How CBD Helps With Anxiety
The health benefits of CBD are characterized by their interaction with the endocannabinoid system (ECS). The ECS is a lipid signaling system made up of endocannabinoids (endogenous cannabis-like molecules), cannabinoid receptors, and enzymes.
Studies suggest that the ECS plays an essential role in regulating gastrointestinal, immune, behavioral, cardiovascular, and mammalian reproduction functions. Other studies also noted that controlling ECS functions might help treat drug addiction and alcoholism(1).
The ECS has a family of receptors known as CB1 and CB2. The former is mainly distributed in the brain, while the latter is mainly found in the immune system(2).
The CB1 receptors also play a role in memory processing, motor regulation, appetite regulation, pain sensation, sleep, and mood(3).
Studies also suggest that the activation of CB1 receptors may trigger neuroprotective responses. According to a 2010 study, cannabinoids with a higher affinity for CB1 receptors might help treat neurodegenerative diseases, including Alzheimer’s disease, Parkinson’s disease, and multiple sclerosis(4).
Meanwhile, another study suggested that activating the CB2 receptors may prevent inflammation, reduce chronic pain, and lessen tissue damage(5).
According to the study, activating the CB2 receptor might help treat inflammation-related conditions. These conditions include arthritis, chronic inflammatory demyelinating polyneuropathy (CIDP), and inflammatory bowel syndrome(6).
CBD interacts with the CB1 and CB2 receptors and other receptors in the body, including the 5-HT1A receptor. Since this receptor is linked to the neurotransmitter serotonin, which contributes to feelings of well-being, CBD might help promote wellness, healing, and balance(7).
In a 2005 study, medical researchers stated that CBD could promote serotonin reuptake in the brain(8). Serotonin is found in the body’s digestive system and blood platelets, and it impacts a variety of body and psychological functions.
Serotonin in the brain affects levels of happiness, anxiety, and mood.
According to the researchers, CBD may help improve serotonin regulation, which may help stabilize mood and reduce anxiety(9). Most pharmaceutical antidepressants interact with serotonin pathways.
In a 2012 study published in the Translational PsychiatryJournal, medical researchers discussed CBD’s ability to manipulate the ECS in the body to produce more natural cannabinoids. One of them is anandamide, a neurotransmitter that regulates emotions(10).
The study indicated that anandamide levels were higher in patients who received CBD(11).
According to a recent study, the increased production of anandamide production in the brain may prevent stress while reducing anxiety and fear(12).
Another recent study showed that CBD may help boost anandamide levels in treating anxiety-related medical conditions(13).
Studies from Cannabis and Cannabinoid Research noted that CBD might boost the hippocampus’ activities to regenerate nerve cells(14).
Hippocampus is a part of the brain located in the temporal lobe that plays a crucial role in memory and learning(15).
According to preclinical studies, CBD demonstrates pro-neurogenic properties in the hippocampus, which might trigger CBD’s anxiolytic effects(16).
A 2018 study also indicated that CBD may function as a potential remedy to depression(17).
Benefits of Using CBD for Anxiety
A prescription is required when buying medications for anxiety, including serotonin-norepinephrine reuptake inhibitors (SNRIs), selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and benzodiazepines.
In contrast, some US states authorize the purchase of hemp-derived CBD products even without a prescription.
According to Nora Volkow, director of the National Institute on Drug Abuse (NIDA), CBD is also non-psychoactive and non-addictive, making the cannabinoid an appealing option for anxiety patients who do not want to be drug dependent(18).
A 2017 Cannabis and Cannabinoid Research journal review noted that CBD is well-tolerated at doses of up to 1,500mg per day(19).
The review is backed by another critical review of CBD from the World Health Organization (WHO), stating that the cannabinoid has a good safety profile(20).
Risks of Using CBD for Anxiety
The United States Food and Drug Administration still has not regulated CBD. As of December 2002, FDA has only approved Epidiolex, a CBD-derived medication for epileptic seizures associated with Lennox-Gastaut Syndrome and Dravet Syndrome(21).
CBD may also come with side effects, including diarrhea, tiredness, appetite changes, and weight changes. CBD may also change how the body metabolizes certain medications(22).
It may also be challenging to identify whether a CBD product has the CBD concentration its label claims since the products sold online and in dispensaries are still unregulated(23).
