CBD for Anxiety: The Promising Future of CBD for Anxiety Disorders

Before discussing the relationship between CBD and anxiety, it’s important to note that the FDA does not allow claims to be made that a CBD product will elicit a positive effect for a specific health condition or symptom (i.e. anxiety). Our statements have not been evaluated by the FDA and our product is not intended to diagnose, treat, mitigate, cure or prevent any disease. Most of the therapeutic effects discussed in this blog were observed in pre-clinical studies and should be read in that light.

The understanding of anxiety and, more specifically, anxiety disorders has grown considerably in recent years. One essential concept that has gained ground is the need to recognize when anxiety has reached an unhealthy level and to treat that anxiety effectively. For almost 40 years, treatment has been centered around prescription medications and psychotherapy. But as the canon of CBD research continues to grow, it appears that high-quality CBD can also be an invaluable asset in the field of mental health.

Healthy Anxiety— your body’s natural response to the dangers of life.

As alluded to above, anxiety can be a normal and healthy response to a threat or a future concern— a response that has proven useful for survival. It can help you to manage a dangerous situation. It can propel you to be better prepared for the challenges of life, from giving a speech to planning for the birth of a child. When your body is working properly, your sympathetic nervous system will engage in the presence of a threat, sending a message to the adrenal glands to release stress hormones such as adrenaline, noradrenaline and cortisol. The physiological response to these stress hormones include the following:

• increased heart rate
• rapid breathing
• dilation of muscle blood vessels
• auditory exclusion
• tunnel vision
• dilation of pupils

When your body reacts this way at an appropriate time, it is elevated to a state that is better equipped to handle an imminent challenge. But your body is not meant to remain here. In a modern society with limited immediate dangers, these anxiety-laced responses tend to be prompted by more commonplace stressors. Most experts believe that anxiety works by taking these appropriate responses to legitimate threats to your physical well-being (i.e. a predator) and activating them when there is no imminent physical risk [9]. Your “fight or flight” response stays perpetually triggered, just below the surface, whether or not you are in any real danger.

The Prevalence of Anxiety Disorders— What national statistics reveal about anxiety.

When a person hovers in a constant “fight or flight” state, their heightened anxiety levels can usually be attributed to a form of anxiety disorder. This undesirable state of anxiety is quite common in the United States; the National Comorbidity Survey found that anxiety disorders have a lifetime prevalence of 33.7%, meaning that 1 in every 3 Americans will suffer from one at some point in their life. In a span of a year, 1 in 5 people will deal with an anxiety disorder, as they have a 12-month prevalence of 21.3%. These rates are easily the highest of any mental disorder in the United States [8]. On top of that, the World Health Organization estimates that approximately 50% of the cases of anxiety disorders go unrecognized and undiagnosed [8]. While these statistics do well to reveal the extent of this form of mental illness, it is the implications of anxiety and stress that are often overlooked.

Implications of Chronic Stress— The powerful relationship between mental health and holistic well-being.

The real gravity of anxiety disorders lies within their consequences, which reach far beyond the most apparent disadvantages. Among health and wellness professionals, there is a growing appreciation for the correlation between an individual’s mental health and their holistic well-being. The following are some of the far-reaching effects that anxiety can have when left unchecked.

As the brain is constantly sending and receiving signals throughout the entire body, your thoughts have a serious impact on your physical health. A perpetually anxious person will maintain elevated levels of stress hormones, which subjects them to somatic symptoms such as:

• fatigue
• migraines
• irritability
• muscle aches
• inability to focus
• restlessness

When stress hormone levels persist, the physical symptoms also persist and go on to cause more permanent physical conditions. For instance, excessive anxiety puts you at greater risk for several cardiovascular disorders such as heart disease and diabetes. This generally occurs via increased body weight and abdominal fat, high blood pressure, and greater levels of triglycerides and cholesterol brought on by anxiety. Stress hormones also increase glucose levels in the bloodstream to give your muscles the energy needed for a fight or flight response, but sustained levels lead to obesity [9].

Another physical effect of chronic stress and stress hormones is a suppression of the immune system. In a legitimate “fight or flight” scenario, processes such as bodily healing can wait for a threat to subside. But people with anxiety disorders, whose hormones remain elevated by everyday stressors, lose their subconscious ability to control immune functions, thus contributing to heightened systemic inflammation that increases the risk of cardiovascular and even autoimmune disorders [9].

