CBD for Anxiety: Dosage and Effectiveness

CBD oil for anxiety

CBD or cannabidiol is a non-psychoactive and non-addictive cannabis compound that has demonstrated benefits in the treatment of anxiety. Today in Cannactiva‘s post, we will review the latest research on the subject by Dr. Caudevilla.

Note: We remind you that this is an informative article that seeks to bring the current information available in scientific studies to the general public. It is not intended to diagnose, treat or prevent any disease.

What is anxiety?

Anxiety is an unpleasant feeling of fear, uneasiness and dread. In principle, it is neither a disease nor a pathological symptom, but a feeling as natural as happiness, anger or sadness. Being nervous about an exam, a life change or an unfamiliar environment is perfectly normal.

At a biological and evolutionary level, anxiety is considered a mechanism that prepares organisms to escape in the face of a threat. When an animal perceives or senses the presence of danger, it activates mechanisms to facilitate escape. For this reason, anxiety is often accompanied by physical symptoms such as tachycardia, palpitations, muscle tension, dry mouth, rapid breathing….

When is it necessary to treat anxiety?

In contrast to the physiological or adaptive anxiety described above, there are several different types of pathological anxiety. Some characteristic examples of the latter are:

  • Chronic anxiety, often related to an intense or sustained stressor.
  • Anxiety that manifests itself as an expression of unconscious psychological conflicts.
  • Anxiety before social interaction with other people or stimuli that objectively do not pose risk or danger(phobias).
  • Panic attack: anxiety that occurs suddenly and unexpectedly.
  • Anxiety that makes it difficult to carry out the activities of daily living.
Possible uses of CBD for anxiety
CBD for anxiety: anxiety disorders for which cannabidiol has been studied (infographic)

Is pathological anxiety common?

Anxiety is the most frequent disorder in the field of Mental Health. Up to 10.4% of the population presents symptoms of pathological anxiety at some point in their lives and 6.7% of the population may meet the criteria for a diagnosis of “anxiety disorder”.

According to data in the Spanish population (1), the anxiety problem is more frequent in women (8.8%) than in men (4.5%). And with respect to age, there are no significant differences between young people, adults or the elderly when it comes to developing anxiety disorders.

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Conventional Treatment of Anxiety

Diagnosis by a physician, psychiatrist or psychologist is a prerequisite for treatment. Anxiety usually has psychological causes, but it can also be the manifestation of an organic disease (hormonal alterations of the thyroid, parathyroid and corticoid hormones) or the adverse effect of a medication: antiasthmatics (salbutamol) or antibiotics (azithromycin).

Benzodiazepines such as diazepam (Valium ®), lorazepam (Orfidal ®) or bromazepam (Lexatin ®) may be used in occasional or mild cases. However, the continued use of these drugs as the only approach is discouraged in all clinical protocols and guidelines. In practice and unfortunately, these recommendations are not always followed.

In general, the psychotherapeutic approach to anxiety accompanied by drugs is the one that offers the best results, especially in moderate-severe and long-lasting symptoms.

CBD and Anxiety Treatment

Mechanism of Action: Endocannabinoid System and Anxiety

The endocannabinoid system plays an important role in emotion regulation and anxiety control mechanisms. Specifically, it acts on the brain circuits that determine behavior and reactions to emotional stimuli, especially those of a negative nature (2) (3).

In studies on mice, genetic mutations have been found that produce a lower activity of the endocannabinoid system. When these animals are exposed to a stressful stimulus, it is observed, through their physiological responses and their behavioral pattern, that a lower activity of the endocannabinoid system leads to an impaired regulation of anxiety mechanisms. These same genetic mutations and altered response to anxiety have also been verified in humans (4).

It is also known which brain receptors are involved: the CB1 cannabinoid receptors. Its activation produces anxiolytic effects, which are relevant for symptoms of anxiety disorders (5). The activity of this receptor is also closely related to the brain mechanisms that deactivate the physical symptoms that accompany anxiety (6).

CBD’s Potential for Anxiety

In view of the above, the availability of drugs that act on CB1 receptors opens the door to new treatments for anxiety. Cannabinoids interact selectively on these receptors and are ideal candidates.

THC, the major psychoactive cannabinoid in marijuana, has the disadvantage of producing mental effects that are more likely to be unpleasant in a person with anxiety (10).

In contrast, CBD is non-psychoactive, safe, has few adverse effects and its pharmacological properties in humans are well known. In addition, it acts on other brain receptors involved in mood disorders, such as serotonin receptors (7).

Scientific studies on CBD for anxiety

Overall, the existing evidence strongly supports the potential of CBD as a treatment for anxiety disorders. In animals, cannabidol exhibits a wide range of effects against anxiety, panic, compulsive behaviors, physical symptoms accompanying anxiety and long-term prevention of stress. (8)

The available data suggest that CBD is a good candidate for the treatment of generalized anxiety disorder, panic attacks and social anxiety disorder, at least acutely. Also in other mental health problems in which anxiety is an important element, such as post-traumatic stress disorder(PTSD) or obsessive compulsive disorder (OCD)(9, 19, 20).