Researchers published a review in the American Medical Association Journal noting that some CBD products have inaccurate product labels. Some products had more CBD and some had less CBD than what was promised(24).
Below are some of the potential risks of CBD as listed by the FDA(25):
- Liver distress
- Gastrointestinal distress
- Mood changes
- Lack of appetite
- Interactions with other medications
- Interactions with other drugs and alcohol
The department also warned users of the several unknown factors that make using CBD potentially harmful(26):
- How does CBD affect developing fetuses or newborns?
- How do cannabinoids interact with other medicinal plants?
- Does CBD use have adverse effects on the male reproductive system?
- How much CBD is required to trigger the risks linked with it?
- What are the effects of long-term use of CBD?
- Do different consumption methods alter the effect of CBD?
- How does the cannabinoid affect developing brain functions in children?
Treatments for Anxiety
Doctors usually treat anxiety with medications, which only relieve symptoms. Although psychiatrists usually prescribe medication for anxiety, some states also authorize psychologists with specialized training to prescribe anti-anxiety medications(27).
According to the National Institute of Mental Health (NIMH), the three common types of medications used to treat anxiety-related medical conditions are anti-anxiety drugs, antidepressants, and beta-blockers.
The most well-known anti-anxiety medications are benzodiazepines, which help reduce the symptoms of anxiety, worry or extreme fear, and panic attacks(28).
Typically used as first-line treatments for anxiety disorders, benzodiazepines have both pros and cons.
According to NIMH, the drug is effective in relieving anxiety. It is also more fast-acting than antidepressant drugs prescribed to treat anxiety(29).
However, benzodiazepine users may build up a tolerance to the medication if they take the medicine over a long period. Thus, patients with anxiety may have to take increasing doses of the drug to get the same effect, resulting in drug dependence(30).
To solve the issue, medical professionals prescribe benzodiazepines for short periods. Prescribing short-term use of benzodiazepine helps people with substance abuse problems, older adults, and people who become drug dependent easily(31).
Another drawback of benzodiazepine use is that patients who suddenly stop taking the drug may experience withdrawal symptoms or the return of anxiety. This drawback is why doctors usually prescribe lower doses of the medication before they stop taking the medication(32).
In terms of long-term use, benzodiazepines are often regarded as a second-line treatment for anxiety, following antidepressants. Doctors prescribe the drug to patients who experience distressing flare-ups of symptoms(33).
Buspirone is another type of anti-anxiety medication designed for the treatment of chronic anxiety. However, according to NIMH, the drug is not always effective(34).
Antidepressants are medications formulated to treat depression. However, doctors may also prescribe the medicine to patients with anxiety disorders(35).
Antidepressants help manage how the brain uses certain chemicals that control mood or stress. Medical professionals may prescribe several different antidepressant medicines before finding the one that effectively manages the patient’s symptoms with tolerable side effects(36).
Most of the time, doctors consider antidepressants that have helped a patient before. A medication that worked for a patient’s close family member may also be considered(37).
Antidepressants may take some time to work, so NIMH recommends to wait before deciding on the medication’s effectiveness(38).
NIMH also advises against suddenly stopping antidepressants without the help of a doctor. If a doctor and a patient decide to stop the medication, the doctor should help their patient slowly and safely decrease dosing(39).
Abruptly stopping antidepressants may cause withdrawal symptoms, NIMH warned(40).
SSRIs and SNRIs are considered first-line treatments for anxiety. Meanwhile, TCAs and monoamine oxidase inhibitors (MAOIs), which are less common, are also considered effective(41).
Typically used as medications to lower blood pressure, beta-blockers may also be prescribed to relieve the physical symptoms of anxiety, including blushing, rapid heartbeat, and trembling(42).
When taken for a short period, beta-blockers may help manage the physical symptoms of anxiety. You may also use it as needed to control acute anxiety(43).
Some of the treatments for anxiety are yoga and massage.
According to an article from the Harvard Health Publishing of the Harvard Medical School of Harvard University, yoga may help treat anxiety because it functions as self-soothing techniques, including exercise, relaxation, meditation, exercise, or spending time with friends(44).
