Lots of people are asking us about how cannabidiol (CBD) effects the body. One of the topics that we see discussed all over the internet has to do with CBD oil for anxiety.
People want to know if they take CBD hemp oil, will it lead to reduced anxiety, panic attacks, social anxiety disorder, anxiety and depression, and other anxiety induced symptoms? What does the science have to say about the benefits of cbd and cannabis products in treating anxiety and related medical conditions?
In this article we will delve into the science to see what studies have found to be the relationship between CBD and anxiety.
While pharmaceuticals for anxiety exist in a wide variety of forms, they often come with side effects severe enough that many people who suffer from anxiety avoid medications altogether. These side effects range from addiction and nausea to sexual dysfunction.
With all of these side effects, many are turning to natural remedies in the hope of achieving a more balanced mood. Natural remedies range from habits you can add into your life to plant-based medicines.
One plant compound that is receiving extensive studies currently on its medicinal properties is cannabidiol (CBD).
What is CBD?
Cannabidiol (CBD) is extracted from the Cannabis Sativa plant. Hemp and marijuana are both cannabis plants that come from the same genus and species of plant, however hemp plants contain little to no tetrahydrocannabinol (THC), the psychotropic cannabinoid responsible for the “high” one gets when they smoke or consume marijuana.
CBD hemp oil is now available in every state in the United States, with research expanding due to the legalization of recreational and medical marijuana in multiple states. Before this change in legal status, very few studies were performed on cannabis and its constituents, leading to confusion around the effects of CBD.
In this article we will review what studies have found when looking at CBD and anxiety disorders.
The Endocannabinoid System and Anxiety
In the 1990s the endocannabinoid system (ECS) was first discovered. This system is composed of endocannabinoids and cannabinoid receptors (CB1 and CB2) found throughout our brains and bodies.
Research into understanding how the ECS works and what functions it’s involved in are still underway. That being said, we are beginning to better understand much about this system and how phytocannabinoids, such as THC and CBD, may impact the ECS and thus our health.
Recently evidence has emerged for the involvement of the ECS in our anxiety and fear response. By understanding how the ECS plays a role in anxiety, it may be possible to apply therapies that have an effect on the ECS.
Anandamide (AEA) and 2-arachidonoylglycerol (2-AG) are two endocannabinoids, meaning they are cannabinoids produced within our bodies. These endocannabinoids activate cannabinoid type 1 (CB1) receptors. CB1 receptors, found in neuron terminals throughout our brains, control the release of multiple neurotransmitters.
Glutamate and gamma-aminobutyric acid (GABA) are two of the most important neurotransmitters in the brain when we are discussing anxiety. The ECS has also been tied to the regulation of the serotonergic system, thus having an impact on the neurotransmitter serotonin.
It is through this neurotransmitter role that the ECS is thought to play a role in our anxiety and fear response, and it is through manipulation of this system by outside cannabinoids and other drugs that we may be able to impact this response.
Drugs that act as CB1 receptor antagonists, CB1 receptor agonists, and endocannabinoid degradation inhibitors may be useful for those suffering from mood disorders such as anxiety.
To complicate matters, it has been found that cannabinoids can have biphasic properties, meaning opposite effects in the body. One example of this is with AEA. AEA acts as an anxiolytic agent on the CB1 receptor, meaning that it is a calming agent that would have an effect of reducing anxiety, but when acting on a different type of receptor called a transient receptor potential vanilloid type 1 channel (TRPV1), it has an anxiogenic effect, meaning it promotes anxiety.
Through studies on mice we have been able to better understand these mechanisms and the actions of cannabinoids in relation to anxiety.
CBD and Anxiety?
The medicinal benefits of Cannabis sativa have been documented for thousands of years, with the first report of use for the purpose of headaches dating back to the second millennium BCE. Up until cannabis became illegal in 1937, cannabis was widely used to treat a number of medical conditions, with doctors and researchers experimenting with dosage and uses.
