Table of contents
Overview of anxiety disorder
Promising benefits of CBD to cope with anxiety
Studies about CBD and anxiety
Choosing the right dose of CBD
How to use
Notice when using CBD to treat anxiety
Anxiety disorders, including panic disorder with or without agoraphobia, generalized anxiety disorder, social anxiety disorder, specific phobias, and separation anxiety disorder, are the most prevalent mental disorders and are associated with immense health care costs and a high burden of disease in terms of quality of life and overall wellness.
According to large population-based surveys, up to 33.7% of the population are affected by an anxiety disorder during their lifetime. Most patients with anxiety disorders are managed as outpatients, they probably receive less attention from clinical psychiatrists than patients with other disorders that require inpatient treatment, namely schizophrenia or bipolar disorder. Additionally, undertreatment of anxiety caused by side effects of medications, non-adherence, efficacy of medicine and so on, is also a considerable health concern. In this paper, we are going to provide basic knowledge about anxiety disorder and promising benefits of using CBD to treat this condition.
Overview of Anxiety disorder
It’s normal to feel anxious about moving to a new place, starting a new job, or taking a test. This type is called “ordinary anxiety” that comes and goes without interfering with your everyday life. In the case of anxiety disorder, the feeling of fear may persist with you all the time and cause you to stop doing things you enjoy. If left untreated, the symptoms will keep getting exacerbated.
Anxiety affects patients in different ways, depending on the person's experience. You may have a general feeling of worry, or you may fear a specific thing or social situation. In some cases, you may experience a panic attack (a feeling of intensive fear). In addition, the manifestation of anxiety include physical symptoms (headache, stomachache, heart palpitations), insomnia, restlessness, shaking, etc.
Types of anxiety
- Based on the symptoms and time of onset, the diagnostic and statistical manual of mental disorder (Fifth edition – DSM 5) categorized anxiety disorder into 11 subtypes, including:
- Separation anxiety disorder: Excessive fear of separation from attachment figures (Parents, siblings)
- Selective mutism: Failure to speak in specific social settings
- Specific phobia: Extreme fear trigger by a specific objects or things
- Social phobia: Intense anxiety of being judged, evaluated, rejected or embarrassed in social situations
- Panic disorder: Recurrent unexpected abrupt panic attacks
- Generalized anxiety disorder: Excessive worry and anxiety of events or activities
- The other subtypes include agoraphobia, drug-induced anxiety, other and unspecified anxiety disorder.
The experts don't know the exact etiology of anxiety, however they indicate that the pathophysiology can’t be attributable to one single cause, and is associated with interruption in the activities of neurotransmitters, namely dopamine, GABA, serotonin and nor-adrenaline.
Development of anxiety disorder is also stimulated by complex interaction among various factors, such as gender, family history, age, and personal history of trauma.
Once you receive a diagnosis with anxiety, you can consult treatment options with your healthcare providers. Treatment for anxiety falls into three categories:
- Non-pharmacological therapy: Stress management, relaxation techniques, taking exercise, diet modification, v.v.
- Psychotherapy: Cognitive behavioral therapy, interpersonal therapy and motivational interviewing.
- Pharmacological therapy: Selective serotonin reuptake inhibitors (SSRIs), benzodiazepines, selective norepinephrine reuptake inhibitors (SNRIs), antipsychotics.
People with mild symptoms should treat anxiety by non-pharmacological measures with clinical consultation. However, this may not be effective for moderate or long-term anxiety disorder. If no relief, psychotherapy or medication will be initiated based on patient preference. In the case of psychotherapy, a trained mental health specialist talks with you about thoughts and feelings and suggests ways to understand and manage anxiety disorder. Moderate to severe disease can be also treated by medications, which reduce the symptoms and improve quality of life.
Psychotherapy is aimed at not only providing support and relieving the symptoms, but also help individuals to develop and practice skills to prevent future recurrence of symptoms. It doesn’t carry the risk of side effects and showed comparable effectiveness with drug therapy in a short-term study. Furthermore, there are also limitations that need to be overcome, including cost, delayed effectiveness, availability of therapists, etc.