In a 2015 study published in the Frontiers in Psychology, high levels of oxytocin, a hormone produced in the brain, is associated with increased well-being, social interaction, and anti-stress effects(45). A 2004 study indicated that the brain produces oxytocins in response to several kinds of massage(46).
Although manipulating oxytocin levels to treat mental health disorders has not yet been studied sufficiently, medical researchers believe that low oxytocin levels have been linked to depression(47).
Meanwhile, a 2012 study looked at the potential of essential oils and aromatherapy to reduce anxiety, reduce depression symptoms, and improve sleep(48).
Medical researchers also noted that massage may also help relieve pain in cancer patients, helping relieve fatigue, anxiety, and stress(49).
The American Massage Therapy Association (AMTA) backed the findings of the study. According to AMTA, the potential value of massage therapy for depressed patients comes from regularly disturbing the pattern of depression(50).
AMTA stated that interrupting the pattern allows patients to remember what it is like to live with a healthy mental state, providing hope that it is possible(51).
Choosing the Right Medication
According to NIMH, certain medications may work better for certain types of anxiety disorders. NIMH recommends working closely with medical professionals to identify which medication is best for an individual with anxiety disorders(52).
NIMH also warned that certain substances may worsen the symptoms of anxiety disorders or interact with medication. These substances include caffeine, cold medicines, prohibited drugs, and herbal supplements(53).
It is recommended for patients with anxiety to talk to their doctor to ask which substances they must avoid and which substances are safe.
Choosing the right medication, treatment plan, and dose must be done under an expert’s care and based on a person’s needs and medical condition. A medical professional may try prescribing several medicines before finding the right one for the patient.
CBD Dosage and Administration Routes for Anxiety
The FDA has not approved CBD as a supplement, making the guidelines for proper CBD dosage for specific medical conditions still unclear.
There are several factors to consider when determining the correct dose for an individual. These factors include the product’s CBD concentration, the user’s body weight, and the desired results.
According to a 2019 study, CBD doses of 300mg to 600mg (given in single doses) may help reduce anxiety(54).
The researchers studied CBD’s effects in adults with anxiety disorders and sleep problems(55). Most subjects received a capsule containing 25 mg of CBD once a day, while some received 50mg CBD or 75mg CBD.
After the two months of taking CBD, 78.1% to 79.2% of the participants reported improvements in anxiety symptoms. However, researchers also noted that 5.3% to 19.5% of the participants developed worse symptoms after taking CBD(56).
It is still recommended to seek medical advice before taking CBD for anxiety. Although considered generally safe, CBD’s long-term effects have yet to be examined, a 2011 review in the Current Drug Safety Journal stated(57).
Routes of Administration
There are several methods to consume CBD. Some of the most common methods are:
- Mixing CBD into drinks or meals
- Taking CBD using a measured dropper
- Ingesting CBD edibles or capsules
- Applying CBD balms or balms into the skin
- Sublingually (dropping the oil under the tongue)
One of the most common methods of CBD consumption is oral administration. CBD oil capsules and edibles, including tablets, brownies, softgels, and gummies, are some of the CBD products you may take orally.
Oral administration of CBD is a convenient and consistent way to take CBD oil, especially for new CBD users.
Meanwhile, CBD oil tinctures or drops may be the best option for CBD users looking for quick-acting remedies. CBD oils may be taken sublingually or dropped under the tongue by using a measured dropper. Before swallowing, hold the oil in the mouth for 30 seconds, allowing CBD into the bloodstream.
According to a 2002 study, the sublingual method of CBD administration is an efficient way of taking CBD tinctures. According to the study, CBD oil has a sublingual bioavailability of 13% to 19%(58).
Bioavailability pertains to the extent and rate at which an active drug ingredient is absorbed and becomes readily available for the body to metabolize (break down)(59).
In a 2015 review from the International Journal of Pharmacy and Pharmaceutical Sciences, researchers found that with the sublingual consumption method, peak blood levels of most compounds are achieved in 10 to 15 minutes(60). According to the study, this is faster than when the same drugs are ingested orally.
If you do not like the taste of pure CBD hemp extract, some CBD brands offer CBD gummies in delicious flavors. Gummies also come in a fixed dose, making it consistent and convenient to take.
Some brands also offer unflavored options for their CBD oil product line to attract more customers.
