Could cannabidiol assist us in dealing with stress? CBD & cannabis for anxiety: can it help?
Presently, we are experiencing anxiety-provoking circumstances. The coronavirus is the perfect ingredient to transform even the most relaxed and level-headed among us into anxious wrecks, anticipating the worst possible scenarios for ourselves and our loved ones, notwithstanding their improbability.
And that, dear friends, is the daily existence of a person with anxiety. I know because I have inhabited this inner realm for the past fifteen years. Only for me, minor evils such as whether I’ll make a total fool of myself in a social gathering or my favorite anxiety rabbit hole – feeling nervous over feeling anxious – are the source of my anxiety.
While there is no silver bullet to permanently eliminate anxiety, treating anxiety symptoms is a regularly cited reason for using cannabis, both medically and recreationally, with CBD showing particular promise in preliminary research.
HOW DOES ANXIETY AFFECT US?
Anxiety disorders are a group of mental health conditions characterized by excessive worry about future events, which causes physiological responses in the body such as chest tightness, shortness of breath, muscle tension, disturbed sleep, excessive sweating, agitation, restlessness, irritability, and difficulty concentrating.
Anxiety sufferers frequently employ avoidance behavior as a coping mechanism. If you’ve experienced a panic attack while crossing a bridge, there’s a good chance you’ll never cross that river again. And for the socially apprehensive among us, including myself, not attending a party, after-work drinks, or a friend’s wedding is a common technique.
However, the more events we avoid, the smaller our worlds get, and it is at this moment that anxiety disorders are frequently diagnosed. Currently, it is estimated that 264 million individuals worldwide suffer from some form of anxiety illness, including around 40 million Americans.
Anxiety disorders include generalized anxiety disorder (GAD), when anxiety is felt about a wide range of situations or issues; social anxiety disorder (SAD), the fear of being negatively judged or rejected in social situations; panic disorder, sudden feelings of terror resulting in panic attacks; obsessive compulsive disorder (OCD), unwanted repetitive thoughts and behavior; and phobias, an extreme fear triggered by a situation or object. and post-traumatic stress disorder (PTSD) – anxiety characterized by flashbacks that develops after a stressful experience.
Due to the complexity and individuality of anxiety disorders, there is no one-size-fits-all method to treating them. Cognitive behavioral therapy (CBT) is frequently paired with anti-anxiety medications such as SSRI antidepressants or benzodiazepines for an immediate calming effect. Benzodiazepines, sometimes known as tranquilizers, include Xanax and Valium, and while they may induce a state of anxiety-free calm in patients, long-term use can lead to addiction.
Therefore, it is evident that a new class of anti-anxiety medications, free of misuse and dependence risks and adverse effects, must be produced. And the greatest “green” hope is that cannabis may contain the key.
STRESS, ANXIETY & THE ENDOCANNABINOID SYSTEM
One of the primary reasons millions of people take cannabis is to deal with stress or unwind after a hard day. While the ordinary recreational user is uninterested in the molecular principles underlying why they feel more comfortable after smoking a joint, the cause is probably certainly the direct activation of their endocannabinoid system (ECS).
The ECS consists of endocannabinoids, which are fatty ligands that bind to a broad network of cannabinoid receptor sites (CB1 and CB2) in the brain, central nervous system, immune system, and organs. Its dynamic nature ensures that all of our physiological systems remain in equilibrium.
Life is full of external stressors, such as pollution, bad sleep, that dispute with your employer, and the 24-hour news coverage of the millions of people worldwide who are dying from the coronavirus. Thankfully, the ECS acts as a buffer to prevent our organisms from developing a disease as a result. It also plays an essential function in controlling fear, anxiety, and stress coping.
It has been shown that activating CB1 receptors in the brain and central nervous system reduces anxiety, which explains why cannabis consumption tends to calm people down. Higher amounts of THC, the primary psychoactive ingredient in cannabis, can induce anxiety.
Enhanced communication between CB1 receptors and the endogenous cannabinoid anandamide in the amygdala, a critical brain region for fear processing, has been demonstrated to aid mice in forgetting traumatic experiences. This is of clinical interest for the treatment of anxiety disorders in which terrifying previous events become permanently imprinted in a patient’s memory and feed future sensations of fear.
The endocannabinoid system can, however, be compromised by chronic stress. Long-term exposure to stress inhibits CB1 receptor activation in emotional processing-related brain areas. Chronic stress also elevates levels of fatty acid amide hydrolase (FAAH), the enzyme that degrades anandamide in the body, resulting in decreased levels of the feel-good endocannabinoid.
With decreased endocannabinoid signaling, anxiety and sadness are more likely to occur. In fact, one study demonstrated a definite inverse link between anandamide levels and the intensity of anxiety in women with major depression; Thus, the more deficient we are in anandamide, the more worried we may feel.