Generally, the anti-anxiolytics work effective, but there are a wide range of side effects that need to be taken into account, such as GI upset, sexual dysfunction, cardiac disorders and dependence. GI upset and sleep disturbance are self-resolved after a few weeks of using SSRI/SNRI, however some of the effects are persistent and dangerous. Sexual dysfunction, for example, affects most of patients taking SSRIs/SNRIs, leading unsatisfactory sex life and psychological trauma, especially in young adults. In addition, long-term use of diazepam increases risk of drug dependence and cognitive impairment. Cardiac disorder is also a fatal side effect in patients taking citalopram or escitalopram, therefore they are absolutely contraindicated in patients having cardiovascular disease.
For individuals looking to take control of their anxiety, it is important to understand the limitations of antidepressants and to know that other options are available. Consult with your doctors about the pros and cons of each medicine to decide which one is best for your symptoms.
Promising benefits of CBD to cope with anxiety
Current available pharmacological treatments, such as SSRIs, SNRIs or Diazepam, are associated with limited response rates, residual symptoms, and adverse events that limit adherence and tolerability. The burden of anxiety disorder and the disadvantages of current treatment place a high priority on developing a novel treatment. Cannabidiol, a Cannabis sativa constituent, is considered as a promising agent for the treatment of anxiety disorder because it has positive results in studies, doesn’t affect cognition and has a safety profile. Unlike THC, the pharmacological effects of CBD are non-psychoactive. Recently, the number of publications on CBD has increased remarkably and support the view that it has broad therapeutic properties across a range of neurological conditions, psychiatric disorders, and pain. Among these possibilities, the anxiolytic effects of CBD stand out which is considered to be similar to those of approved drugs, although its effectiveness and exact mechanism aren’t fully understood. Therefore, we provide a list of scientific literature on anxiolytic properties of CBD in both animal and human studies as well as the potential risk and benefits of CBD as a treatment for anxiety.
Studies about CBD and anxiety
Comparison between cannabidiol and sertraline for the modulation of post traumatic stress disorder-like behaviors and fear memory in mice
Post-traumatic stress disorder is characterized by poor adaptation to a traumatic experience and disturbance in fear memory, and currently lacks effective medications. A study conducted by researchers in China National Institute of Biological science investigated the effects of CBD on PTSD-like behaviors and trauma-related fear memory using mouse PTSD model. Through interaction with multiple aspects of fear memory processing, the experts suggested that CBD produced anti PTSD-like actions in mice and disrupted fear memory by reducing the consolidation, retrieval and reconsolidation of trauma-related fear memory.
Effects of cannabidiol and diazepam on behavioral and cardiovascular response induced by contextual and conditioned fear in rats
In animal models, both diazepam and CBD induce anxiolytic- like effects, however, the effects of contextual conditioned fear haven't been studied. Therefore, Brazilian researchers designed an experiment to compare behavioral effects induced by CBD or diazepam in rats submitted to a contextual conditioned fear model. The results showed that CBD has anxiolytic-like properties similar to those of diazepam in rat models.
CBD prescription in clinical practice: an audit of 400 patients in New Zealand
In a 2015 study published in the BJPG open journal, researchers evaluated CBD’s effects on 397 adults living in New Zealand. They have received CBD prescriptions for a variety of ailments, including pain, neurological symptoms, and mental health symptoms.
The participants who used CBD to treat anxiety and depression reported improvements in their ability to perform daily activities and reduce the symptoms of anxiety. In addition, 70% of study participants reported some level of satisfaction with CBD treatment, ranging from good to excellent. Only 0.8% of the study population experienced worsening symptoms and 9.9% of them underwent side effects, such as vivid dream, sedation.
An investigation of cannabis use for insomnia in depression and anxiety in naturalistic sample
The study examined patients with insomnia symptoms in depression (100 patients), anxiety (463 patients) and comorbid depression and anxiety (114 patients). The study was designed to develop a better understanding of the benefits cannabis use for insomnia management in patients with anxiety and/or depression. Overall, cannabis was efficacious across all groups, regardless of age and gender. Individuals with sleep disturbance and anxiety disorder who use cannabis report significant improvement in sleep quality.
Neural basis of anxiolytic effects of cannabidiol in generalized social anxiety disorder: A preliminary case report
The report was published in the journal of psychopharmacology by a combination of experts in the UK and Brazil.
The experiment recruited 10 treatment-naïve men with generalized social anxiety disorder and measured the improvements by functional neuroimaging. Individuals use either CBD (400 mg) or placebo in a double-blind procedure. Relative to placebo, CBD was associated with significantly decreased subjective anxiety. Since CBD has important advantages in comparison with the currently available treatment of social anxiety disorder, such as early onset of action or lack of important side effects, the compound may be a promising therapeutic agent in the management of generalized social anxiety disorder.
