For people with anxiety, CBD oil is touted as an all-natural way to find relief. Find out whether this marijuana compound can help ease your. Along with treating pain, epilepsy and acne, several studies have found that CBD oil is helpful for easing symptoms of anxiety. But is CBD oil. The health benefits of CBD oil including fighting anxiety and inflammation.
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The online version of this article doi: Fear and anxiety are adaptive responses essential to coping with threats to survival. Yet excessive or persistent fear may be maladaptive, leading to disability. Symptoms arising from excessive fear and anxiety occur in a number of neuropsychiatric disorders, including generalized anxiety disorder GAD , panic disorder PD , post-traumatic stress disorder PTSD , social anxiety disorder SAD , and obsessive—compulsive disorder OCD.
Notably, PTSD and OCD are no longer classified as anxiety disorders in the recent revision of the Diagnostic and Statistical Manual of Mental Disorders-5; however, excessive anxiety is central to the symptomatology of both disorders.
These anxiety-related disorders are associated with a diminished sense of well-being, elevated rates of unemployment and relationship breakdown, and elevated suicide risk [ 1 — 3 ]. Currently available pharmacological treatments include serotonin reuptake inhibitors, serotonin—norepinephrine reuptake inhibitors, benzodiazepines, monoamine oxidase inhibitors, tricyclic antidepressant drugs, and partial 5-hydroxytryptamine 5-HT 1A receptor agonists. Anticonvulsants and atypical antipsychotics are also used to treat PTSD.
These medications are associated with limited response rates and residual symptoms, particularly in PTSD, and adverse effects may also limit tolerability and adherence [ 7 — 10 ]. The substantial burden of anxiety-related disorders and the limitations of current treatments place a high priority on developing novel pharmaceutical treatments. CBD has broad therapeutic properties across a range of neuropsychiatric disorders, stemming from diverse central nervous system actions [ 11 , 12 ].
In recent years, CBD has attracted increasing interest as a potential anxiolytic treatment [ 13 — 15 ]. The purpose of this review is to assess evidence from current preclinical, clinical, and epidemiological studies pertaining to the potential risks and benefits of CBD as a treatment for anxiety disorders.
In total, 49 primary preclinical, clinical, or epidemiological studies were included. Neuroimaging studies that documented results from anxiety-related tasks, or resting neural activity, were included. THC ratio , were included. Cannabis sativa , a species of the Cannabis genus of flowering plants, is one of the most frequently used illicit recreational substances in Western culture. The 2 major phyto- cannabinoid constituents with central nervous system activity are THC, responsible for the euphoric and mind-altering effects, and CBD, which lacks these psychoactive effects.
Preclinical and clinical studies show CBD possesses a wide range of therapeutic properties, including antipsychotic, analgesic, neuroprotective, anticonvulsant, antiemetic, antioxidant, anti-inflammatory, antiarthritic, and antineoplastic properties see [ 11 , 12 , 16 — 19 ] for reviews. Pharmacology relevant to these actions is detailed below. The primary mechanism by which eCBs regulate synaptic function is retrograde signaling, wherein eCBs produced by depolarization of the postsynaptic neuron activate presynaptic CB 1 Rs, leading to inhibition of neurotransmitter release [ 23 ].
Interactions with the TRPV1 receptor, in particular, appear to be critical in regulating the extent to which eCB release leads to inhibition or facilitation of presynaptic neurotransmitter release [ 25 ]. TRPV1 receptors are also expressed in the brain, including the amygdala, periaqueductal grey, hippocampus, and other areas [ 26 , 27 ]. The eCB system regulates diverse physiological functions, including caloric energy balance and immune function [ 28 ].
The eCB system is also integral to regulation of emotional behavior, being essential to forms of synaptic plasticity that determine learning and response to emotionally salient, particularly highly aversive events [ 29 , 30 ]. Activation of CB 1 Rs produces anxiolytic effects in various models of unconditioned fear, relevant to multiple anxiety disorder symptom domains reviewed in [ 30 — 33 ].