Increasing CB1 signaling could be a possible therapeutic target for both preventing and treating anxiety disorders, according to a preclinical study on mice with low anandamide levels resulting from stress-induced anxiety. Researchers noticed that blocking FAAH corrected the anandamide shortage of the rats, hence reducing their nervous behavior.
CBD AND ITS MULTIPLEX APPROACH TO COMBAT ANXIETY
Cannabidiol (CBD), a non-intoxicating cannabis compound, has been shown to inhibit anandamide reuptake and delay its metabolism by FAAH, whereas drug companies around the world are experimenting with synthetic FAAH inhibitors in the hopes that they will become the next big thing in anti-anxiety medication. Multiple studies demonstrate that CBD administration increases CB1 signaling, which in turn promotes the formation of new neurons in the hippocampus, which scientists believe contributes further to the compound’s calming impact.
However, CBD’s anti-anxiety effects extend beyond endocannabinoid signaling enhancement. CBD interacts with serotonin 5-HT1A receptors in the brain, which are well-established anti-anxiety drug targets, according to studies on animals.
In one study, CBD administration to rats subjected to 60 minutes of restraint reduced their heart rate, mean arterial pressure, and anxiety levels. When the rats were administered a 5-HT1A antagonist, which prevented CBD from interacting with serotonin receptors, these results were not repeated. Uncertain is whether CBD induces this action by binding directly to 5-HT1A receptors or by enhancing 5-HT1A serotonin transmission indirectly.
Neuroimaging of healthy volunteers administered 400 mg of a CBD isolate revealed that the reported relaxation may have resulted from activity in the limbic and paralimbic brain systems, regions of the brain related with emotional processing, memory, and cognition.
CBD & ANXIETY BEYOND THE LAB
While there is still much to learn about the processes underlying CBD’s anxiolytic impact, in select US states and countries where medical cannabis usage is permitted, doctors are treating anxiety problems with CBD-rich cannabis strains. CBD oil made from hemp has been our anti-anxiety savior for those of us still doomed by prohibition to the dark ages.
Consider the situation of Emily Wilson, a British humanitarian worker residing in Greece who is 30 years old. Emily has been the education coordinator at a refugee camp on the outskirts of Athens for the past three years, where 2800 displaced people from Syria, Afghanistan, Iraq, and Iran live side-by-side in converted shipping containers, many of whom are still suffering from serious trauma.
Emily frequently felt worried and dissatisfied by the restrictions of the work she could perform due to her restricted resources. After two years of working at the refugee camp, her typically upbeat and optimistic disposition was no longer a shield against the everyday physical and mental stress she faced.
“A few times,” Emily recalled, “I’d be walking when I’d start to think about work, at which point my chest would tighten and I’d have to begin taking deep breathes because my chest was constricting so much and my eyes were misting as if I were sobbing. But they were tears of frustration and panic. This occurred once or twice per week for three or four weeks before I noticed something was seriously wrong. It was so incapacitating that I could not leave my bed to go to work.
Emily began taking full spectrum CBD oil, and after gradually increasing the dose from one drop to three drops, three times per day, she began to experience a reduction in her anxiety.
“I believe the greatest benefit for me was that it kept my worry from becoming all-encompassing,” says Emily. It did not eliminate the problems, but it meant that I was aware of them, that I understood I had to work through them, and that they were not in my chest, throat, or preventing me from accomplishing things. Thus, there existed a separation between them. I also had a profound sense of serenity and a profound sense that everything could be resolved.
EVIDENCE AND ITS LIMITATIONS
Without randomised research trials, conventional medical institutions will never accept CBD seriously as an anti-anxiety medication, despite the thousands of positive anecdotal experiences. As with most areas of cannabis research, clinical research on CBD’s effects on anxiety is still very limited.
Due to the breadth of the term anxiety, the majority of prior research has focused on just one type of anxiety illness, specifically social anxiety disorder. The delivery of an anti-anxiety drug to socially anxious individuals prior to a public speaking exam is a well-established methodology for testing the efficacy of anti-anxiety drugs.
In one study, both healthy and socially anxious participants were required to replicate a public speaking test. Those diagnosed with social anxiety disorder received either a single dosage of 600 mg CBD or a placebo. The healthy participants completed the examination without medication.
This large amount of CBD enabled the socially anxious participants to perform the task with “substantially reduced anxiety, cognitive impairment, and discomfort in their speech performance,” in addition to reducing their stress levels before the test. Comparatively, the placebo group fared less well when experiencing high anxiety levels. There was no difference in anxiety or performance between the CBD group and the healthy subjects, suggesting that a single, high dose of CBD before public speaking may enable socially anxious individuals to function similarly to those without social anxiety disorder.
However, a single 600mg dose of purified CBD does not reflect the clinical experiences of clinicians recommending medicinal cannabis to anxious patients or the millions of people across the world who take hemp-based CBD oil for anxiety-related disorders.