It is important to note that during these times the whole Cannabis sativa plant was used. It was not until much more recently that we began experimenting with using only CBD, partly for the purpose of removing the psychoactive side effects caused by THC.
In 2015, researchers published a review of the existing studies on CBD and its potential as a treatment for anxiety-related disorders in Neurotherapeutics. From the 49 studies that were examined, the authors concluded that preclinical studies have found evidence to support the potential of CBD as a treatment for panic disorder, social anxiety disorder, generalized anxiety disorder, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder. (1)
Here we will review many of the studies included in this review to help summarize what scientists have found as the potential benefits and risks of CBD for those who suffer from anxiety disorders.
Reduces THC-Induced Anxiety
Medicinal marijuana is now legal in many states, however some individuals can have undesirable side effects largely due to THC.
One of these side effects is anxiety. In 1974, researchers published their findings regarding the interaction between CBD and THC in the European Journal of Pharmacology. (12)
40 healthy males were assigned to 1 of 8 experimental groups: placebo, 30 mg THC, 15 mg CBD, 30 mg CBD, 60 mg CBD, 30 mg THC and 15 mg CBD, 30 mg THC and 30 mg CBD, or 30 mg THC and 60 mg CBD.
Pulse rate, psychological logical reactions, and time production tasks were measured at multiple time intervals following drug ingestion. The THC only group experienced an increase in pulse, increased time on time tasks, and psychological reactions, while none of the CBD groups experienced these effects. For the groups where both CBD and THC were taken, CBD was found to effectively block most of the effects of THC, as well as decrease the feelings of anxiety.
These effects demonstrate the anxiolytic effects of CBD and how they can counter the anxiety caused by THC. This can be helpful for those who have conditions where they are encouraged to take medical marijuana by their physicians.
A wide range of animal studies have been conducted on the effect of CBD on general anxiety. (1)
In many of these studies, a dose-dependent response was found. The anxiolytic effects of CBD were tested over a wide range of doses, and the result was a bell-shaped dose-response curve, with CBD exhibiting anxiolytic effects at moderate but not high or low doses. (8,9)
A 2011 human study published in Neuropsychopharmacology researched the effect of CBD oil on the anxiety induced by public speaking.
In this study, 24 patients with generalized social anxiety disorder were split into two groups, with one group receiving 600 mg of CBD 90 minutes before a simulation public speaking test (SPST), and the other group receiving a placebo.
Multiple measures were taken, including blood pressure, heart rate, skin conductance, and a variety of subjective ratings based on the Visual Analogue Mood Scale (VAMS) and the Negative Self-Statement scale (SSPS-N), at 6 points during the SPST.
It was found that the increase in anxiety was statistically greater for the subjects who were assigned to the placebo group when compared to those in the CBD group. (5)
While human studies have shown CBD to reduce THC-induced anxiety as well as anxiety from experimentally induced fear or anxiety, a number of studies did not find any effect of CBD on baseline anxiety when administered alone. (1,15)
More research is needed as few studies have been conducted to test the effects of chronic CBD dosing in models of generalized anxiety.
Panic Attacks and Impulsive Behavior
In models of animal behavior, CBD was found to decrease OCD tendencies in mice.
A study published in 2010 in the journal Behavioral Pharmacology submitted mice to the marble-burying test (MBT), a model that is proposed to reflect compulsive behavior in mice. These mice were given 15, 30, and 60 mg/kg CBD, and a significant decrease in the number of buried marbles was found when compared to controls (34%, 41%, and 48%, respectively). These effects were still significant following 7 days of CBD administration and suggest that CBD administration led to less compulsive behavior. (10)
In a 2010 study published in Behavioral Brain Research, researchers set out to test the effect of CBD on models of panic attacks in rats: escape responses evoked by the elevated T-maze (ETM) and electric stimulation of dPAG. The researchers found that microinjections of CBD inhibited avoidance acquisition and escape response. These findings suggest the CBD causes anxiolytic and panicolytic effects, meaning that CBD reduced anxiety and panic-attack related responses. (11)
Post-traumatic Stress Disorder (PTSD)
Animal studies have linked CBD to reduced learned fear, which may help those suffering from PTSD or phobias. (4)
PTSD is linked to traumatic stress exposure, and in 2012 researchers set out to see what effect CBD had on an animal model of PTSD. (15)
Predator exposure in rodents promotes long-lasting anxiogenic effects, which are similar to the symptoms found in those who suffer from PTSD. Rats were exposed to a cat and, 1 hour following the stress, administered with CBD daily. Through an elevated maze test and measurements of 5HT1A receptor mRNA and BDNF protein in multiple brain regions, the researchers concluded that CBD prevented long-lasting anxiogenic effects. These finding led them to conclude that CBD has the potential to benefit those suffering from PTSD.