You may also mix CBD oils to meals. According to a 2018 study, cannabinoid’s highly lipophilic nature (soluble in lipids or oils) allows it to dissolve in the fat content of food, which may increase the compound’s solubility and absorption(61).
However, CBD may need additional fat, such as milk, when it is mixed with a drink for it to bind and completely dissolve.
You may also apply CBD topically or directly on your skin. You may incorporate CBD into other topical products, including lotion, cream, balm, or salve.
One of the benefits of CBD‘s topical application is that it avoids gastrointestinal administration and first-pass metabolism, which results in more constant plasma levels(62).
The first-pass effect is the early metabolization of a medication that reduces drug concentration upon reaching its intended site of action(63).
Meanwhile, vaping is a quick way to introduce CBD in the body since it enters through the lungs’ bloodstream without going through the digestive system.
A study showed that after smoking CBD using a CBD vape, the cannabinoid reached the highest plasma concentrations three minutes after the dose(64).
However, research also suggests that vaping may be harmful to the lungs. According to a recent study, increased vape use in the US resulted in the rise of vaping-related pulmonary diseases(65).
Other risks of vaping include chemical irritation or allergic reactions to the chemicals in the inhaled vapors(66).
According to a 2018 study, the half-life of CBD was reported between 1.4 hours and 10.9 hours after an oromucosal (surface of the mouth) administration. Meanwhile, researchers noted the half-life of CBD in two to five days after an oral administration(67).
CBD’s half-life was reported 24 hours after an intravenous administration and 31 hours after smoking(68).
Legality of CBD
Former President Donald Trump signed the Farm Bill into law in 2018, legalizing hemp cultivation at the federal level. The law also removed hemp and hemp-derived products from the list of Schedule I controlled substances(69).
Under the Farm Bill 2018, farmers may cultivate hemp plants as long as the crops have tetrahydrocannabinol (THC) content less than 0.3%(70).
Still, you must first research about CBD laws before buying CBD products. The FDA still has not regulated the CBD market as of December 2020.
State laws also have varying levels of restrictions in terms of CBD regulations. In some states, like South Dakota, laws about the regulation of CBD products remain unclear(71).
Below is a list of states with Limited Access Marijuana Product Laws. Most of these states allow the development of low-THC and high-CBD hemp products(72):
- North Carolina
- South Carolina
Most companies design drug tests to detect THC. The cannabinoid is present in full-spectrum hemp extracts, although only in trace amounts.
According to a 2017 review published in the Mayo Clinic Proceedings, drug testing cut-off values were set to avoid the possibility that the detection of THC in trace amounts may result in a positive test. The cut-off value was set this way to avoid false-positive results in drug tests(73).
Although drug tests may not detect trace amounts of THC, frequent use of CBD products may raise the THC level in the body above the cut-off values set, which results in a positive drug test.
Cannabidiol (CBD) is typically present in cannabis trichomes (the tiny, hair-like formations in the hemp flower) of cannabis plants. The cannabinoid is non-psychoactive and is usually derived from the hemp variety of cannabis.
Although usually sourced from the cannabis plant‘s indica strain, small traces of CBD may also be found in the Cannabis sativa strain.
CBD oil is made from a concentrated extract from hemp plants, specifically from a thick substance called resin, in the glandular trichomes. You may also find resins in the plant’s stems and leaves.
Aside from CBD, other non-psychoactive cannabinoids that may be extracted from hemp include cannabichromene (CBC) and cannabigerol (CBG).
Other compounds that may be sourced from hemp also include flavonoids and terpenes. Flavonoids provide cannabis flowers their distinct color, while the terpenes give cannabis flowers their distinct smell.
Hemp is a variety of cannabis plants that may grow up to 13 feet in height. Farmers typically cultivate industrial hemp plants for the plant’s flowers, seeds, and stalks.
It is different from marijuana, a cannabis plant cultivated for its relaxing and psychoactive properties. Unlike hemp, marijuana contains high concentrations of THC.
You may find the psychoactive cannabinoid throughout the aerial parts of a marijuana plant. However, THC is most abundant in the flowers of marijuana plants.
Most farmers do not cultivate marijuana seeds and marijuana stalks. Marijuana plants are usually grown and harvested only for their highly resinous flowers, containing high concentrations of cannabinoids.
Although marijuana and hemp have similarities, the two plants are genetically different.