WHAT IS BETTER? PURIFIED OR WHOLE PLANT CBD?
In a race to discover a new anti-anxiety drug that may be worth billions of dollars, there is little financial incentive to explore cannabis-based medications. But purified CBD, while potentially more profitable and easier to research in clinical trials, has medicinal limitations that are not evident in CBD-rich cannabis extracts with the entire spectrum of cannabinoids.
Anyone who has tried a CBD isolate will attest that a high dose is typically required to achieve any therapeutic effect. In a meta-analysis comparing CBD-rich products to purified CBD in epileptic patients, this frequent experience was verified. Compared to the high quantities of purified CBD used in Epidiolex clinical trials, patients need considerably lower dosages of CBD-rich cannabis to successfully manage their seizures, according to the study.
Increasing CB1 signaling could be a therapeutic focus for preventing and treating anxiety disorders.
In addition, animal studies reveal that purified CBD has a ‘bell-shaped dose-response,’ demonstrating that it only demonstrates significant therapeutic value at a substantial dose, with limited efficacy at lower or higher doses.
This inverted bell shaped dose-response was confirmed in the context of social anxiety when healthy volunteers undergoing a simulated public speaking test only experienced a reduction in anxiety with 300mg of CBD, but not with 150mg or 600mg, indicating a narrower therapeutic window compared to CBD-rich cannabis.
Until recently, there was limited data from human research regarding the anti-anxiety effects of long-term CBD administration. In contrast, a placebo-controlled trial was published just last year in which Japanese adolescents with social anxiety and avoidant personality disorder received 300 mg of pure CBD or a placebo daily for four weeks. Not only did CBD dramatically reduce their anxiety, but at the conclusion of the trial, half of the CBD-treated participants expressed a desire to seek therapy or additional treatment, whereas none of the placebo-treated people exhibited such a desire.
In a 2019 open-label retrospective study, 72 psychiatric patients with anxiety or sleep difficulties were given 25-175mg of CBD per day in addition to their current psychiatric drugs. 78.1 percent of patients reported feeling less worried after two months of treatment, and 56.1% reported better sleep.
A EXPTERT’S EXPERIENCE
These encouraging results validate the observations of clinicians who routinely prescribe medical cannabis to anxious patients. According to Dr. Rebecca Moore, a UK-based consultant psychiatrist who sees patients at The Medical Cannabis Clinics in London, cannabis is an excellent option for treating anxiety.
“I’ve witnessed some astoundingly beautiful outcomes. People who have had anxiety for their entire lives, who are doing all the right things in terms of their diet, exercise, and supplements, but still have a really severe anxiety, and after a couple of months, they no longer have any anxiety and can’t believe what’s happened to them.
“One woman informed me that she was able to pick up a book for the first time in twenty years, concentrate on it, and enjoy it. Another stated that she was planning her first vacation in ten years. It’s simply life-altering disparities for folks.”
Dr. Moore has discovered that medicinal cannabis, namely CBD-rich oil, but also containing trace quantities of THC, is beneficial for patients with all forms of anxiety problems. In general, individuals require much lesser dosages of CBD than those employed in published exploratory research, with some patients benefiting from as little as 30mg per day.
Patients typically visit Dr. Moore’s clinic because the anti-anxiety medications they have been prescribed over the years are ineffective and have severe adverse effects. “I’ve seen patients,” adds Dr. Moore, “who were taking four or five drugs but were able to discontinue them all with CBD.” People who were taking two antidepressants, a benzodiazepine, a sleeping pill at night, and an antihypertensive quit all of their medications.”
Dr. Moore has observed some of the most remarkable changes in her patients during the treatment of PTSD with cannabinoids: “It’s so fascinating how trauma memories seem to affect people’s remembrance of their memory. People report feeling as though their traumatic memories are being erased. Then, I’ve heard from a number of individuals that they begin to recall happy experiences that they were previously unable to recall.
Currently, a number of clinical trials are recruiting participants to evaluate the efficacy of CBD for anxiety, including one using 25mg of full spectrum CBD soft gel capsules over a twelve-week period; and a phase II clinical trial evaluating the efficacy of CBD for social anxiety, which will also measure changes in endocannabinoid levels. In addition, a Harvard Medical School study will compare whole-plant and single-extract CBD treatments for anxiety.
Due to the slow pace of clinical research, however, official approval of CBD as an anti-anxiety medication is still a ways off.
In the meanwhile, in an effort to mitigate any damage to our endocannabinoid system caused by present coronavirus stress, which may make us more susceptible to anxiety disorders now and in the future, we could do a lot worse than incorporating CBD-rich cannabis or CBD oil into our self-care regimen.
You got curious about the impact cannabis has on our body and our mind? Find out why in this article!
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