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cannabidiol anxiety

Cannabidiol (CBD) has a proposed novel role in the management of anxiety owing to its actions on the endocannabinoid system. The purpose of this systematic review was to evaluate the current evidence on the safety and efficacy of CBD in anxiety and anxiety-related disorders.

Zachary Curren, BS, Student Pharmacist, McWhorter School of Pharmacy, Samford University, Birmingham, AL

Data sources

A literature search was conducted on PubMed, Google Scholar, and International Pharmaceutical Abstracts from database inception through June 2019. A bibliographic search of relevant articles was also conducted.

CBD has a promising role as alternative therapy in the management of anxiety disorders. However, more studies with standardized approaches to dosing and clinical outcome measurements are needed to determine the appropriate dosing strategy for CBD and its place in therapy.

Jonathan Ennis, BS, Student Pharmacist, McWhorter School of Pharmacy, Samford University, Birmingham, AL

In all, the results of the current study provide evidence for anxiolytic effects of repeated CBD administration in teenagers with SAD. At the same time, however, the author acknowledges several limitations of the current study. No assay of the blood level of CBD was undertaken. A more detailed baseline sociodemographic evaluation could have been performed to ensure the pretreatment similarity of the treatment groups. Measurements need to be performed at additional times between the baseline and the end of the study. These measures would be essential to show, for example, if CBD could produce rapid improvement of social anxiety (a putative advantage over paroxetine). Moreover, possible side effects should be evaluated systematically. Clearly, these are issues for future research that should also be long-term studies with a positive control (e.g., paroxetine) to better assess the potential usefulness of CBD in the therapy of SAD.

Clinical data showing therapeutic effects of CBD in patients with anxiety disorders, however, are still meager (Bergamaschi et al., 2011; Crippa et al., 2011). The purpose of the present study was to investigate these effects in patients with social anxiety disorder (SAD).

Intervention

At the commencement of the study, 40 teenagers with SAD participated, and 20 of them were assigned to the CBD group and the other 20 to the placebo group. This sample size was determined because the current study had been approved by the ethics committee on the condition that, as a pilot study, no more than 20 teenagers take CBD oil. Of the 40 participants, three in the CBD group declined daily treatment with CBD oil during the study because they disliked the smell and the taste of the oil.

Despite such negative impacts of the disorder, the majority of teenagers with SAD are likely to be untreated. Psychotropic medication and CBT are the most common therapeutic options for SAD. However, socially anxious teenagers rarely seek help due to the potential stigma associated with mental issues and fear of interacting therapists and psychiatrists (Ogino, 2004; Teo, 2010). As revealed by the follow-up conducted in the current study, many of the participants treated with CBD became positive in their attitude toward seeking treatment. To overcome the dilemma of teenagers with SAD described above, delivering interventions with CBD could be an effective option for reducing the barriers facing SAD patients in need of treatment.

Devinsky, O., Marsh, E., Friedman, D., Thiele, E., Laux, L., Sullivan, J., et al. (2016). Cannabidiol in patients with treatment-resistant epilepsy: an open-label interventional trial. Lancet Neurol. 15, 270–278. doi: 10.1016/S1474-4422(15)00379-8

First, findings from pre-clinical animal studies show that low to medium doses of CBD produce anxiety-reducing effects, while high doses increase anxiety. Animal research also offers evidence that the anxiety-relieving effects of CBD involve the serotonin receptor 5-HT1A. While on the whole, this research shows compelling support for CBD as an anxiety treatment, the researchers note that these studies have only been conducted among male animals.

A new report published in the journal Cannabis and Cannabinoid Research presents an overview of the clinical findings concerning the effectiveness of cannabidiol (CBD) in the treatment of anxiety. While the report suggests that CBD may offer a safe and effective treatment for anxiety, the authors highlight the need for additional research among the female population.

“Anxiety disorders are highly prevalent worldwide and treatment options tend to have adverse side effects and the majority of patients do not achieve complete remission,” explained Wright, a doctoral student affiliated with the Centre for Addiction and Mental Health and the University of Toronto.

Next, clinical studies among patients with social anxiety disorder have found anxiety-reducing effects with single doses of either 400 or 600 mg of CBD. During a public speaking simulation task, these doses were found to lower anxiety symptoms, reduce cognitive impairment, and reduce discomfort associated with one’s speech performance. A collection of brain imaging studies additionally revealed that CBD intake alters blood flow in the amygdala, hippocampus, hypothalamus, and cingulate cortex — four brain structures implicated in anxiety.

“There are still many questions that need to be addressed and rigorously studied,” Wright said. “The only human studies examining CBD as a treatment for anxiety have been conducted in patients with social anxiety disorder, therefore, research is needed in patients with other anxiety disorders, such as generalized-anxiety disorder and panic disorder. Secondly, much remains unknown about the use of CBD as a treatment for anxiety, such as the most effective route of administration, appropriate doses to be used, and its long-term safety and efficacy.”