One of the most devastating responses to chronic stress occurs in the brain. Sustained levels of stress hormones impairs endocannabinoid (eCB) signaling in the hippocampus and amygdala regions of the brain [1]. When this signaling becomes dulled, the Endocannabinoid System (ECS) is no longer able to repress the neurotransmitters related to anxiety and the stress perpetuates itself. At this point, a cyclical effect is underway where anxiety begets anxiety.

Mental and Emotional Symptoms

The damage of untreated anxiety is certainly not limited to physical health. While people suffering from an anxiety disorder are 3-5 times more likely to be seen by a doctor, they are 6 times more likely to be hospitalized for additional psychiatric disorders than non-sufferers [11]. The emotions and feelings that are brought on by anxiety disorders are often manifested with the following symptoms:

• perceived loss of control
• persistent fear and worry
• avoidance of others
• persistent negative thoughts
• low self-esteem
• diminished interest in significant activities
• general pessimism

Much like how physical symptoms develop into physical conditions, the mental patterns of chronic anxiety turn into major everyday issues. Anxiety is closely associated with a diminished sense of well-being, elevated rates of unemployment, relationship breakdown, and an elevated suicide risk [1].

Indications of Anxiety Disorders— 3 clear signs that your anxiety level is unhealthy.

There are certain signs that your anxiety has gone beyond a healthy level. One aspect to consider is the magnitude of the fear. When levels of fear are disproportionate to their cause (which is something an anxious person is often keenly aware of) that is a sign of disorder.

Many people with anxiety disorders cannot pinpoint the trigger of their emotional upheaval. The absence of an identifiable cause can actually intensify the fear associated with an anxiety attack, leaving one stuck in a cycle of panic. The fear begins to center around the symptoms experienced rather than the initial cause. Anxiety usually does have a trigger, whether an event or a thought. But people are often unable to draw these triggers to consciousness, which can be a telling feature of an unhealthy anxiety.

Another clue that anxiety has gone too far is when the symptoms last for days or weeks beyond the stressor. Your body is just not meant to remain in such an intense survival mode. If symptoms persist, you may need to seek treatment for an anxiety disorder.

Traditional Methods of Treatment— How medication and psychotherapy address anxiety.

Anxiety Disorders have been recognized by the American Psychiatric Association and included in the Diagnostic and Statistical Manual (DSM) since 1980. Since that time, the two most prescribed treatment plans have been psychotherapy and medication. Below is a brief overview of these treatments.

Medication

Depending on the type of anxiety disorder (i.e. Generalized Anxiety, Panic Disorder, Social Phobia, PTSD, and Obsessive-Compulsive Disorder), people can be prescribed a few different forms of medication. The most common are antidepressant SSRIs (Selective Serotonin Reuptake Inhibitor) such as Prozac or Zoloft. These are frequently used to treat anxiety because of their ability to increase serotonin levels in the brain by blocking the reuptake of the serotonin neurotransmitter. This allows for more serotonin to remain in the spaces between neurons and, thus, an improved mood and more positive feelings. (This video provides an excellent illustration of “reuptake” inhibition).

Benzodiazepines, like Xanax and Valium, are another type of medication prescribed for anxiety. They are known for their sedative properties, as “benzos” have the effect of slowing of the central nervous system (CNS), inducing a state of relaxation. This is generally prescribed to people whose anxiety disrupts their sleep patterns.

Finally, beta-blockers, such as Inderal and Tenormin, are occasionally prescribed for their ability to block the effects of adrenaline released in a fight-or-flight response. This helps control the physical symptoms of anxiety such as rapid heart rate and high blood pressure. Beta-blockers are generally taken in anticipation of an event that will elicit a high-stress condition.

Psychotherapy

The ultimate goal with any type of psychotherapy is to help patients manage their stress, understand their patterns of behavior and regulate their emotions— to include the emotions associated with anxiety. In that regard, it is unlike anxiety medication; therapy is designed to treat more than just the symptoms of the problem. Therapists can help clients to identify causes of anxiety and present valuable tools like coping mechanisms and problem-solving skills.

