Anxiety and Cannabis
Administered acutely “as needed”, CBD appears safe, well-tolerated, and may be beneficial to treat a number of anxiety-related disorders, including: Panic disorder, Obsessive Compulsive Disorder (OCD), Social phobia, Post-Traumatic Stress Disorder (PTSD), Generalized Anxiety Disorder (GAD), and mild to moderate depression.
Anxiety and depression are pathologies that affect human beings in many aspects of life, including social life, productivity and health. Cannabidiol (CBD) is a constituent non-psychotomimetic of Cannabis sativa with great psychiatric potential, including uses as an antidepressant-like and anxiolytic-like compound.
Studies involving animal models, performing a variety of experiments on the above-mentioned disorders, suggest that CBD exhibited an anti-anxiety and antidepressant effects. Experiments with CBD demonstrated non-activation of neuroreceptors CB1 and CB2. Most of the studies demonstrated a good interaction between CBD and the 5-HT1A neuro-receptor.
Research Proves How CBD helps with Anxiety Disorders
The Endocannabinoid System and Anxiety.
The medical properties of Cannabis sativa is known for centuries. Since the discovery and characterization of the endogenous cannabinoid system, several studies have evaluated how cannabinoid compounds and, particularly, how the modulation of the endocannabinoid (eCB) system influences a wide range of functions, from metabolic to mental disorders.
Cannabinoids and eCB system often exert opposite effects on several functions, such as anxiety. Although the mechanisms are not completely understood, evidence points to different factors influencing those effects.
Stress is a major risk factor for the development of mood and anxiety disorders; elucidation of novel approaches to mitigate the deleterious effects of stress could have broad clinical applications.
Pharmacological augmentation of central endogenous cannabinoid (eCB) signaling may be an effective therapeutic strategy to mitigate the adverse behavioral and physiological consequences of stress. Here we show that acute foot-shock stress induces a transient anxiety state measured 24 h later using the light-dark box assay and novelty-induced hypophagia test. Acute pharmacological inhibition of the anandamide-degrading enzyme, fatty acid amide hydrolase (FAAH), reverses the stress-induced anxiety state in a cannabinoid receptor-dependent manner. FAAH inhibition does not significantly affect anxiety-like behaviors in non-stressed mice. Moreover, whole brain anandamide levels are reduced 24 h after acute foot-shock stress and are negatively correlated with anxiety-like behavioral measures in the light-dark box test. These data indicate that central anandamide levels predict acute stress-induced anxiety, and that reversal of stress-induced anandamide deficiency is a key mechanism subserving the therapeutic effects of FAAH inhibition. These studies provide further support that eCB-augmentation is a viable pharmacological strategy for the treatment of stress-related neuropsychiatric disorders.
Cannabidiol regulation of emotion and emotional memory processing: relevance for treating anxiety-related and substance abuse disorders.
Learning to associate cues or contexts with potential threats or rewards is adaptive and enhances survival. Both aversive and appetitive memories are therefore powerful drivers of behaviour, but the inappropriate expression of conditioned responding to fear- and drug-related stimuli can develop into anxiety-related and substance abuse disorders respectively. These disorders are associated with abnormally persistent emotional memories and inadequate treatment, often leading to symptom relapse. Studies show that cannabidiol, the main non-psychotomimetic phytocannabinoid found in Cannabis sativa, reduces anxiety via 5-HT1A and (indirect) cannabinoid receptor activation in paradigms assessing innate responses to threat.
There is also accumulating evidence from animal studies investigating the effects of cannabidiol on fear memory processing indicating that it reduces learned fear in paradigms that are translationally relevant to phobias and post-traumatic stress disorder.
Cannabidiol does so by reducing fear expression acutely and by disrupting fear memory reconsolidation and enhancing fear extinction, both of which can result in a lasting reduction of learned fear. Recent studies have also begun to elucidate the effects of cannabidiol on drug memory expression using paradigms with translational relevance to addiction. The findings suggest that cannabidiol reduces the expression of drug memories acutely and by disrupting their reconsolidation. Here, we review the literature demonstrating the anxiolytic effects of cannabidiol before focusing on studies investigating its effects on various fear and drug memory processes. Understanding how cannabidiol regulates emotion and emotional memory processing may eventually lead to its use as a treatment for anxiety-related and substance abuse disorders.
