of anxiety disorders, each with their own unique symptoms and diagnostic criteria. As shown above, CBD might prove to be an effective treatment for several different types of anxiety disorders.

Despite a lacuna in research on the physiological basis of anxiety and any connection to the endocannabinoid system (ECS), some potential ways that CBD may affect each type of anxiety disorder include:

• GAD: By interacting with the body’s endocannabinoid system and other receptors in the brain CBD may help reduce symptoms of GAD, such as excessive worry.
• Panic disorder: CBD may help reduce symptoms of panic disorder, such as panic attacks, by interacting with the body’s serotonin receptors, which are involved in regulating mood and anxiety.
• SAD: CBD may help reduce symptoms of SAD, such as fear of public speaking, by reducing activity in the amygdala, which is a part of the brain that is involved in processing fear and anxiety.
• Specific phobias: By interacting with the above-mentioned brain areas, CBD may help reduce anxiety and fear responses, lessening the symptoms of specific phobias.
• OCD: Again through its interactions with the body’s serotonin receptors which reduce the presentations of anxiety, CBD may help reduce symptoms of OCD, such as intrusive thoughts and compulsive behaviors.
• PTSD: CBD may help reduce symptoms of PTSD, such as intrusive memories and avoidance behaviors, by interacting with the body’s ECS and other receptors in the brain.

CBD Products and Forms

CBD is available in a variety of forms, including oils, tinctures, capsules, edibles, topicals, and more. Each form has its own unique properties and may impact the effectiveness of CBD for anxiety relief in different ways.

The different forms of CBD available in the market include:

• CBD oils and tinctures: These are liquid forms of CBD that are typically taken sublingually (under the tongue) or added to food or drinks. They are typically made by extracting CBD from the hemp plant and mixing it with a carrier oil, such as MCT oil.
• CBD capsules: These are oral capsules that contain a measured dose of CBD. They are typically made by encapsulating CBD oil or powder in a gelatin or vegetable-based capsule.
• CBD edibles: These are food products that contain CBD, such as gummies, chocolates, and baked goods. They are typically made by infusing CBD into the food product.
• CBD topicals: These are skincare products that contain CBD, such as creams, lotions, and balms. They are typically applied directly to the skin and are designed to target localized areas of pain or inflammation.
• CBD vapes: These are inhalable forms of CBD that are typically made by heating CBD oil or flower and inhaling the vapor.
• CBD concentrates: These are highly potent forms of CBD, such as wax, shatter, or crystals, that are typically vaporized or dabbed.

While all forms of CBD have the potential to be effective for anxiety relief, some forms may be more effective than others, depending on the individual’s needs and preferences. Some factors that may impact the effectiveness of CBD for anxiety relief include:

• Bioavailability: The bioavailability of CBD refers to the amount of CBD that is absorbed into the bloodstream and available for the body to use. Some forms of CBD, such as oils and tinctures, have high bioavailability, while others, such as edibles and capsules, have lower bioavailability.
• Onset and duration of effects: Different forms of CBD have different onset and duration of effects. For example, inhalable forms of CBD, such as vapes, have a rapid onset of effects but a shorter duration of effects, while oral forms of CBD, such as edibles and capsules, have a slower onset of effects but a longer duration of effects.
• Convenience and ease of use: Some forms of CBD, such as oils and tinctures, are easy to dose and can be taken on-the-go, while others, such as topicals and concentrates, may require more preparation and specialized equipment.

Here’s a convenient graph of the varying degrees of bioavailability for various kinds of CBD products you can use for anxiety:

While there is no one-size-fits-all approach to using CBD for anxiety relief, some specific CBD products that may be helpful include:

• CBD oils and tinctures: These are a popular choice for anxiety relief, as they offer a fast and convenient way to take CBD. They can be taken sublingually or added to food or drinks.
• CBD capsules: These are a go-to mode of delivery for people who prefer a measured dose of CBD and don’t like the taste of oils or tinctures.
• CBD edibles: These are a good option for people who want a tasty and discreet way to take CBD, although their bioavailability may be lower than other forms of CBD.
• CBD topicals: In contrast to the above options, topicals are for people who experience localized pain or tension related to anxiety and are applied externally at the affected area.