The most common form of therapy used to treat anxiety disorders is Cognitive Behavioral Therapy, as it is intentional in targeting the thoughts that give oxygen to the anxiety. The whole premise behind CBT is that it is our thoughts— not circumstances — that dictate the way we feel. For people with anxiety disorders, negative patterns of thinking fuel the negative emotions of anxiety and fear. By identifying the inaccurate and negative thoughts that cause anxiety, clients are able to restructure their thought life and, hence, change the way that they feel.

Another psychological method of treatment is known as Exposure Therapy. The cyclical tendency of anxiety disorders, where avoiding a fear simply makes it stronger, is attacked head-on with this approach. Using a methodical approach called systematic desensitization, clients are gradually exposed to stimuli that is mildly threatening, working their way up to the object of the fear itself until the threat no longer has a stronghold in their life. This technique helps to build the confidence of the client while helping them to master skills for controlling their anxiety.

Treatment

Drawbacks— Side effects and obstacles of conventional anxiety remedies

The reason that these two treatment methods have persisted for nearly 40 years is largely because they have a proven level of effectiveness. But therapy and anxiety medications both have their drawbacks. Mentioning these issues is not meant to discredit these treatments, but rather to paint the picture of anxiety treatments as accurately as possible.

Medications

Antidepressants: Though generally considered safe, a relapse into an anxious state is common when coming off of SSRI / SNRI medications. Other symptoms that may occur are cognitive decline; a decline in sexual interest, performance, and satisfaction; development of antidepressant tolerance; and an increased risk of suicide [10].

Benzodiazepines: These drugs are extremely effective at targeting anxiety symptoms, but they come with a high risk of dependency, especially when taken as a long term solution (i.e. greater than 30 days). The addictive nature of benzodiazepines has, in part, been attributed to their effectiveness, as it creates a strong affinity in patients towards the medication. Patients then tend to pressure doctors into renewing prescriptions well past their intended use. In cases of dependency, withdrawal symptoms can result in symptoms such as tremors, muscle cramps, and life-threatening seizures [12].

Beta-Blockers: While beta-blockers are useful for high-intensity situations as they help control your heart rate and other autonomic functions, they don’t target the emotional and psychological aspects of anxiety such as worry, feeling overwhelmed, or distress. So, while they may help reduce the nerves for an anticipated stressful event, there are many critical aspects of anxiety disorders that beta-blockers do not address.

Therapy

Expense: While the fees therapists charge vary according to geographic location and levels of training, one standard session (45-55 minutes) of talk therapy generally runs between $80 and $120 [13]. Though there are creative workarounds to make therapy more affordable (i.e. sliding scales, payment plans, seeing university counseling students), the cost still deters many from seeking professional mental health. Of the more than 30 million U.S. adults who do not receive the mental health services they need, 45% cited cost as the decisive barrier to mental health care [13].

Ineffectual Diagnosis: According to a survey of qualified psychiatrists, 45% of patients suffered from symptoms of Generalized Anxiety Disorder for two years or more before they were correctly diagnosed with the disorder [8]. That’s two years without treatment for a serious mental health condition.

Permanence of Treatment: Many patients experience social or contextual cues that trigger anxiety symptoms following their experience with psychotherapy. This re-emergence highlights the limited effectiveness of psychological treatments in their ability to prevent relapse [4]. Additionally, psychotherapy typically takes longer than drug therapy to produce noticeable effects—an average of six to eight weeks for psychotherapy as compared to the average four to six weeks for medication.

Aversion to Psychotherapy: There are various reasons, specific to anxiety sufferers, for choosing not to seek professional mental help. People with social anxiety tend to hide their struggle with anxiety due to shyness or shame. Those dealing with a panic disorder may assume that their condition is physiological rather than mental, leaving them chasing down physical symptoms instead of the true underlying concern.

High Quality CBD as Treatment— The potential for CBD to aid in mental health

Efficacy of CBD

While it is true that more studies still need to be conducted on using cannabidiol as a medication, much research already has been conducted. In an article entitled “Cannabidiol as a Potential Treatment for Anxiety Disorders,” scientists from the New York University School of Medicine examine the collective research related to high quality CBD as an anxiety medication in a concise, scholarly review.