Currently, long-term studies on humans, as well as studies examining only CBD, are lacking.
Two human studies exist where PTSD symptoms were reduced following chronic cannabis use, however the ratio of THC to CBD was not given. (13,14)
How Does CBD Work?
Compounds and medications that may benefit those suffering from anxiety disorders are known as anxiolytics, and CBD has been found in multiple studies to exhibit anxiolytic properties in the human studies conducted thus far. (1)
While the exact mechanisms through which CBD exerts its effects are still being researched, one way that CBD is thought to play a role in reducing anxiety through its effect on the 5-HT1A receptor. While CBD has a low affinity for both the CB1 and CB2 receptors, it has been shown in studies to exert an agonistic effect on the 5-HT1A receptors.
These receptors are the target of SSRIs that have long been used in the treatments of depression and anxiety. It is through this agonistic effect that it is believed CBD leads to an increase in serotonin activity, which can lead to a decrease in the symptoms associated with anxiety and depression.
Other mechanisms through which CBD is thought to exert anxiolytic activity are through indirect cannabinoid receptor activation, increasing anandamide through reuptake inhibition, reuptake inhibition of adenosine, and anti-oxidant effects, just to list a few.
So Does CBD Help Reduce Anxiety Symptoms?
The studies outlined above offer a basis for additional research in the realm of CBD and anxiety disorders.
While these numerous findings are promising, chronic CBD dosing has not been widely studied. Additionally, more studies are needed in relevant clinical populations to further understand the mechanisms of CBD and the therapeutic effects. (1)
These studies suggest that CBD may help to encourage a calm mood, which could alleviate symptoms associated with a wide variety of anxiety disorders.
Is CBD Safe?
A review, published in the journal Current Drug Safety in 2011, collected data from a large number of in vivo and in vitro studies of CBD administration. (7) Over the wide range of concentrations included in these studies, the authors concluded that high, chronic doses of CBD of up to 1,500 mg/day are reportedly well tolerated in humans. Many studies found CBD to be non-toxic, not leading to changes in food consumption, heart rate, blood, pressure, gastrointestinal transit, motor skills, or psychological functions.
That being said, there were studies that found CBD to have some side effects, such as decreased fertilization capacity, inhibition of hepatic drug metabolism, and decreased activities of some drug transporters.
It is recommended to discuss the addition of any new supplement into your daily routine with your physician, and this is true for CBD as well.
