Cannabidiol is a pharmacologically broad-spectrum drug that in recent years has drawn increasing interest as a treatment for a range of neuropsychiatric disorders.
Fear and anxiety are adaptive responses essential to coping with threats to survival.
However, 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, panic disorder, post-traumatic stress disorders (PTSD), social anxiety disorders, and obsessive-compulsive disorder (OCD). These anxiety-related disorders are associated with a diminished sense of well-being, elevated rates of unemployment and relationship breakdown, and elevated suicide risk with a lifetime prevalence rate of 29% in the United States.
Currently available pharmacological treatments include serotonin reuptake inhibitors, benzodiazepines, monoamine oxidase inhibitors, and tricyclic antidepressants among others. Anticonvulsants and atypical antipsychotics are also used to treat PTSD. These treatments are associated with limited response rates and residual symptoms, particularly in PTSD, and adverse effects may also limit tolerability and adherence.
Cannabidiol (CBD) is a phytocannabinoid that lacks the psychoactive effects of tetrahydrocannabinol (THC). CBD has broad therapeutic properties across a range of neuropsychiatric disorders, stemming from diverse central nervous system actions.
In recent years, CBD has received increased interest as a potential treatment for anxiety-related disorders.
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. CBD has been found to be well tolerated across a wide dose range, up to 1500 mg/day orally with no reported psychomotor slowing, negative mood effects, or vital sign abnormalities.
CBD has a broad pharmacological profile, including interactions with several receptors known to regulate fear and anxiety-related behaviors.
Endocannabinoids (eCBs) are fatty acid derivatives that are synthesized on demand in the brain. The eCB system regulates diverse physiological functions, including caloric energy balance and immune function. 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 and particularly highly aversive events.
As of the writing of this particular study, few studies have examined chronic (long-term) dosing effects of CBD in models of generalized anxiety.
CBD has been found to have a bell-shaped response curve, with higher doses (100 mg/kg) being ineffective as well as low doses (10 mg/kg) with most benefit shown at moderate doses.
Stress is an important contributor to anxiety disorders and traumatic stress exposure is essential to the development of PTSD. In a long-term study, systemic CBD prevented increased anxiety produced by chronic unpredictable stress.
Overall, existing pre-clinical evidence strongly supports the potential of CBD as a treatment for anxiety disorders. CBD exhibits a broad range of actions, relevant to multiple symptom domains, including anti-anxiety, anti-panic, and anti-compulsive actions as well as a decrease in autonomic arousal, a decrease in conditioned fear expression, enhancement of fear extinction, reconsolidation blockade, and prevention of the long-term anxiety-producing effects of stress.
A notable contrast between CBD and other agents that target the eCB system, incuding THC, is a lack of anxiety-producing effects at a higher dose. Further studies are needed to establish the efficacy of CBD when administered in chronic dosing.
Overall, pre-clinical evidence supports systemic CBD as an acute treatment of generalized anxiety disorder, social anxiety disorder, panic disorder, OCD, and PTSD, and suggests that CBD has the advantage of not producing anxiety effects at higher doses.
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. As THC acutely induces anxiety, this pattern may also be evident for chronic anxiety symptoms.
Evidence from human studies supports the potential for CBD as a treatment for anxiety disorders. Oral doses ranging from 300-600 mg have been shown to reduce experimentally-induced anxiety in healthy controls without affecting baseline anxiety levels and reduces anxiety in patients with social anxiety disorder.
Neuroimaging findings provide evidence of neurobiological targets that may underlie CBD’s anti-anxiety effects, including reduced amygdala activation and altered medial prefrontal amygdala connectivity.
Human experimental findings support pre-clinical findings and also suggest a lack of anxiety-producing effects, minimal sedative effects, and an excellent safety profile. Further studies are needed to establish whether chronic dosing of CBD has similar effects in relevant clinical populations.
Marijuana (cannabis) is only legal in certain states and contains THC (5-10%+) and also contains CBD in varying amounts.
Hemp is legal in all 50 states and contains very little THC (0.3-1.5%) and primarily CBD.
THC is a psychoactive compound associated with a “high” feeling whereas CBD is not and no high is experienced.
**CBD IS LEGAL! THC IS NOT!**