CBD For Anxiety: Hope Or Hoax?



If you haven’t been living under a rock, you’ve probably heard of CBD. The natural remedy du jour, CBD is being touted as a miracle drug — a cure-all for everything from cancer to epileptic seizures. But what about anxiety? The science is in the early stages, but scientists are (cautiously) enthused.

For millennia, humans have used cannabis to treat all manner of ailments. There are Assyrian and Ayurvedic texts that describe the healing effects of the plant, and the internet loves the story of Queen Victoria’s cannabis-loving royal physician. But it’s only recently that the microscopic lens of modern science has begun to lay bare some of the mysteries of the plant and its component parts.

First discovered in the 1940s, CBD (or cannabidiol) is a cannabinoid. Named after the cannabis plant, cannabinoids are chemicals that interact with the body’s endocannabinoid system — an inter-related system of receptors and chemicals located throughout the brain and body. Broadly speaking, the endocannabinoid system works to maintain homeostasis within the body. This includes energy balance and immune function, as well as the regulation of emotional behavior.

CBD is one of two dominant plant-based cannabinoids found in cannabis plants (the other being its infamous cousin, THC). It is attracting a lot of interest for its long list of potential benefits, which range from neuroprotection to anti-inflammatory and anti-spasmodic effects.

But among its much-advertised benefits, one of the most clinically promising is its apparent ability to help regulate emotions. The internet is abuzz with the stories of people who swear by CBD as a natural way to deal with stress. Meanwhile, scientists are being kept busy working out if, how, and to what extent CBD could be used as an effective treatment for different forms of anxiety.

One of the most common forms of anxiety is social anxiety disorder. We all experience social anxiety at times. Not unfamiliar are the clammy hands and short, tight breaths brought on by public speaking or making small talk with strangers. Social anxiety disorder takes all that unpleasantness to another level, leaving people isolated, depressed, and avoiding any situation that might trigger their anxiety.

While the current pharmacological options for treatment are hit-and-miss at best, several recent studies have shown CBD to have promising results for this form of anxiety. One of these, a 2011 randomized controlled trial (published in Neuropharmacology), had several dozen volunteers prepare to deliver a speech to a large audience. The group included both volunteers who had been diagnosed with social anxiety disorder and those without the disorder.

The speeches were delivered, and the findings were conclusive. Those given CBD experienced significantly reduced anxiety, cognitive impairment, and discomfort as they delivered their speech. The placebo group, on the other hand, “presented higher anxiety, cognitive impairment, discomfort, and alert levels when compared with the control group.”

Of course, as with all scientific inquiry, the process has not been without bumps in the road. Not all the research points to CBD as a wonder drug when it comes to social anxiety. The mixed results include a 2017 clinical trial published in Cannabis and Cannabinoid Research. This double-blind, placebo-controlled study showed CBD to have no measurable impact on healthy volunteers that were presented with social rejection and “emotional facial expressions.”

But undaunted, scientists continue their work. There is a strong link between anxiety and negative behaviors like substance abuse, and a lot of recent and ongoing research is looking into CBD’s impact on emotional memory processing.

“Learning to associate cues or contexts with potential threats or rewards is adaptive and enhances survival,” writes Carl Stevenson, senior author of a recent review on CBD and anxiety-related addiction published in the British Journal of Pharmacology. “Memories are therefore powerful drivers of behavior.”

Those memories can be a formidable stumbling block for those recovering from addiction. But there is building evidence that CBD can help reduce learned fear. Multiple animal studies have demonstrated CBD’s impact on lessening fear memory responses and blocking predator threat stress. Not surprisingly, these studies have relevance for both post-traumatic stress disorder and addiction.

In a recent interview on NPR, Esther Blessing, a psychiatrist and researcher at New York University, puts it succinctly: “I think there’s good evidence to suggest that CBD could be an effective treatment of anxiety and addiction and other disorders. But we need clinical trials to find out.” Those clinical trials will be forthcoming. Blessing is currently conducting a clinical trial that will test if CBD can help those who suffer from both PTSD and alcohol abuse.

There is no dearth of anecdotal evidence, in addition to the accruing scientific evidence, that CBD helps with anxiety. But how exactly does it work? The research to date points to multiple mechanisms, but one of CBD’s main modes of operation seems to be upon the whimsically named 5-HT1A receptor.

This receptor is a subtype of serotonin receptor located in both the brain and throughout the body, and its role in anxiety is well established. Recent research includes an animal study showing that mice bred without 5-HT1A receptors show increased anxiety, while a study of people diagnosed with panic disorder showed them to exhibit an impaired 5-HT1A function.

In their trailblazing research on CBD and anxiety, Jose Alexandre Crippa and his fellow researchers have demonstrated that at high concentrations, CBD directly activates 5-HT1A receptors, exerting “an anti-anxiety and antidepressant effect in animal models.” This effect of CBD on 5-HT1A receptors has far-reaching implications — for anxiety regulation certainly, but also for sleep, appetite, pain perception, and addiction.

In “Cannabidiol as a Potential Treatment for Anxiety Disorders,” a 2015 review published in Neurotherapeutics, the authors agree that CBD acts both directly and indirectly on the 5-HT1A receptor with therapeutic benefits. They are quick to add, though, that how it all works is complex and “not well established.”

This is a recurring theme in much scientific research on CBD. This uncertainty is due in part to the complexity of its modes of action, but also to the relatively recent nature of much of the research. We’re still in the early stages.

That being said, the endocannabinoid system presents another relatively well-trodden avenue of research — specifically, CBD’s effect on the system’s CB1 receptor. Activation of the CB1 receptor is known to have anti-anxiety effects when it comes to unconditioned fear. CBD actually isn’t able to bind to this receptor, but influences it indirectly, with beneficial results for the anxious mind.

The CB1 receptor also comes up frequently in the scientific literature in reference to CBD’s impact on the way our bodies react to THC, the cannabinoid responsible for the “high” you get when you smoke pot. THC actually has an impressive array of therapeutic benefits, but getting high is not generally listed among them — at least when it is being used medicinally.

The feeling of being high is created when THC binds with the CB1 receptor. CBD, on the other hand, does not bind to the receptor and therefore has no associated high. In fact, CBD acts antagonistically to limit THC’s ability to bind to the CB1 receptor, thereby counteracting its psychoactivity. Almost every scientific study on CBD mentions this, along with its good safety profile.

It’s one of the features that make CBD very attractive as a potential treatment.

CBD has a long road to travel before it is accepted as a mainstream treatment for anxiety, but people aren’t waiting for the Food and Drug Administration’s permission to experiment with it. The anecdotal evidence and, for those with the patience to wade through the research, the growing scientific evidence is too compelling. And with the recent wave of marijuana legalization, the taboo of using cannabinoids as medication is fast disappearing.

This article was originally published in Brain World Magazine’s print edition.

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