Regarding conditioned fear, the effect of CB 1 R activation is complex: CB 1 R activation may enhance or reduce fear expression, depending on brain locus and the eCB ligand [ 34 ]; however, CB 1 R activation potently enhances fear extinction [ 35 ], and can prevent fear reconsolidation. Genetic manipulations that impede CB 1 R activation are anxiogenic [ 35 ], and individuals with eCB system gene polymorphisms that reduce eCB tone—for example, FAAH gene polymorphisms—exhibit physiological, psychological, and neuroimaging features consistent with impaired fear regulation [ 36 ].
Reduction of AEA—CB 1 R signaling in the amygdala mediates the anxiogenic effects of corticotropin-releasing hormone [ 37 ], and CB 1 R activation is essential to negative feedback of the neuroendocrine stress response, and protects against the adverse effects of chronic stress [ 38 , 39 ]. Accordingly, CB 1 R activation has been suggested as a target for anxiolytic drug development [ 15 , 43 , 44 ].
In addition to dose-dependent activation of TRPV1 channels, the anxiogenic versus anxiolytic balance of CB 1 R agonists also depends on dynamic factors, including environmental stressors [ 33 , 49 ]. In preclinical studies, 5-HT 1A R agonists are anxiolytic in animal models of general anxiety [ 51 ], prevent the adverse effects of stress [ 52 ], and enhance fear extinction [ 53 ]. They are expressed on serotonergic neurons in the raphe, where they exert autoinhibitory function, and various other brain areas involved in fear and anxiety [ 54 , 55 ].
Mechanisms underlying the anxiolytic effects of 5-HT 1A R activation are complex, varying between both brain region, and pre- versus postsynaptic locus, and are not fully established [ 56 ]. Initial studies of CBD in these models showed conflicting results: When tested over a wide range of doses in further studies, the anxiolytic effects of CBD presented a bell-shaped dose—response curve, with anxiolytic effects observed at moderate but not higher doses [ 61 , 90 ].
All further studies of acute systemic CBD without prior stress showed anxiolytic effects or no effect [ 62 , 65 ], the latter study involving intracerebroventricular rather than the intraperitoneal route. No anxiogenic effects of acute systemic CBD dosing in models of general anxiety have yet been reported. As yet, few studies have examined chronic dosing effects of CBD in models of generalized anxiety.
Anxiolytic effects in models used: Anxiolytic effects of CBD in models of generalized anxiety have been linked to specific receptor mechanisms and brain regions. The midbrain dorsal periaqueductal gray DPAG is integral to anxiety, orchestrating autonomic and behavioral responses to threat [ 91 ], and DPAG stimulation in humans produces feelings of intense distress and dread [ 92 ]. The bed nucleus of the stria terminalis BNST serves as a principal output structure of the amygdaloid complex to coordinate sustained fear responses, relevant to anxiety [ 93 ].
In the prelimbic cortex, which drives expression of fear responses via connections with the amygdala [ 94 ], CBD had more complex effects: As noted, CBD has been found to have a bell-shaped response curve, with higher doses being ineffective. Stress is an important contributor to anxiety disorders, and traumatic stress exposure is essential to the development of PTSD.
In a chronic study, systemic CBD prevented increased anxiety produced by chronic unpredictable stress, in addition to increasing hippocampal AEA; these anxiolytic effects depended upon CB 1 R activation and hippocampal neurogenesis, as demonstrated by genetic ablation techniques [ 81 ].
Finally, CBD, partially via CB 1 Rs, decreased defensive immobility and explosive escape caused by bicuculline-induced neuronal activation in the superior colliculus [ 89 ]. Several studies assessed CBD using contextual fear conditioning. Briefly, this paradigm involves pairing a neutral context, the conditioned stimulus CS , with an aversive unconditioned stimulus US , a mild foot shock.
After repeated pairings, the subject learns that the CS predicts the US, and subsequent CS presentation elicits freezing and other physiological responses. By contrast, CBD microinjection in the infralimbic cortex enhanced conditioned freezing [ 70 ].