Dosage and Administration

Determining the right CBD dosage for anxiety can be challenging, as there is no one-size-fits-all approach. The optimal dosage may vary depending on the individual’s weight, metabolism, medical history, and other factors. However, there are some general guidelines and factors to consider when finding the right CBD dosage for anxiety.

The following factors help determine the right CBD dosage for anxiety and should be carefully considered before starting any treatment:

• Body weight: Generally, higher body weight may require a higher dose of CBD to achieve the desired effects.
• Tolerance: People who are new to CBD may need to start with a lower dose and gradually increase it over time, while those with more experience may require a higher dose.
• Severity of symptoms: People with more severe anxiety symptoms may require a higher dose of CBD to achieve the desired effects.
• Metabolism: Similarly, people with faster metabolisms may require a higher dose of CBD to achieve the desired effects.
• Medical history: People with certain medical conditions or who are taking certain medications should consult with a healthcare provider before taking CBD. They may require a special dose or need to take it with extra precaution while continuing to take other medications.

Finding the optimal dosage of CBD for anxiety may require some trial and error, as there is no one-size-fits-all approach. Some tips for finding the optimal CBD dosage for anxiety include:

• Start with a low dose: It’s generally recommended to start with a low dose of CBD, such as 5-10mg, and gradually increase the dose as needed.
• Keep a journal: Keeping a journal of how you feel after taking different doses of CBD can help you determine the optimal dosage for your specific needs.
• Talk to a healthcare provider: A healthcare provider can help you determine the optimal dosage of CBD based on your medical history and current medications.
• Use a dosage calculator: There are online dosage calculators available that can help you determine the optimal CBD dosage based on your weight and the severity of your symptoms.

While CBD is generally considered safe, and will never produce the occasionally disorienting effects of THC, taking too much CBD can lead to certain risks and side effects, such as fatigue, diarrhea, changes in appetite and weight, dry mouth, dizziness, and low blood pressure. Hence it’s important for people new to CBD to start with a low dose and gradually increase it as needed to avoid taking too much. For people with complex medical histories or currently on medication, it is advisable to talk to a healthcare provider before taking CBD in any form.

Potential Side Effects and Interactions

Especially since CBD can interact with other medications, it may not be safe for certain populations. As with any substance we ingest, there are some potential side effects and risks associated with using CBD.

Despite CBD being generally considered safe and well-tolerated, some possible side effects of using CBD for anxiety include:

• Fatigue
• Diarrhea
• Changes in appetite and weight
• Dry mouth
• Dizziness
• Low blood pressure
• Changes in liver function tests (although this is rare)

Yes, CBD can interact with other medications taken for anxiety or other conditions. Specifically, CBD can inhibit the activity of certain enzymes in the liver that are responsible for metabolizing medications, which can lead to higher levels of those medications in the bloodstream. This can increase the risk of side effects and may be dangerous for some people.

Some medications that may interact with CBD include:

• Antidepressants (such as SSRIs and MAOIs)
• Anti-anxiety medications (such as benzodiazepines)
• Antipsychotics
• Blood thinners
• Seizure medications
• Opioids

Once again, it’s important to talk to a healthcare provider before using CBD if you are taking any medications, to ensure that there are no potential interactions.

There are some specific populations that may be at higher risk for side effects or interactions of CBD with other medications. These populations include:

• Pregnant or breastfeeding women: There is limited research on the safety of using CBD during pregnancy or while breastfeeding, and it is generally not recommended.
• Children and adolescents: There is limited research on the safety of using CBD in children and adolescents, and it should only be used under the guidance of a healthcare provider.
• People with liver disease: CBD may increase the risk of liver damage in people with liver disease, and it should only be used under the guidance of a healthcare provider.
• People taking medications that may interact with CBD: As mentioned above, CBD can interact with certain medications and should only be used under the guidance of a healthcare provider.
• People with a history of addiction: While CBD is not physically addictive, people with a history of addiction may be more vulnerable to addiction or substance abuse.

While CBD may be a game-changing option for some people’s struggles with anxiety, there are certain groups of people who must proceed with caution. As with any new phytochemical that behaves similarly to a pharmacologically active substance, it’s important to talk to a healthcare provider before using it, especially if you are taking any medications or have any medical conditions. By working with a healthcare provider, you can ensure that you are using CBD safely and effectively, and minimize the risk of side effects and interactions with other medications.