CBD and Anxiety
CBD for anxiety (infographic). In many countries such as Spain, the oral use of CBD is not regulated. Cannactiva products are for external use. Consult a physician before using CBD for anxiety.

Clinical Studies

Early studies showed that CBD reverses the anxiety effects that THC can produce in humans (10) (11). A beneficial effect of cannabidiol has also been demonstrated in the immediate treatment of patients with social phobia (12), and even in areas such as anxiety in heroin addicts (13) and cocaine addicts (14).

There are ongoing clinical trials with CBD for generalized anxiety disorder resistant to other treatments (15), post-traumatic stress disorder (16), social anxiety (17), and cancer anxiety (18). Some of them are at a very advanced stage and their results are expected to be published in the coming months.

How to take CBD for anxiety?

Most of the human clinical trials on cannabidiol and anxiety are using oil extracts from CBD cannabis plants, in CBD oil format. Considering the available data, the most appropriate route of administration of cannabidiol oil would be drops in the form of sublingual or oral CBD.

Based on studies, cannabidiol was shown to be effective for anxiety at doses between 200 and 800 mg daily of CBD in a 12-week treatment (15). However, a physician should be consulted before starting to use CBD to treat anxiety and consider possible interactions between CBD and medications.

How long does it take for CBD to take effect?

In studies that have evaluated the effect of CBD in stressful situations, such as cannabidiol for public speaking, CBD oil was administered 60-90 minutes beforehand. However, the effectiveness of CBD will vary depending on the form of consumption, dosage, type of anxiety and other individual circumstances (consult a specialist).

Can CBD vaporizations be used for anxiety?

There is not much data on the effect of CBD vaporizations to treat anxiety. Theoretically, the effect of cannabidiol via the respiratory route should be faster and more intense than that of CBD oil, but of shorter duration. Therefore, some practitioners believe that CBD vaporizations can be combined with CBD oil for anxiety, although there are no studies that verify this type of practice.

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In Conclusion…

Scientific evidence supports the anxiolytic potential of CBD, and this component of cannabis continues to be the subject of research. At the clinical level, at present, there are no data to recommend cannabidiol for anxiety disorders. Its long-term efficacy, its drug interactions or its role as a complementary therapy are some of the aspects to consult with the physician when considering a treatment such as CBD.

Note: This is an informational article and is not intended to prevent, diagnose or treat any disease. Its contents may complement, but should never replace, any diagnosis or treatment of any disease or symptom. Cannactiva products are not medicines and are intended for external use. Cannactiva is not responsible for the misuse of this information. Please note that new scientific evidence may become available since the date of publication. Therefore, consult your doctor before using CBD.