In summary, they found that preclinical evidence conclusively demonstrates the efficacy of CBD in reducing anxiety behaviors in disorders such as Post-Traumatic Stress Disorder, Obsessive-Compulsive Disorder, General Anxiety Disorder, Panic Disorder, and Situational Anxiety Disorder, with a notable lack of anxiogenic (anxiety-inducing) effects [1]. This is highly encouraging, as the scope of this scholarly review was not small; the articles cites 121 distinct studies centered around CBD efficacy, lending to the credibility of the consensus.

In 2018, an online survey was conducted where cannabidiol users were polled to determine who had used CBD, why they used it, and their therapeutic results. Out of the 2409 respondents, 61.5% said they used it to treat a medical problem such as anxiety. An astounding 95% of the people who used CBD for medical purposes found it to work at least “well” [2]. Numbers like these certainly bolster the case for CBD products as treatment to conditions like anxiety.

The Safety of CBD

Another encouraging aspect to the idea of taking cannabidiol for anxiety is that studies have shown it to be rather safe. The World Health Organization conducted a review of cannabidiol in which they describe the substance as being “well tolerated with a good safety profile” [3]. The W.H.O. goes on to state that there have been no “public health-related problems” associated with the use of CBD to date. CBD has shown to be well tolerated across a wide dose range, even up to 1500 milligrams per day, with no indication of declined motor skills, negative mood effects, or vital sign abnormalities [7]. There have been no reported cases of dependence or abuse potential with cannabidiol [3]. Research is still being conducted on the long-term effects of chronic CBD consumption, as its widespread use is a relatively new trend.

Mechanisms of CBD— How CBD actually works on your body

CBD has been found to have broad therapeutic value across a range of neuropsychiatric disorders stemming from its diverse central nervous system actions [6]. CBD is proposed to activate or modify the function of several receptors in the CNS, which in turn creates many physiological responses. The interactions listed are not exhaustive, but we’ll discuss some prominent interactions that occur at the CB1 (Cannabinoid Receptor Type 1) and 5-HT1A (Serotonin 1A Receptor) receptors.

CB1 Receptor

Found primarily in nerve cells of the brain and spinal cord, CB1 Receptors (Cannabinoid Receptor Type 1) influence functions such as memory processing, pain regulation, and motor control. CB1 receptors are thought to have strong ties to how fear is processed by the mind. In preclinical studies, activation of CB1 receptors produces “anxiolytic” (anxiety -reducing) effects when introduced alongside an unconditioned fear stimulus designed to replicate symptoms of anxiety disorder [1].

These receptors are activated by endocannabinoids (eCBs), cannabis-like substances that are native to our body. A proposed cause of anxiety symptoms is a deficiency of eCBs and, thus, less frequent activation of CB1 receptors.

Though CBD molecules do not bind directly to CB1 receptors, their indirect effect on the receptors is widely recognized. CBD significantly increases the amount of eCBs in your body by blocking FAAH— an enzyme that binds with and breaks down eCBs. CBD has a strong affinity for binding with FAAH and, when this binding occurs, more eCBs are available to activate CB1 receptors [5]. As mentioned above, activation of CB1 receptors has been shown to reduce anxiety levels associated with unconditioned fear.

CB1R and Fear Extinction

A specific form of therapy that is used for anxiety conditions such as PTSD and Social Phobia Disorder is known as extinction training. In summary, extinction training is a sort of reverse-operant conditioning or exposure therapy, where a person is repeatedly presented with a conditioned stimulus (one that usually drives them to an anxious state; i.e. gunfire), but with the absence of a troubling outcome (uncontrolled stimulus). This is repeated until the conditioned stimulus has lost its effect of inducing anxiety. This type of conditioning is believed to work not because it changes the existing memory, but because new, innocuous memories block out or dampen the existing one [14].

While this type of conditioning can be accomplished without pharmacological intervention, preclinical studies have captured the effects of several anxiety-related substances on the extinction process. For instance, when patients have been on a regimen of benzodiazepines prior to therapy, the effects of fear extinction training are disrupted and fear memories tend to reconsolidate [12]. In contrast, systemic CBD administration immediately after retrieving a contextual fear memory disrupted reconsolidation, resulting in a lasting reduction in fear expression during later retrieval [5]. This effect is directly associated with the activation of CB1 receptors (due to elevated eCB levels) and the subsequent anxiolytic response.