- Blessing E., Steenkamp M., Manzanares J., & Marmar C. Cannabidiol as a Potential Treatment for Anxiety Disorders. Neurotherapeutics. 2015 Oct;12:825-836 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604171/
- Sarris J., McIntyre E., & Camfield D. Plant-based medicines for anxiety disorders, part 2 a review of clinical studies with supporting preclinical evidence. CNS Drugs. 2013;27:301-319. doi: 10.1007/s40263-013-0059-9 http://www.academia.edu/11642054/Plant-Based_Medicines_for_Anxiety_Disorders_Part_2_A_Review_of_Clinical_Studies_with_Supporting_Preclinical_Evidence
- Ruehle S., Rey A., Remmers F., Lutz B. The endocannabinoid system in anxiety, fear memory and habituation. J. Psychopharmacol. 2012;26:23–39. doi: 10.1177/0269881111408958 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3267552/pdf/10.1177_0269881111408958.pdf
- Bertoglio L., Lee J., Stevenson C., et al. Cannabidiol regulation of emotion and emotional memory processing: relevance for treating anxiety-related and substance abuse disorders. British Journal of Pharmacology. 2007 March; doi: 10.1111/bph:13724 https://www.researchgate.net/publication/314290552_Cannabidiol_regulation_of_emotion_and_emotional_memory_processing_relevance_for_treating_anxiety-related_and_substance_abuse_disorders_CBD_regulation_of_fear_drug_reward_processing
- Bergamaschi MM, Queiroz RHC, Chagas MHN, et al. Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naive social phobia patients. Neuropsychopharmacology. 2011;36:1219–1226. doi: 10.1038/npp.2011.6 https://www.ncbi.nlm.nih.gov/pubmed/21307846
- Martin-Santos R, Crippa JA, Batalla A, et al. Acute effects of a single, oral dose of d9-tetrahydrocannabinol (THC) and cannabidiol (CBD) administration in healthy volunteers. Curr Pharm Design. 2012;18:4966–4979. doi: 10.2174/138161212802884780. https://www.ncbi.nlm.nih.gov/pubmed/22716148/
- Bergamaschi MM, Queiroz RH, Zuardi AW, et al. Safety and side effects of cannabidiol, a Cannabis sativa constituent. Curr Drug Saf. 2011;6:237–249 https://www.ncbi.nlm.nih.gov/pubmed/22129319
- Onaivi ES, Green MR, Martin BR. Pharmacological characterization of cannabinoids in the elevated plus maze. J Pharmacol Exp Ther. 1990;253:1002–1009. https://www.ncbi.nlm.nih.gov/pubmed/2162942
- Guimaraes FS, Chiaretti TM, Graeff FG, Zuardi AW. Antianxiety effect of cannabidiol in the elevated plus-maze. Psychopharmacology (Berl) 1990;100:558–559. doi: 10.1007/BF02244012 https://www.ncbi.nlm.nih.gov/pubmed/1969666
- Casarotto PC, Gomes FV, Resstel LB, Guimaraes FS. Cannabidiol inhibitory effect on marble-burying behaviour: involvement of CB1 receptors. Behav Pharmacol. 2010;21:353–358. doi: 10.1097/FBP.0b013e32833b33c5. https://www.ncbi.nlm.nih.gov/pubmed/20695034/
- Soares Vde P, Campos AC, Bortoli VC, et al. Intra-dorsal periaqueductal gray administration of cannabidiol blocks panic-like response by activating 5-HT1A receptors. Behav Brain Res. 2010;213:225–229. doi: 10.1016/j.bbr.2010.05.004. https://www.ncbi.nlm.nih.gov/pubmed/20457188/
- Karniol IG, Shirakawa I, Kasinski N, Pfeferman A, Carlini EA. Cannabidiol interferes with the effects of delta 9 – tetrahydrocannabinol in man. Eur J Pharmacol. 1974;28:172–177. doi: 10.1016/0014-2999(74)90129-0. http://www.sciencedirect.com/science/article/pii/0014299974901290?via%3Dihub
- Greer GR, Grob CS, Halberstadt AL. PTSD symptom reports of patients evaluated for the New Mexico Medical Cannabis Program. J Psychoactive Drugs. 2014;46:73–77. doi: 10.1080/02791072.2013.873843.
- Passie T, Emrich HM, Karst M, Brandt SD, Halpern JH. Mitigation of post-traumatic stress symptoms by Cannabis resin: a review of the clinical and neurobiological evidence. Drug Test Anal. 2012;4:649–659. doi: 10.1002/dta.1377.
- Campos AC, Ferreira FR, Guimaraes FS. Cannabidiol blocks long-lasting behavioral consequences of predator threat stress: possible involvement of 5HT1A receptors. J Psychiatr Res. 2012;46:1501–1510. doi: 10.1016/j.jpsychires.2012.08.012. https://www.ncbi.nlm.nih.gov/pubmed/22979992/