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CBD and Anxiety

CBD and Anxiety

Have you been experiencing anxiety and traditional prescription medications are not seeming to work for you? Maybe you should consider trying cannabidiol, aka CBD. In this article we explore how CBD can help to counteract anxiety.

Anxiety is something that we have all experienced at some point in our lives. Whether it be an important event coming up, the pressures of work and/or family, or something changing in our life – we all know what it is like to feel nervous. It can present as a variety of symptoms such as increased heart rate, trouble breathing, sweating, upset stomach, feeling faint, or headaches. However, for those who have an anxiety disorder, it can be more than just feeling nervous or stressed. It can be extremely paralyzing and interferes with their everyday lives. There are different varieties of anxiety disorders that people can develop. It can be just a general feeling of consistent anxiety, having panic attacks, feeling anxiety when out in public surrounded by people, feeling an obsession or compulsion toward something, having recurring memories and anxiety about a terrible past experience, or other forms of anxiety.

Unfortunately, anxiety is becoming an increasingly common problem for the population. The cause of anxiety is a combination of genetics, environment, and personality. According to the Anxiety and Depression Association of America (ADAA), anxiety is the most common mental illness in the United States. It affects more than 40 million adults each year. Even though anxiety disorders are highly treatable, less than 40% of people actually seek treatment for them. This is likely due to the stigma surrounding mental illness. The ADAA also states that people with an anxiety disorder are three to five times more likely to go visit the doctor and six times more likely to be hospitalized for psychiatric disorders than those who do not have an anxiety disorder. This is a major problem because increased hospitalizations lead to increased risk of getting infections such as MRSA, which is a bacteria involved with infections that are difficult to treat.

Traditionally, when treating anxiety, the first thing that comes to mind is cognitive behavioral therapy (CBT). This involves behavior modification such as using mindfulness meditation techniques to help manage anxiety as it arises. However, sometimes additional agents are needed in addition to these techniques. Most commonly these agents include benzodiazepines or selective serotonin reuptake inhibitors (SSRIs). Benzodiazepines include drugs like alprazolam (Xanax) or lorazepam (Ativan). These drugs work by enhancing the effects of gamma-aminobutyric acid (GABA), a neurotransmitter in the brain. Neurotransmitters are simply messengers in the brain that send signals across nerves. When the neurotransmitter GABA is increased, it causes sedative effects and relieves anxiety. SSRIs include drugs like fluoxetine (Prozac) and citalopram (Celexa). These drugs work by stopping the reuptake (or breakdown) of serotonin, another neurotransmitter, which leaves more serotonin in the body. The increased serotonin levels help to improve mood and thereby reduce anxiety. These medications have been proven to work for anxiety through various randomized clinical trials. However, a lot of patients do not like to take these medications due to the side effects. Side effects can include drowsiness, nausea, dry mouth, trouble sleeping, agitation, and sexual dysfunction. These side effects are reasons that patients stop taking these medications altogether or keep switching between drugs to find the one that helps them but has more tolerable side effects.

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So where does CBD fit into all of this? It turns out that there are numerous research studies to support CBD use for anxiety disorders. Research from the Annual Review of Neuroscience shows that the mechanism of how CBD exerts its anti-anxiety effects might be through the serotonin pathway. This means that it may work similarly to SSRIs which might explain how it is able to help people feel more relaxed. The research also explains that through brain imaging they found that CBD reduced the activation in certain areas of the brain that deal with anxiety.

Another review article from Neurotherapeutics detailed various preclinical and clinical studies that support the use of CBD with anxiety. The difference between preclinical and clinical studies is that preclinical studies are conducted with animals and clinical studies are conducted in humans. So far, there is more preclinical than clinical data, however the results look promising. The preclinical data supports the possible use of CBD with Generalized Anxiety Disorder (GAD), Social Anxiety Disorder (SAD), Panic Disorder (PD), Obsessive Compulsive Disorder (OCD), and Post Traumatic Stress Disorder (PTSD). Interestingly enough, the studies showed that CBD has an advantage because it does not cause anxiety at higher doses, unlike some other agents. In rats, it even showed that CBD may be similar in effectiveness to diazepam (Valium).

