Anxiety is the experiencing of an excessive amount of worry or fear and feeling helpless to do anything about these feelings. Experiencing occasional anxiety is a normal part of life. However, people with anxiety disorders typically have repeated bouts of terror or fear, sometimes coming on suddenly, as in panic attacks, and sometimes more prolonged as in generalized anxiety disorder. Nevertheless, such disorders are often socially and economically crippling since anxiety affects every parameter of one’s existence.
Post-traumatic stress disorder (PTSD) previously was classified as an anxiety disorder and although characterized by high levels of anxiety, is now classified as its own diagnosis and consists of a subset of symptoms of which anxiety is only one. Other symptoms include re-experiencing a traumatic event, emotional numbness and avoidance of anything that reminds the person of the trauma, and difficulty sleeping, feeling irritated and jumpy with heightened states of arousal.
How Prevalent are Anxiety/PTSD Disorders?
It is estimated that 40 million people in the United States alone and about 1 in 13 people worldwide suffer from an anxiety disorder. Anxiety disorders are the most commonly diagnosed mental disease in the world. About 7-8% of the population will suffer from PTSD at any point in their lives.
How are Anxiety and PTSD Currently Treated?
Psychological treatments are popular but are often limited or temporary in their effectiveness. Typical medications used such as antidepressants, benzodiazepines, mood stabilizers, anticonvulsants and antipsychotics are also often used with widespread patient dissatisfaction along with a high rate of adverse side-effects. There are no satisfactory answers to treating the problems of anxiety or PTSD currently making CBD an interesting potential opportunity.
Is there a Future for CBD in Mental Health Disorders?
CBD holds promise as an effective treatment modality in PTSD and related depression, anxiety disorders, social anxiety disorder (SAD), generalized anxiety disorder (GAD), obsessive-compulsive disorders and panic disorder. While pre-clinical evidence is positive relative to CBD’s anxiety relieving effects, it is well recognized that the field needs much more study with large scale placebo controlled clinical trials.
CBD for acute vs. chronic anxiety
Current studies have been fairly limited in scope to acute anxiety with chronic long-term situations remaining to be studied.
One clinical trial on the effectiveness of CBD compared with a benzodiazepine found that both the benzodiazepine and CBD had significant effects on the reduction of anxiety but only the benzodiazepine showed sedative effects.
Another human trial showed that pretreatment with 600 mg CBD prior to a speaking engagement statistically reduced the social anxiety disorder symptoms of anxiety, cognitive impairment and discomfort in speech performance. The placebo group that received no medication exhibited statistically significant higher scores on the same parameters.
Potential benefit of CBD in PTSD therapy
For CBD to be effective in PTSD, it must play a role in memory, recall and possibly even dreams. Since depression is often a comorbid condition, it should act as an antidepressant as well. Recent studies have confirmed the ability of CBD to alter specific portions of aversive memories and lessen their retention. CBD is known to affect the 5-HT1A receptor that is also involved in the mechanism of action of antidepressant medications.
Exposure to traumatic stress is necessary for the formation of PTSD and exposure to CBD is an effective way at reducing both the cardiovascular responses and the anxiogenic effects precipitated by stress.
A case study of a 10 year old child who had been sexually traumatized since age 5 and unresponsive to conventional treatments responded positively to 12-25 mg of full-spectrum CBD oil once per day with predominant symptoms resolving and night time sleep restored within several weeks of CBD only treatment.
How Does CBD Combat Anxiety and PTSD?
Science is just beginning to unravel the mysteries behind the CBD molecule and its many functions. The human body has many “receptors” which are protein based structures attached to cells that receive signals from a variety of stimuli and produce different neurotransmitters and chemicals in response to stimulation. While CBD interacts with many receptors and has many functions, 3 primary areas stand out.
CBD and Serotonin
There are 14 receptors associated with the neurotransmitter serotonin. CBD interacts with serotonin receptor 5-HT1A, the receptor most associated with anxiety and panic reduction. The 5-HT1A receptor is also involved with the mechanism of action of antidepressants. It has been suggested that CBD activates this receptor in several brain regions. Serotonin is the chemical involved in mood regulation occasionally being called the “happy” chemical. Serotonin sends signals throughout the nervous system with imbalances leading to depression, anxiety and mood swings.
In preclinical studies, CBD oil had anti-anxiety and anti-depressant effects in an animal model associated with 5-HT1A activation. The 5-HT1A receptor is involved in serotonin production. Low serotonin levels have been associated with anxiety and depression.
CBD and Endocannabinoids
The endocannabinoids are fatty acid derivatives that are synthesized upon demand in response to cellular changes. Two of the body’s endocannabinoids are anandamide (AEA) and 2—arachidonoyl glycerol (2-AG). The endocannabinoid system is essential to learning and emotionally stable responses to stimuli. CBD is thought to act via indirect action on the CB1 and CB2 cannabinoid receptors showing little direct affinity for these receptors.