Legal and Regulatory Aspects

The legal status of CBD usage for various ailments including anxiety varies depending on the region. In some countries and states, CBD is legal for medical or recreational use, while in others, it is only legal for medical use or completely illegal along with other cannabis-derived substances. Additionally, the regulation of CBD products can vary widely, making it important for consumers to be diligent in selecting safe and high-quality products.

Some regions where CBD is legal for medical or recreational use include:

• Canada
• Some states in the United States (such as California, Colorado, and Oregon)
• Uruguay
• Some countries in Europe (such as Switzerland and the Netherlands)

In other regions, CBD is only legal for medical use, such as in Australia, Lebanon, Uganda, Ghana, and some states in the United States. CBD as part of traditional Ayurvedic preparations, such as vijaya, are legal for medicinal uses in India. CBD is completely illegal in several other Asian countries and in most Middle Eastern countries.

Very recently in the United States CBD is no longer subject to an outright ban in any state. Current laws specify whether CBD derived from cannabis flowers or industrial hemp may be used, and whether people need a prescription for medical cannabis to use them.

Given the rapidly emerging market for medicinal-grade CBD and various extracts, sometimes the regulation of this dynamic industry is lax or struggling to keep up the pace. As a CBD consumer, make sure you perform your due diligence before purchasing or consuming any CBD product. Some tips for ensuring that you are purchasing safe and high-quality CBD products include:

• Look for third-party testing: Reputable CBD companies will typically have their products tested by a third-party laboratory, and will make those results available to consumers.
• Check the THC content: THC is the psychoactive compound in cannabis that can cause a “high”. Legal CBD products must contain less than 0.3% THC by weight, so it’s important to check the THC content of the product before purchasing.
• Consider the extraction method: CBD can be extracted from the hemp plant using a variety of methods, some of which may be safer and more effective than others. Look for companies that use CO2 extraction or other safe methods.
• Read reviews and do research: Look for reviews and do research on the company before purchasing. Reputable companies will typically have positive reviews across platforms and a strong online presence.
• Be wary of health claims: CBD companies are not allowed to make health claims about their products, so be wary of companies that make grandiose claims about the health benefits of their CBD products.

When one’s health is concerned, you can never be too careful. By looking for third-party testing, checking the THC content, considering the extraction method, and doing research on the company, consumers can ensure that they are purchasing safe and effective CBD products for anxiety relief.

Online Resources for understanding CBD interplay with anxiety management

• 
  Mayo Clinic - CBD Oil for Anxiety

  A comprehensive guide to CBD and its potential benefits in treating anxiety from one of the most trusted medical organizations in the world.

• 
  National Institute of Mental Health - Anxiety Disorders

  A resource from a leading government agency that provides information on anxiety disorders and their treatment, including the potential use of CBD.

• 
  Project CBD - Anxiety

  A collection of articles and research on CBD and its potential use in treating anxiety from a nonprofit organization dedicated to promoting research into the medical uses of CBD.

• 
  American Psychological Association - Cannabidiol (CBD) and Mental Health

  An article exploring the potential benefits and risks of CBD for mental health, including anxiety, from a leading professional organization for psychologists in the United States.

• 
  Anxiety and Depression Association of America - CBD

  A collection of resources and information on CBD and its potential use in treating anxiety from a leading nonprofit organization dedicated to helping people with anxiety and depression.

• 
  Consumer Reports - How to Shop for CBD

  A guide to purchasing safe and high-quality CBD products, including tips on what to look for and what to avoid, from a leading consumer advocacy organization.

Conclusion

After spending years in the shadow of THC, CBD has rapidly become one of the most well-known cannabinoids. By interacting with the body’s vast endocannabinoid system and various regions of the brain, such as the amygdala, CBD has many potential therapeutic benefits. These benefits include alleviating the symptoms of mental health disorders like anxiety, which affect millions of people in America and across the globe. They also provide a potential alternative treatment to traditional pharmaceuticals prescribed for anxiety like benzodiazepines. Though there is still a lot to learn about dosage, long-term effects, and potential drug interactions, the research so far has demonstrated that some people may safely take CBD for their anxiety and live less encumbered lives.

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