Anxiety is a common mental health condition that causes great distress and discomfort leading to diminished quality of life and well-being, increased rates of unemployment and relationship difficulties, and higher risks of suicide. It is estimated that 29% of the U.S. population experiences some form of anxiety within their lifetime, with women twice as more likely to suffer from it than men. Individuals will typically have symptoms starting in childhood or adolescence, although they can begin at any time. Typical symptoms of anxiety include both psychological and physiological symptoms. Common psychological symptoms include feelings of worry (including issues concerning work or family responsibilities, money, health, or safety), doubt, fear of the future or unknown events, irritability, restlessness, difficulty concentrating or focusing, and sleep disturbances. Physiological symptoms may include palpitations, racing heart, flushing of the chest and face, sweating, a sensation of a lump in the throat, hand shaking, muscle tension, muscle twitches, stomach pains, and irritable bowel (including either constipation, diarrhea or both).
A condition commonly experienced in conjunction with anxiety is a panic attack. This is an acute flare-up with symptoms usually reaching peak intensity within 10 minutes and diminishing shortly thereafter, making it difficult for a health care provider to make an accurate diagnosis. The symptoms of panic attacks are often very unsettling for individuals and can cause worry and fear about them recurring or happening in new environments. Symptoms are similar to an anxiety attack, but may also include cognitive symptoms of fear of dying, fear of losing control or going crazy, feelings of unreality, strangeness, or detachment from the self, and physical symptoms of chest pain or discomfort, shortness of breath, dizziness, fainting, sensations of choking, nausea, vomiting, or numbness and tingling sensations. It is not uncommon for individuals experiencing panic attacks to also suffer from depression.
In addition to psychotherapy and neurofeedback, typical medications prescribed to alleviate the symptoms of both anxiety and panic attacks include benzodiazepines (such as Ativan, Valium, Xanax or Klonopin), antidepressants (such as Prozac or Lexapro), monoamine oxidase inhibitors, or tricyclic antidepressants. Although these medications work for some individuals, many do not experience relief from symptoms. Others may not want to take these prescription medications because of the high risk for addiction, abuse, and difficulty in weaning off the drug at a future time. This has led many individuals to seek alternative solutions to deal with their anxiety.
Cannabidiol (CBD) is phytocannabinoid extracted from the Cannabis sativa plant that does not contain any of the psychoactive properties associated with the more commonly known tetrahydrocannabinol (THC). Research on the neuropsychiatric effects of CBD has shown broad anxiolytic effects stemming from its action upon various central nervous system areas as well as the endocannabinoid system. Because of its ability to interact with multiple neurological systems, CBD is able to bind to the same receptors as pharmaceutical anxiolytics and antidepressants, such as those producing the neurotransmitters serotonin and dopamine, in addition to CB1r receptors unique to the endocannabinoid system.
The endocannabinoid system is responsible for regulating and maintaining various physiological requirements of the body including calorie metabolism, the immune system, and emotional behaviors. CBD activates the CB1r receptors producing anxiolytic effects, reducing unconditioned fear response, and stimulating the amygdala and hippocampus, both parts of the brain associated with memory and response to emotional stimuli. Furthermore, activation of CB1r receptors is necessary to facilitate healthy management of stress and protecting the body from the negative effects associated with chronic stress. This revelation is critical as chronic stress actually impairs the functioning of the amygdala and hippocampus within the endocannabinoid system leading to anxiety, as is often seen in individuals suffering from Post Traumatic Stress Disorder.
Due to the ability of CB1r receptors to reduce anxiety and protect the brain from the damaging effects of chronic stress, they have been proposed as a target for anxiolytic drug development. CBD becomes a clear choice to activate these receptors over other compounds, such as THC or the synthetic Marinol, because it does not produce any psychotropic effects, and is capable of stimulating many other receptors, such as serotonin 5-HT1A, TRPV1, CB2, and GPR55. It has also been found to have neurogenic properties within the hippocampus and facilitate increased neuroplasticity, both of which are crucial to reducing future incidences of anxiety.
The key to experiencing the anxiolytic benefits of CBD is directly related to the dosage. A recent study by Zuardi et al, published in May 2017 in the journal Frontiers in Pharmacology, found that CBD’s anxiolytic effects follow an inverted U-shaped dose-response curve. The researchers found doses of 300mg of CBD produced the best anxiolytic effects compared to 100mg and 900mg. It is not yet clear why CBD produces this inverted U-shaped dose-response. It was also observed that CBD produced a significantly lower sedation rate compared to the benzodiazepine clonazepam. This is is very important because sedation and poor motor coordination is a common adverse side-effect associated with benzodiazepines, in addition to their high potential for addiction, cognitive deficits and withdrawal symptoms, that individuals with anxiety wish to avoid. While more research is needed to definitively understand all of the mechanisms involved in the relief of anxiety symptoms associated with CBD, the preliminary research looks promising and long term doses of up to 1,500mg per day have been tolerated well by individuals.