Other receptors integral to the endocannabinoid signaling process include the vanilloid type 1 (TRPV1), the G protein-coupled 55 and the peroxisome proliferator-activated receptor-gamma. It is via TRPV1 that CBD modulates the anxiety producing effects sometimes experienced with THC use.
CBD’s involvement in the endocannabinoid system is thought to mediate the effects seen on anxiety disorders, sleep, emotional responses and fear management.
CBD, Endocannabinoids and PTSD
People with PTSD show reduced peripheral AEA and reduced endocannabinoid tone. CBD can reverse this effect on tone by making more AEA available through inhibition of the enzyme that breaks AEA down, fatty acid amide hydrolase ( FAAH) inhibition. They also exhibit reduced 2-AG which has recently been implicated in the regulation of fear and anxiety.
CBD and Neural Regeneration
In a rat model, CBD was shown to stimulate neurogenesis in the hippocampus. The hippocampus is involved in learning and memory.
Chronic stress and anxiety are known to impact the brain damaging neurological circuitry. CBD has demonstrated in animal models it can repair damage in vulnerable parts of the brain and increase AEA levels in the hippocampus. CBD may also encourage neurogenesis in the aging process through the actions of related receptors.
How Much CBD Oil Should I Take for Anxiety?
How much CBD oil or product you should take is individual and depends on the type of product chosen whether CBD isolate or full/broad spectrum and the amount of time you want to take to see an effective response.
The inverted U shaped response curve for CBD isolate
The dosage for CBD is an inverted U shaped curve where there is a “sweet spot” that works for each individual. Some studies have shown results with 600 mg and others have had results with 12-25 mg/day. When analyzing the differences between the studies a striking difference was observed as to the CBD product used in the study. An inverted U shaped dose response curve is typical of CBD isolate where one study found 300 mg to be effective against anxiety when doses of 100, 300, 600 and 900 mg were given.
A linear dose response curve for CBD with full spectrum oil
The standard recommendation is to start low and go slow. This is especially true with full or broad spectrum oil where the inverted U shaped dose response curve turns linear. With each escalating dose an increase in effect is seen. Thus, a lower dose theoretically is possible to achieve the desired effect in a reasonable timeframe.
It was observed in the speaking engagement study that onset of benefits of the CBD isolate at a dosage of 600 mg was effective almost immediately whereas in the case study of the child it took several months for a full spectrum dose to be successful. The dose response time seems to be related to both the type of product chosen and dosage given. Again, more research is needed.
Dosing strategies for anxiety and PTSD
Low Dose= 15-25 mg/day
Medium Dose= 35-75 mg/day
High Dose = 100+ mg/day
Dose is individualized according to age, sex, metabolism, health status and endocannabinoid tone in addition to product type.
How Much CBD Oil Should I Take for PTSD?
In a study of 11 patients with PTSD a dose of 25-50 mg/day controlled the symptoms of 91% of the participants. CBD also offered relief to a set of patients who reported nightmares as part of their syndrome.
Does CBD Produce Tolerance?
No. CBD does not create tolerance or addiction. Once an effective dose is established there is no reason to increase it. There is no direct effect on CB receptors. THC has a direct effect on receptors and thus exerts tolerance.
Does CBD Affect Other Medications?
CBD is a potent inhibitor of some of the drug metabolism pathways in the P-450 cytochrome oxidase system. CBD may increase the concentrations of benzodiazepines, opiates, warfarin, antidepressants, antihistamines, beta blockers and antipsychotics to name a few. Be sure your doctor knows you are taking CBD.
What Quality Concerns Should Be Looked at for CBD Oil?
Look for and consider:
- It is better to use a Full-spectrum product
- Organically grown hemp plants
- Preferably CO2 extracted
- CBD isolate has higher dosing problems and lack of entourage effect
- CBD isolate is usually extracted from industrial hemp using harsh solvents and contains no terpenes, flavonoids or other cannabinoids
- Is there a Certificate of Analysis?
- Does what is on the Certificate of Analysis match the product label?
Animal models have paved the way with some interesting and intriguing potential therapeutic models for treating conditions such as anxiety and PTSD that have no viable and effective treatment options. Pharmacological management of the endocannabinoid signaling system at the level of the receptors, transporters and degradative enzymes is a probable strategy for targeting PTSD therapy.
We need studies that compare CBD with anxiolytics. We need to study the effects of CBD on chronic anxiety, not just acute anxiety in human subjects of all ages and sex. Only one pediatric case study was found. Pediatrics is an understudied group.
Most of all, we need large scale, randomized, human clinical trials to tease out the effects of the cannabis plant on human physiology, chronic disease and particularly, the role of CBD, dosages and therapeutic indications.