Cannabidiol reduce the anxiety caused stimulated public speaking in treatment-naïve social phobia: A double-blind trial
A total of 24 individuals diagnosed with social phobia were randomly received a dose of 600 milligrams CBD or placebo prior to performing a public speaking test. Each participant was measured at 6 different time points to assess mood change, negative self-statement and physiological indices. The result showed that pre-treatment with CBD significantly reduced anxiety, cognitive impairment, and discomfort in their speech performance as compared to placebo group.
Choosing the right dose of CBD
There is no one size fits all dosage for CBD. What’s optimal mainly depends on a range of factors, such as body weight, tolerance, symptoms, metabolism, and so on. These factors can yield unique effects for each CBD consumer. Keeping in mind that you should pay close attention to how you feel after each dose. It might not occur immediately, or even overnight. As soon as you experience positive effects, lock in that dose and stick with it.
Start at a dose of 20 milligrams per day (using twice or three times a day) and increase the dose gradually to achieve desirable effects.
The recommended dosage forms are CBD capsule, sublingual CBD oil and CBD oil for vaping.
How to use
Taking capsules is the simplest and most convenient way to use CBD. You only need to swallow the capsule with at least 300 ml of water. The drawbacks of oral route are low availability and delayed onset of effects.
The method of applying CBD sublingually is incredibly easy. CBD oil needs to be put under the tongue and held from 60 to 120 seconds without swallowing to allow adequate time for CBD to diffuse completely across the epithelial cells. The method remains the same when you use CBD oils or tinctures. You must hold the CBD under the tongue since different areas of the mouth might not be permeable enough for diffusion into the bloodstream. Taking CBD sublingually provides fast onset of action and high bioavailability
Vaping CBD seems to be slightly more difficult than taking CBD sublingually. The first step to vape properly is to determine how much CBD you consume each time. If you feel unconfident at first, you should start with the easiest option. Disposable cartridges and pods are the simplest tool for new users. Refillable vape pens are a little bit more advanced, but more cost-effective in the long-term. It is important to read the instructions carefully before using them.
Notice when using CBD for Depression
- Overall, it is important that your doctor checks your improvements, disease progression, side effects and interaction with food or drugs at regular visits to make sure CBD is working properly.
- Notice any side effects and tell your doctor right away.
- Don’t take other medicine (including ETC, OTC medicines, herbal, vitamin supplements) unless they have been discussed with your doctor.
- If you use CBD by taking it under the tongue or vaping, there are a few things that you should take into account. We will provide details in the following section.
Applying CBD sublingually
- Shake well before use
- Determine the number of drops in accordance with the dose of CBD taken each time
- Start at a low dose as I recommend above and increase the dose to provide therapeutic effects.
- Hold the CBD under the tongue for at least 60 seconds
- Accidentally swallowing the CBD oil won’t pose any risks to your body. However, once you swallow this substance, you no longer take it sublingually. Instead, you are eating it, which means that it has to pass the digestive system and metabolism before your body can utilize it. Although it’s not dangerous, it does mean decreased bioavailability and slower onset of action.
- Taking CBD sublingual bypasses the digestive system, there’s no need to worry about taking it with or without food.
- After the necessary time is up, drinking water or eating food won’t interfere with the working of the CBD. At best, you might wait a few minutes prior to drinking water.
- Putting a few drops of CBD under the tongue won’t turn your teeth yellow as well as make your breath smell.
- Determine your suitable CBD dosage, the number of puffs each time, and types of CBD vape
- Read carefully the user manual, especially if you are a new user
- Wait 5 – 10 minutes between puffs and observe how CBD affects you
- Always start at low dose, and work your way up to the optimal dose
- After inhaling, you should check the battery life or clean the vape tank if needed
People considering or taking CBD products should always mention their use to their doctor, especially if you are taking other medications or have underlying ailments, such as kidney disease, liver disease, heart failure, or immunocompromised condition. Pharmacists are also a reliable source to help you learn about potential drug interaction with supplements, over-the-counter drugs or prescribed drugs.
Feedback after 1 month of using CBD oil from HempSapa.
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In conclusion, we mention all aspects about potential benefits of CBD to manage anxiety, namely evidence, improvement of symptoms, dosage, drug interaction, etc. Keeping in mind that you should talk with your doctor prior to using CBD or changing your treatment plan.