Finally, El Batsh et al. In this study, CBD was administered prior to conditioning rather than prior to re-exposure as in acute studies, thus further directly comparable studies are required.
CBD has also been shown to enhance extinction of contextually conditioned fear responses. Extinction training involves repeated CS exposure in the absence of the US, leading to the formation of a new memory that inhibits fear responses and a decline in freezing over subsequent training sessions.
Further studies showed CB 1 Rs in the infralimbic cortex may be involved in this effect [ 82 ]. CBD also blocked reconsolidation of aversive memories in rat [ 76 ]. Briefly, fear memories, when reactivated by re-exposure retrieval , enter into a labile state in which the memory trace may either be reconsolidated or extinguished [ 97 ], and this process may be pharmacologically modulated to achieve reconsolidation blockade or extinction.
Overall, existing preclinical evidence strongly supports the potential of CBD as a treatment for anxiety disorders. Activation of 5-HT 1A Rs appears to mediate anxiolytic and panicolytic effects, in addition to reducing conditioned fear expression, although CB 1 R activation may play a limited role.
While CBD predominantly has acute anxiolytic effects, some species discrepancies are apparent. In addition, effects may be contingent on prior stress and vary according to brain region.
Further receptor-specific studies may elucidate the receptor specific basis of this distinct dose response profile. Further studies are also required to establish the efficacy of CBD when administered in chronic dosing, as relatively few relevant studies exist, with mixed results, including both anxiolytic and anxiogenic outcomes. In particular, results show potential for the treatment of multiple PTSD symptom domains, including reducing arousal and avoidance, preventing the long-term adverse effects of stress, as well as enhancing the extinction and blocking the reconsolidation of persistent fear memories.
The anxiolytic effects of CBD in humans were first demonstrated in the context of reversing the anxiogenic effects of THC. CBD reduced THC-induced anxiety when administered simultaneously with this agent, but had no effect on baseline anxiety when administered alone [ 99 , ]. Further studies using higher doses supported a lack of anxiolytic effects at baseline [ , ].
By contrast, CBD potently reduces experimentally induced anxiety or fear. CBD reduced anxiety associated with a simulated public speaking test in healthy subjects, and in subjects with SAD, showing a comparable efficacy to ipsapirone a 5-HT 1A R agonist or diazepam [ 98 , ]. CBD also reduced the presumed anticipatory anxiety associated with undergoing a single-photon emission computed tomography SPECT imaging procedure, in both healthy and SAD subjects [ , ].
Finally, CBD enhanced extinction of fear memories in healthy volunteers: These rCBF changes were not correlated with anxiolytic effects [ ]. In a series of placebo-controlled studies involving 15 healthy volunteers, Fusar-Poli et al. Response activation is diminished in PTSD and other anxiety disorders, and increased activation predicts response to treatment [ ]. CBD produced no changes in predicted areas relative to placebo but reduced activation in the left insula, superior temporal gyrus, and transverse temporal gyrus.
The fearful faces task activates the amygdala, and other medial temporal areas involved in emotion processing, and heightened amygdala response activation has been reported in anxiety disorders, including GAD and PTSD [ , ]. CBD attenuated blood-oxygen-level dependent activation in the left amygdala, and the anterior and posterior cingulate cortex in response to intensely fearful faces, and also reduced amplitude in skin conductance fluctuation, which was highly correlated with amygdala activation [ ].
Dynamic causal modeling analysis in this data set further showed CBD reduced forward functional connectivity between the amygdala and anterior cingulate cortex [ ]. Epidemiological studies of various neuropsychiatric disorders indicate that a higher CBD content in chronically consumed cannabis may protect against adverse effects of THC, including psychotic symptoms, drug cravings, memory loss, and hippocampal gray matter loss [ — ] reviewed in [ ].