Unlike hemp, marijuana is included in the list of Schedule I drugs under the Controlled Substance Act because of the plant’s high potential for abuse, which may be attributed to marijuana’s psychoactive effects.
Meanwhile, hemp and its products have been removed from the list of controlled substances as long as the products have less than 0.3% THC.
There are currently three types of CBD products available in the CBD industry today: full-spectrum CBD, broad-spectrum CBD, and CBD isolate.
Full-spectrum CBD oil has all phytonutrients and phytocannabinoids from hemp, including terpenes, fatty acids, flavonoids, essential oils, and even trace amounts of THC.
Some CBD users opt for a full-spectrum CBD product because of its “entourage effect,” which refers to the suggested positive effect brought on by terpenes and cannabinoids working together(74).
Broad-spectrum CBD products are like full-spectrum products without THC. Using these products provides users with the same benefits linked with full-spectrum CBD, without ingesting THC.
Meanwhile, CBD isolates only contain isolated CBD. CBD isolate products are recommended for CBD users allergic to certain hemp plant compounds or who want to keep their body THC-free.
Most brands incorporate carrier oils with CBD to create CBD oils. Some brands use hemp seed oil, while others use medium-chain triglycerides oil (MCT oil) as their tincture carrier oils.
Other brands also offer discounts and money-back guarantees to encourage CBD users to buy their products.
How to Identify High-Quality CBD Products
Regardless of the kind of CBD products you are looking for, you must employ careful consideration when looking for the highest-quality CBD oil for anxiety.
Below are some tips to remember to ensure the safety and reliability of hemp CBD products:
- Choose the best CBD oils for anxiety made by reliable and legitimate CBD brands.
You must only purchase high-potency CBD products made from non-genetically modified organisms (non-GMO) offered by reliable brands. Some brands also offer gluten-free products.
Most reliable companies that produce high-quality products cultivate their industrial hemp from their own farms. Some legitimate brands also purchase grown hemp from licensed and reputable hemp producers.
Most US brands also grow their hemp from farms in Colorado. The state has been at the forefront of hemp oil production because of the state’s favorable CBD laws.
In Colorado, the medical and recreational use of CBD and other products derived from cannabis plants have been legal since 2012(75). Some of the popular CBD brands with farms in the state include CBDPure, CBDistillery, and NuLeaf Naturals.
- Research the state regulations applicable to CBD in the area.
CBD laws vary from state to state, highlighting the importance of studying CBD state laws before buying products.
- Read product reviews.
It is recommended to read product reviews when purchasing CBD online. Meanwhile, when buying from a store or a CBD dispensary, you must first check whether the store is allowed by the government to sell CBD.
Stanley brothers’ Charlotte’s Web is one of the CBD companies with good reviews from previous customers.
- Determine the extraction method used in creating the CBD product.
Determine the CBD company’s extraction process used in manufacturing its CBD product. The FDA considers the supercritical-CO2 extraction method as safe to use in pharmaceutical manufacturing(76).
The supercritical-CO2 extraction method, also known as the supercritical fluid extraction (SFE) process, uses carbon dioxide (CO2) to extract CBD from the original hemp material.
During this process, CBD manufacturers use an extraction machine to compress and freeze carbon dioxide until the compound reaches a supercritical cold liquid state. Hemp oil then passes through the plant material, taking all the cannabinoids and terpenes with it.
Solvent-based extraction methods are another type of extraction process used by CBD brands. During this procedure, manufacturers use solvents, such as propane, butane, and ethanol, to extract cannabinoids from hemp plants.
- Look for certification codes.
Certification authorities recognize certain products only after conducting thorough screening tests.
You may check if a company is certified by the US Hemp Authority or accredited by the Better Business Bureau (BBB). The former awards certification to companies with the best CBD products, while the latter collects consumer reports and accredits companies with the best business practices.
- Compare the information on the product label to data from third-party lab reports.
You must determine if the company’s claims about its products match the information indicated in third-party lab testing reports. A third-party lab result typically includes information about a product’s CBD potency and concentration, THC content, and presence of harmful contaminants.
- Consult a medical professional before using CBD.
Before taking any CBD products, visit a medical professional experienced in CBD use. This consultation is critical, especially if you are also taking prescription medications for a severe medical condition.