References
  1. Mental health in data: prevalence of health problems and consumption of psychotropic and related drugs from primary care clinical records. Publication date: December 2020. Ministry of Health. Government of Spain.
  2. Castillo PE, Younts TJ, Chavez AE, Hashimotodani Y. Endocannabinoid signaling and synaptic function. Neuron. 2012 Oct 4;76(1):70-81. doi: 10.1016/j.neuron.2012.09.020. PMID: 23040807; PMCID: PMC3517813.
  3. Riebe CJ, Pamplona FA, Kamprath K, Wotjak CT. Fear relief-toward a new conceptual frame work and what endocannabinoids gotta do with it. Neuroscience. 2012 Mar 1;204:159-85. doi: 10.1016/j.neuroscience.2011.11.057. Epub 2011 Dec 3. Erratum in: Neuroscience. 2012 Jun 14;212:225. Pamplona, F [corrected to Pamplona, F A]. PMID: 22173015.
  4. Dincheva I, Drysdale AT, Hartley CA, Johnson DC, Jing D, King EC, Ra S, Gray JM, Yang R, DeGruccio AM, Huang C, Cravatt BF, Glatt CE, Hill MN, Casey BJ, Lee FS. FAAH genetic variation enhances fronto-amygdala function in mouse and human. Nat Commun. 2015 Mar 3;6:6395. doi: 10.1038/ncomms7395. PMID: 25731744; PMCID: PMC4351757.
  5. Melis M, Greco B, Tonini R. Interplay between synaptic endocannabinoid signaling and metaplasticity in neuronal circuit function and dysfunction. Eur J Neurosci. 2014 Apr;39(7):1189-201. doi: 10.1111/ejn.12501. PMID: 24712998.
  6. Ruehle S, Rey AA, Remmers F, Lutz B. The endocannabinoid system in anxiety, fear memory and habituation. J Psychopharmacol. 2012 Jan;26(1):23-39. doi: 10.1177/0269881111408958. Epub 2011 Jul 18. PMID: 21768162; PMCID: PMC3267552.
  7. Resstel LB, Tavares RF, Lisboa SF, Joca SR, Corrêa FM, Guimarães FS. 5-HT1A receptors are involved in the cannabidiol-induced attenuation of behavioral and cardiovascular responses to acute restraint stress in rats. Br J Pharmacol. 2009 Jan;156(1):181-8. doi: 10.1111/j.1476-5381.2008.00046.x. PMID: 19133999; PMCID: PMC2697769.
  8. García-Gutiérrez MS, Navarrete F, Gasparyan A, Austrich-Olivares A, Sala F, Manzanares J. Cannabidiol: A Potential New Alternative for the Treatment of Anxiety, Depression, and Psychotic Disorders. Biomolecules. 2020 Nov 19;10(11):1575. doi: 10.3390/biom10111575. PMID: 33228239; PMCID: PMC7699613.
  9. Blessing EM, Steenkamp MM, Manzanares J, Marmar CR. Cannabidiol as a Potential Treatment for Anxiety Disorders. Neurotherapeutics. 2015 Oct;12(4):825-36. doi: 10.1007/s13311-015-0387-1. PMID: 26341731; PMCID: PMC4604171.
  10. Zuardi AW, Shirakawa I, Finkelfarb E, Karniol IG. Action of cannabidiol on the anxiety and other effects produced by delta 9-THC in normal subjects. Psychopharmacology (Berl). 1982;76(3):245-50. doi: 10.1007/BF00432554. PMID: 6285406.
  11. Zuardi AW, Cosme RA, Graeff FG, Guimarães FS. Effects of ipsapirone and cannabidiol on human experimental anxiety. J Psychopharmacol. 1993 Jan;7(1 Suppl):82-8. doi: 10.1177/026988119300700112. PMID: 22290374.
  12. Rosário BDA, Lemes JA, de Lima MP, Ribeiro DA, Viana MB. Subjective, behavioral and neurobiological effects of cannabis and cannabinoids in social anxiety. Rev Neurosci. 2023 Oct 11;35(2):197-211. doi: 10.1515/revneuro-2023-0078. PMID: 37812748.
  13. Hurd YL, Spriggs S, Alishayev J, Winkel G, Gurgov K, Kudrich C, Oprescu AM, Salsitz E. Cannabidiol for the Reduction of Cue-Induced Craving and Anxiety in Drug-Abstinent Individuals With Heroin Use Disorder: A Double-Blind Randomized Placebo-Controlled Trial. Am J Psychiatry. 2019 Nov 1;176(11):911-922. doi: 10.1176/appi.ajp.2019.18101191. Epub 2019 May 21. Erratum in: Am J Psychiatry. 2020 Jul 1;177(7):641. PMID: 31109198.
  14. Meneses-Gaya C, Crippa JA, Hallak JE, Miguel AQ, Laranjeira R, Bressan RA, Zuardi AW, Lacerda AL. Cannabidiol for the treatment of crack-cocaine craving: an exploratory double-blind study. Braz J Psychiatry. 2021 Sep-Oct;43(5):467-476. doi: 10.1590/1516-4446-2020-1416. PMID: 33146345; PMCID: PMC8555645.
  15. Berger M, Li E, Rice S, Davey CG, Ratheesh A, Adams S, Jackson H, Hetrick S, Parker A, Spelman T, Kevin R, McGregor IS, McGorry P, Amminger GP. Cannabidiol for Treatment-Resistant Anxiety Disorders in Young People: An Open-Label Trial. J Clin Psychiatry. 2022 Aug 3;83(5):21m14130. doi: 10.4088/JCP.21m14130. PMID: 35921510.
  16. Clinical Trial: Safety and Efficacy of Cannabidiol (CBD) for Symptoms of Post-Traumatic Stress Disorder (PTSD) in Adults Using Liquid StructureTM Formulation (NantheiaTM ATL5). Clinical Trials. Available at: https://clinicaltrials.gov/study/NCT05269459
  17. Clinical Trial: Cannabidiol as a Treatment for Social Anxiety Disorder (R61). Clinical Trials. Available at: https://clinicaltrials.gov/study/NCT05571592
  18. Clinical Trial: RCT of CBD for Anxiety in Advanced Breast Cancer. Clinical Trials. Available at: https://clinicaltrials.gov/study/NCT04482244
  19. Skelley JW, Deas CM, Curren Z, Ennis J. Use of cannabidiol in anxiety and anxiety-related disorders. J Am Pharm Assoc (2003). 2020 Jan-Feb;60(1):253-261. doi: 10.1016/j.japh.2019.11.008. Epub 2019 Dec 19. PMID: 31866386.
  20. Blessing EM, Steenkamp MM, Manzanares J, Marmar CR. Cannabidiol as a Potential Treatment for Anxiety Disorders. Neurotherapeutics. 2015 Oct;12(4):825-36. doi: 10.1007/s13311-015-0387-1. PMID: 26341731; PMCID: PMC4604171.

Dr. Fernando Caudevilla
Family Physician | Expert in Drug Addictions. He works in different assistance, research and training projects related to drugs, including therapeutic cannabis.

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