As THC acutely induces anxiety, this pattern may also be evident for chronic anxiety symptoms. Two studies were identified, including an uncontrolled retrospective study in civilian patients with PTSD patients [ ], and a case study in a patient with severe sexual abuse-related PTSD [ ], which showed that chronic cannabis use significantly reduces PTSD symptoms; however, these studies did not include data on the THC: Thus, overall, no outcome data are currently available regarding the chronic effects of CBD in the treatment of anxiety symptoms, nor do any data exist regarding the potential protective effects of CBD on anxiety potentially induced by chronic THC use.
Evidence from human studies strongly supports the potential for CBD as a treatment for anxiety disorders: Limited results in healthy subjects also support the efficacy of CBD in acutely enhancing fear extinction, suggesting potential for the treatment of PTSD, or for enhancing cognitive behavioral therapy.
Further studies are also required to establish whether chronic, in addition to acute CBD dosing is anxiolytic in human.
Human experimental findings support preclinical findings, and also suggest a lack of anxiogenic effects, minimal sedative effects, and an excellent safety profile. Overall, this review emphasizes the potential value and need for further study of CBD in the treatment of anxiety disorders. Disclosure forms provided by the authors are available with the online version of this article. National Center for Biotechnology Information , U. Journal List Neurotherapeutics v. Published online Sep 4. Blessing , 1 Maria M.
Steenkamp , 1 Jorge Manzanares , 1, 2 and Charles R. Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC.
Abstract Cannabidiol CBD , a Cannabis sativa constituent, is a pharmacologically broad-spectrum drug that in recent years has drawn increasing interest as a treatment for a range of neuropsychiatric disorders.
Electronic supplementary material The online version of this article doi: Cannabidiol, Endocannabinoids, Anxiety, Generalized anxiety disorder, Post-traumatic stress disorder. Introduction Fear and anxiety are adaptive responses essential to coping with threats to survival. CBD Pharmacology Relevant to Anxiety General Pharmacology and Therapeutic Profile Cannabis sativa , a species of the Cannabis genus of flowering plants, is one of the most frequently used illicit recreational substances in Western culture.
Table 1 Preclinical studies. Open in a separate window. Effective doses are in bold Receptor specific agents: Stress-induced Anxiety Models Stress is an important contributor to anxiety disorders, and traumatic stress exposure is essential to the development of PTSD. Summary and Clinical Relevance Overall, existing preclinical evidence strongly supports the potential of CBD as a treatment for anxiety disorders. Table 2 Human psychological studies.
Table 3 Neuroimaging studies. Evidence from Epidemiological and Chronic Studies Epidemiological studies of various neuropsychiatric disorders indicate that a higher CBD content in chronically consumed cannabis may protect against adverse effects of THC, including psychotic symptoms, drug cravings, memory loss, and hippocampal gray matter loss [ — ] reviewed in [ ]. Summary and Clinical Relevance Evidence from human studies strongly supports the potential for CBD as a treatment for anxiety disorders: Electronic supplementary material Below is the link to the electronic supplementary material.
Required Author Forms Disclosure forms provided by the authors are available with the online version of this article. Anxiety disorders in primary care: Suicide risk in patients with anxiety disorders: Quality of life in the anxiety disorders: Twelve-month use of mental health services in the United States: Cost of disorders of the brain in Europe An effect-size analysis of the relative efficacy and tolerability of serotonin selective reuptake inhibitors for panic disorder.
Remission rates in patients with anxiety disorders treated with paroxetine. Adjunctive risperidone treatment for antidepressant-resistant symptoms of chronic military service-related PTSD: Multiple mechanisms involved in the large-spectrum therapeutic potential of cannabidiol in psychiatric disorders. Low-cost CBD oils usually fall between five and 10 cents per mg; mid-range prices are 11 to 15 cents per mg; and higher-end oils cost 16 cents per mg or higher. Although price may be an indicator of CBD oil quality, we suggest researching the following factors to ensure the oil you select is considered high-quality.
Some forms of CBD oil — such as vapors and tinctures — normally have higher-than-average concentrations, whereas sprays and topicals tend to have lower concentrations. When buying CBD oil for the first time and comparing different products, here are a few variables to keep in mind: As noted in the previous section, CBD oil prices vary significantly by brand.