Serotonin and the 5-HT1A Receptor

The 5HT system, more widely known as the serotonin system, is one of the most important and comprehensive systems of your body. Thinking back to some of your biology or psychology courses, you’ve likely heard of the neurotransmitter serotonin and its “feel good” properties. Affectionately termed the “hormone of happiness,” serotonin is known for its ability to keep your mood and emotions in check. Deficits of serotonin have strong links to psychological disorders such as depression. For this reason, most current medications for depression and anxiety (i.e. SSRIs) are designed to prevent the reuptake (or recycling) of serotonin. In addition to mood regulation, the serotonin system is also credited with regulating functions such as aggression, learning, appetite, sleep, consciousness and reward-seeking behavior.

A critical part of the serotonin (5HT) system is its receptors, as they are the part of the cell that mediate how often neurotransmission occurs. 5-HT1A receptors are a specific grouping of serotonin receptors that are widely distributed in the brain, especially in regions related to stress and anxiety such as the raphé nuclei, hippocampus, prefrontal cortex, amygdala and hypothalamus [14].

Activation of 5-HT1A Receptors

While the exact mechanisms behind the effects of the 5HT1A receptor have yet to be identified, preclinical studies have conclusively shown that activation of presynaptic 5HT1A receptors induces a remarkable anxiolytic (anxiety-reducing) effect. Additionally, these studies demonstrate that 5HT1A activation can facilitate adaptation to stress and improve the effectiveness of fear extinction [1]. Activation of these receptors causes a cascade of chemical signals to be sent throughout your body to regulate functions like mood.

CBD and the 5-HT1A Receptor

In light of these findings, a logical question would be “What activates 5-HT1A receptors?” Serotonin is the main activator (or “agonist”) of the 5HT receptors, which is why your mood is largely dependent on having normal serotonin levels. But, as you may have guessed, CBD has recently been identified as another substance that activates the 5HT1A receptor. Jose Alexandre Crippa of the University of Sao Paulo has led several studies focused on the interaction of CBD molecules with 5HT1A receptors. His team has found that CBD is one of the more effective agonists of 5HT1A [15].

Getting Help— Practical resources for managing your anxiety

This article is not meant to herald CBD as the holy grail of anxiety disorders. It was simply written to shed light on some of the potential therapeutic benefits of taking CBD for anxiety. As mentioned, anxiety research is still being conducted to answer questions regarding the best applications for cannabidiol. But one thing seems to be increasingly apparent: CBD as a treatment for anxiety has a promising future.

Anxiety disorders are serious conditions. It is imperative to recognize when anxiety has escalated from normal levels to an unhealthy amount. Again, some clear indicators of anxiety disorder include:

• a disproportionate level of anxiety in relation to a given stressor
• an indistinguishable cause of the anxious condition
• anxiety symptoms that persist far beyond issue resolution

If your anxiety has reached these levels, we strongly urge you to seek help. Here are some resources that may prove helpful when dealing with anxiety:

• SAMHSA’s National Helpline (1-800-662-4357) is a free, confidential, 24/7, 365-day-a-year treatment referral service for those facing mental and/or substance use disorders.
• National Alliance of Mental Illness has another helpline that can be reached M-F, 10 am–6 pm, ET. (1-800-950-NAMI) They can also be reached via text by texting “NAMI” to 741741.
• A recently published NPR article provides helpful tips on how to practically handle anxiety .
• Lower anxiety medication costs by using GoodRx, a website that offers free coupons and discounts for various prescriptions.
• Everyday Health has published a blogpost that is essentially an organized list of resources for those specifically dealing with high levels of anxiety.
• A valued partner of Redeem writes a blog dedicated to the anxiety associated with motherhood— one of the leading causes of anxiety.

While self-help coping strategies can be very effective, it is important to seek professional help when these methods fall short. As stated in this article, you can consider your mental health just as important as your physical health. We encourage you to take the necessary steps to become the best version of yourself possible.