The preclinical data showed exciting results for use in PTSD by helping with certain symptoms of it. These include decreasing arousal and avoidance, preventing long-term side effects from stress, and stopping the recall of fear memories. If more data supports this, CBD could be a vital part of PTSD recovery. Currently, SSRIs are mostly recommended for treatment of PTSD along with cognitive behavioral therapy. Benzodiazepines should be avoided in those with PTSD because it may actually prolong and/or worsen PTSD. Therefore, CBD could offer another treatment option for those suffering with PTSD.

The clinical studies seem to support the preclinical studies. This means that the research data in humans is supporting the research data in animals, which is a good thing! It is showing the progress that CBD research is making. CBD reduced anxiety that was experimentally induced and reduced anxiety in people with SAD. There was some smaller evidence that showed it helped with fear in adults – which again supports the potential use for PTSD. Human data also suggests that CBD does not cause anxiety, as was noted in the preclinical data. This is important to point out because many people think that they can self-treat anxiety by using traditional marijuana products, which are known to actually cause anxiety in some people. This is because of the THC that exists in these traditional marijuana products. CBD does not have THC in it and thus does not further exacerbate anxiety.

So what dose of CBD helps best with anti-anxiety? Based off of these studies, the oral dose ranged from 300 mg to 600 mg. However, this effectiveness could vary from person to person. It is always a good practice to start with lower doses when first starting any medication or supplement, and then increasing the dose as time goes on. The studies also showed an excellent safety profile, therefore the higher doses should not cause safety problems. It offers few side effects and fewer contraindications (meaning you cannot take two drugs or supplements together) than other agents. You would have to take it orally however, instead of topically. Topical treatments of CBD are usually for skin related problems. Oral versions of CBD could include capsules, gummies, or the actual oil itself.

It is important to note that these studies are limited by small sample sizes and lack of reproducible results. Because of this, it is hard to say definitively that CBD will have these anti-anxiety effects in everyone. This simply means that they are still in the early stages of research and have not had the time to gain more data behind it. However, with the exponentially popular use of CBD there will be more research to come. Additionally, these studies like most other studies, only showed a small time frame of the CBD effects. Thus, more long-term studies need to be conducted to help us gain a better understanding of the use of CBD for chronic anxiety. Although the human data is only supporting CBD use in SAD so far, more research in humans might mimic the preclinical results.

CBD could even help to decrease the amount of people that are not treating their anxiety disorders. Because of the stigma and perceived judgement involved with taking traditional prescription medications, CBD could offer a way to get treatment without being judged for taking “anxiety medication”. Since CBD can be used to help with a variety of health issues, no one could really guess the reason a person is using the CBD. Some patients may feel more comfortable taking CBD and they would be getting some treatment that they need.

Overall, it seems that we are just starting to uncover the potential that CBD has to help with anxiety. It could be a potential treatment option for those who have tried cognitive behavioral therapy and medications and are still having trouble managing their anxiety. Taking the CBD could even cause them to decrease the amount of other medications they take, leading to fewer side effects and less pill burden overall. It could also help those who do not want to start traditional medications right away and want to try more natural methods (as long as their physician is on board as well).

So, if you are looking for a way to relax – CBD might be an alternative option to try out!

References:

  1. https://adaa.org/about-adaa/press-room/facts-statistics
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5818147/
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604171/#CR98

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Dr. Harry Zollars (Pharm D)

Harry, COO of Skollarz LLC, is a practicing Pharmacist with over 5 years of experience in the community setting. He graduated highest honors with a Doctor of Pharmacy and a Specialization in Pharmacy Education and a Certificate in Pharmacy Informatics.In addition to his academic career, he was an integral part of several research labs that studied organic chemistry synthesis modifications as well as analyzing and defining structural activity relationship maps of somatostatin derivatives.Harry is currently a Pharmacy Manager, Secretary of the Illinois Pharmacist Association Executive Board, Lead Luminary of the Illinois Community Pharmacy Enhanced Network, Adjunct Pharmacy School Professor, and Pharmacy School Advisory Board Member.He recently was awarded the IPhA Distinguished Young Pharmacist Award.

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