The best practice for most is to determine a per-milligram budget for CBD oil, as well as a maximum price for the entire bottle. Also, if ordering online, be sure to include potential shipping costs. Weight plays a role in the effects of CBD oil, and bottle size should be selected based on how much you weigh. If you weigh more than pounds and desire strong effects, then this same concentration will supply roughly 10 doses. Also, state residence may indicate that fewer buying locations are available.
If the answer is yes, then full spectrum CBD oils may not be a feasible option due to their THC content; although these oils contain trace amounts of THC, this may lead to a failed drug test.
Crystalline isolate oils, on the other hand, contain no THC and will not compromise drug tests in any way. Third-party testing information is vital for consumers; any CBD oils that do not supply these details should be avoided.
Lab results are not as crucial, but may indicate a higher-quality product if they are included. Both online and brick-and-mortar experiences carry pros and cons for CBD oil shoppers.
In addition to natural, unscented CBD oils, many oils come in different flavors. This factor boils down to personal preference — although the flavor selection will be broader with some brands than others. How Does Marijuana Affect Sleep? This research is supported by you, our readers, through our independently chosen links, which earn us a commission.
Crystalline Isolate Oil is extracted from cannabis plant, then allowed to cool; this isolates the CBD from other cannabinoids The oil forms crystals and is crushed into a powder None White and twinkly No Full Spectrum Oil Oil is extracted from the cannabis plant Oil is not cooled, allowing it to retain THC and other cannabinoids 0. CBD oil can be consumed in several different ways.
CBD oils may be manufactured as small capsules that are orally ingested. Another form of oral CBD oil ingestion is the tincture, often used as a food additive. Tinctures are sold in dropper bottles; most users place one or two drops beneath their tongue for several minutes in order to experience the full effects.
Tinctures normally have stronger concentrations compared to other CBD products. CBD oil can be ingested as an oral spray. Sprays tend to have lower concentrations compared to other CBD products. This form of CBD oil is applied directly to the skin; it usually has the consistency of lotion. Weight Group Recommended Dosage for Mild Effects Recommended Dosage for Moderate Effects Recommended Dosage for Strong Effects Light less than pounds 11 mg or less 12 to 14 mg 15 to 17 mg Medium to pounds 18 mg or less 15 to 23 mg 18 to 28 mg Heavy more than pounds 23 mg or less 24 to 30 mg 29 to 45 mg.
The anxiety-alleviating and sleep-prolonging qualities of CBD oil make it a good option for many people with insomnia. Those who experience insomnia due to pain or discomfort may also find that using CBD oil alleviates their physical symptoms to a noticeable extent. CBD oil may also promote daytime wakefulness when taken in small amounts; people with insomnia can use it as a pick-me-up if they feel excessively tired due to lack of restful sleep.
REM behavior disorder RBD is a parasomnia disorder characterized by shouting, becoming physically agitated, or otherwise acting out during sleep. Both depression and anxiety disorder have been linked to sleep disruption. CBD oil can alleviate symptoms of these disorders because it activates serotonin receptors in the brain; the release of serotonin has soothing, anti-anxiety effects that can help people sleep.
CBD oil also increases levels of adenosine in the brain; adenosine is a neurotransmitter that aids cardiovascular function and eases painful inflammation. CBD oil may be prescribed for patients with Lennox-Gastaut syndrome or Dravet syndrome, two rare forms of severe epilepsy; the medication Epidiolex, a CBD oil oral solution, is typically prescribed in these instances. CBD oil can also ease the severity of seizures for people with other forms of epilepsy.
Due to its anti-psychotic effects, non-THC CBD oil can reduce the symptoms of schizophrenia and other disorders with psychotic effects. The liver regulates the way different drugs are metabolized within the body; this process is known as hepatic drug metabolism. Higher-than-average doses of CBD oil can slow the hepatic drug metabolism process. As a result, users may not be able to process other drugs as quickly.