References

• Blessing, E.M., Steenkamp, M.M., Manzanares, J., & Marmar, C.R. (2015). Cannabidiol as a Potential Treatment for Anxiety Disorders. Neurotherapeutics, 12, 825-836.
• Corroon, J., & Phillips, J. A. (2018). A Cross-Sectional Study of Cannabidiol Users. Cannabis and Cannabinoid Research,3.1, 1-10. doi:10.1089/can.2018.0006
• World Health Organization. (2018). Cannabidiol (CBD) Critical Review Report. Expert Committee on Drug Dependence, 40th ser., 1-28. Retrieved July 15, 2019, from https://www.who.int/medicines/access/controlled-substances/CannabidiolCriticalReview.pdf.
• Lee, J. L., Bertoglio, L. J., Guimarães, F. S., & Stevenson, C. W. (2017). Cannabidiol regulation of emotion and emotional memory processing: Relevance for treating anxiety-related and substance abuse disorders. British Journal of Pharmacology, 174(3242), 3256th ser., 1-15. doi:10.1111/bph.13724
• Jurkus, R., Day, H.L.L., Guimarães F.S., Lee J.L., Bertoglio L.J. and Stevenson C.W. (2016). Cannabidiol Regulation of Learned Fear: Implications for Treating Anxiety-Related Disorders. Frontiers in Pharmacology. 7:454. doi: 10.3389/fphar.2016.00454
• Campos, A. C., Moreira, F. A., Gomes, F. V., Del Bel, E. A., & Guimaraes, F. S. (2012). Multiple mechanisms involved in the large-spectrum therapeutic potential of cannabidiol in psychiatric disorders. Phil. Trans. R. Soc. B,367(3364), 3378th ser., 1-15. doi:10.1098/rstb.2011.0389
• Bergamaschi, M. M., Queiroz, R. H., Zuardi, A. W., & Crippa, J. S. (2011). Safety and Side Effects of Cannabidiol, a Cannabis sativa Constituent. Current Drug Safety,6(4), 237-249. doi:10.2174/157488611798280924
• Bandelow, B., MD, & Michaelis, S., MD. (2015). Epidemiology of anxiety disorders in the 21st century. Dialogues in Clinical Neuroscience,17(3), 327-335. Retrieved July 18, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4610617/.
• Jovanovic, T., Ph.D, Lott, A. P., Ph.D, Michopoulos, V., Ph.D, Stevens, J., Ph.D, Van Rooij, S., Ph.D, Carter, S., Ph.D, Stenson, A., Ph.D (n.d.). What is Anxiety. Retrieved July 22, 2019, from https://www.anxiety.org/what-is-anxiety
• Harvard Health Publishing. (2019, March 19). What are the real risks of antidepressants? Retrieved July 20, 2019, from https://www.health.harvard.edu/mind-and-mood/what-are-the-real-risks-of-antidepressants
• Folk, J. (2019, May 11). Anxiety Effects on Society Statistics. Retrieved July 22, 2019, from https://www.anxietycentre.com/anxiety-statistics-information.shtml
• Janhsen, K., Ph.D, Roser, P., Ph.D, & Hoffmann, K., Ph.D. (2015). The Problems of Long-Term Treatment With Benzodiazepines and Related Substances. Dtsch Arztebl Int,112(1-2), 1-7. doi:10.3238/arztebl.2015.0001
• Babakian, G. (2013, December 23). How much does mental health care cost? Part 2: Finding Affordable Psychotherapy. Retrieved July 22, 2019, from https://clearhealthcosts.com/blog/2013/12/much-mental-health-care-cost-part-2-finding-affordable-psychotherapy/
• Resstel, L. B., Tavares, R. F., Lisboa, S. F., Joca, S. R., Corrêa, F. M., & Guimarães, F. S. (2009). 5-HT1A receptors are involved in the cannabidiol-induced attenuation of behavioural and cardiovascular responses to acute restraint stress in rats. British Journal of Pharmacology,156, 181-188. doi:10.1111/j.1476-5381.2008.00046.x
• Russo, E. B., Burnett, A., Hall, B., & Parker, K. K. (2005). Agonistic properties of cannabidiol at 5-HT1a receptors. Neurochemical Research,30(8), 1037-1043. doi:10.1007/s11064-005-6978-1