This is particularly concerning for CBD oil users who also take prescription medications. As is the case with many other hemp- and marijuana-based products, CBD oil often leads to a condition known as dry mouth or cottonmouth.
This is likely due to cannabinoids altering receptors in the lower jaw that trigger salivation. In most cases, mild discomfort and stronger-than-average thirst are the only issues associated with dry mouth. CBD oil may incite a small drop in blood pressure immediately after it is consumed; this may also cause the user to feel lightheaded.
Diarrhea is a common side effect for people who take relatively large doses of CBD oil, and is linked to the substance interacting with the digestive system.
Lowering oil doses often minimizes this effect. CBD oil may make users feel hungrier than usual, which is a common effect of most cannabinoids. Marijuana-based CBD oils are illegal to use recreationally or for medical reasons. The state senate recently introduced legislation that would legalize CBD oil, but the governor struck down this motion. Marijuana-based CBD oil is illegal to use recreationally, but is available to medical patients participating in a clinical trial.
Hemp-based CBD is legal. Marijuana-based CBD oil is illegal to use recreationally, but is legal for research purposes when used to treat epilepsy. Marijuana- and hemp-based CBD is exclusively available to medical patients participating in clinical trials.
It is available to use recreationally and for medical purposes, provided the product meets FDA approval. If passed, the Michigan Marijuana Legislation Initiative would legalize recreational and medical marijuana use for all adults over the age of This measure was approved. If passed, Utah Proposition 2, Medical Marijuana Initiative would legalize the use of marijuana for individuals with qualifying medical illnesses. The initiative was approved. Most brands that make CBD oil allow customers to purchase products directly from them.
Their websites have online shopping areas where products can be bought and ordered. Most CBD oils are sold through online retailers.
These establishments tend to have the widest product range, and many offer free doorstep delivery. Online retailers also frequently post product reviews, allowing buyers to compare different oils based on customer experiences to determine which is best for them. These reviews can also be used to evaluate the retailer based on customer service, delivery, and product quality. Hemp-based CBD oils are often sold over the counter at certain brick-and-mortar establishments, including health supplement stores and head shops.
Physical stores give buyers the full customer experience, and service staff can often provide helpful recommendations. In states where marijuana is legal for recreational use, dispensaries are a common sight. They are much rarer in states with more restrictions.
In states that permit the use of medical marijuana, hemp-based CBD oils do not normally require a prescription but marijuana-based oils do. Like brick-and-mortar locations, dispensaries offer more customer service. Also, CBD oil prices tend to be significantly higher at dispensaries. The method by which CBD oil is processed from hemp plants can be very telling. Some manufacturers extract and process the oil using toxic materials like propane or butane; in most cases, these oils are cheaply priced.
Where the hemp is grown: Like other crops, hemp plants may become contaminated with metals, minerals, and other materials found in the soil where they are grown. Consumers should learn more about farms where hemp plants are grown — and ensure the soils used at these establishments are free of harmful contaminants. Once a CBD oil is manufactured, CBD oil companies will often submit their products for third-party tests, which are conducted by non-company personnel to ensure the product is safe for public consumption and meets quality standards.
CBD oils should always be accompanied with information about third-party tests; best practice is to avoid oils that do not supply these details. These fine-print details are often included with CBD oils to back up third-party testing claims. General rule of thumb: What is your CBD oil budget?
How much do you weigh? In which state do you currently reside? Do you have a job with drug testing requirements? Do you take prescription medication? Does the CBD oil you're considering list third-party testing and lab result details? Do you prefer to buy CBD oil in a store or online? What are your flavor preferences?
Cannabidiol as a Potential Treatment for Anxiety Disorders
CBD oil products from CBDistillery are available to Tuck. I suffer from anxiety. What would be the best treatment?". If you've asked this question in the past, then this complete guide is for you. Here are the 7 Best CBD . Early research shows promising signs that a product made from cannabis known as cannabidiol (CBD) oil may help relieve anxiety. CBD is a type of.