Linked Articles This article is part of a themed section on Pharmacology of Cognition: a Panacea for Neuropsychiatric Disease? http://onlinelibrary.wiley.com/doi/10.1111/bph.v174.19/issuetoc.
Animal and human studies indicate that cannabidiol (CBD), a major constituent of cannabis, has anxiolytic properties. However, no study to date has investigated the effects of this compound on human pathological anxiety and its underlying brain mechanisms. The aim of the present study was to investigate this in patients with generalized social anxiety disorder (SAD) using functional neuroimaging. Regional cerebral blood flow (rCBF) at rest was measured twice using (99m)Tc-ECD SPECT in 10 treatment-naïve patients with SAD. In the first session, subjects were given an oral dose of CBD (400 mg) or placebo, in a double-blind procedure. In the second session, the same procedure was performed using the drug that had not been administered in the previous session. Within-subject between-condition rCBF comparisons were performed using statistical parametric mapping. Relative to placebo, CBD was associated with significantly decreased subjective anxiety, reduced ECD uptake in the left parahippocampal gyrus, hippocampus, and inferior temporal gyrus, and increased ECD uptake in the right posterior cingulate gyrus. These results suggest that CBD reduces anxiety in SAD and that this is related to its effects on activity in limbic and paralimbic brain areas.
Anxiety and sleep disorders are often the result of posttraumatic stress disorder and can contribute to an impaired ability to focus and to demonstration of oppositional behaviors. Cannabidiol oil, an increasingly popular treatment of anxiety and sleep issues, has been documented as being an effective alternative to pharmaceutical medications. This case study provides clinical data that support the use of cannabidiol oil (CBD Oil) as a safe treatment for reducing anxiety and improving sleep in a young girl with posttraumatic stress disorder.
These symptoms were present in our patient, a ten-year-old girl who was sexually abused and had minimal parental supervision as a young child under the age of five. Pharmaceutical medications provided partial relief, but results were not long-lasting, and there were major side effects. A trial of cannabidiol oil resulted in a maintained decrease in anxiety and a steady improvement in the quality and quantity of the patient's sleep.
Animal and human studies have suggested that cannabidiol (CBD) may possess anxiolytic properties, but how these effects are mediated centrally is unknown. The aim of the present study was to investigate this using functional neuroimaging. Regional cerebral blood flow (rCBF) was measured at rest using (99m)Tc-ECD SPECT in 10 healthy male volunteers, randomly divided into two groups of five subjects. Each subject was studied on two occasions, 1 week apart. In the first session, subjects were given an oral dose of CBD (400 mg) or placebo, in a double-blind procedure. SPECT images were acquired 90 min after drug ingestion. The Visual Analogue Mood Scale was applied to assess subjective states. In the second session, the same procedure was performed using the drug that had not been administered in the previous session. Within-subject between-condition rCBF comparisons were performed using statistical parametric mapping (SPM). CBD significantly decreased subjective anxiety and increased mental sedation, while placebo did not induce significant changes. Assessment of brain regions where anxiolytic effects of CBD were predicted a priori revealed two voxel clusters of significantly decreased ECD uptake in the CBD relative to the placebo condition (p<0.001, uncorrected for multiple comparisons). These included a medial temporal cluster encompassing the left amygdala-hippocampal complex, extending into the hypothalamus, and a second cluster in the left posterior cingulate gyrus. There was also a cluster of greater activity with CBD than placebo in the left parahippocampal gyrus (p<0.001). These results suggest that CBD has anxiolytic properties, and that these effects are mediated by an action on limbic and paralimbic brain areas.
Some research shows that Cannabis is not the only plant to help anxiety
Plant-based medicines for anxiety disorders: A review of clinical studies with supporting preclinical evidence.
Research in the area of herbal psychopharmacology has revealed a variety of promising medicines that may provide benefit in the treatment of general anxiety and specific anxiety disorders. However, a comprehensive review of plant-based anxiolytics has been absent to date. Thus, our aim was to provide a comprehensive narrative review of plant-based medicines that have clinical and/or preclinical evidence of anxiolytic activity. We present the article in two parts. In part one, we reviewed herbal medicines for which only preclinical investigations for anxiolytic activity have been performed. In this current article (part two), we review herbal medicines for which there have been both preclinical and clinical investigations of anxiolytic activity. A search of the MEDLINE literature revealed 1,525 papers, of which 53 plants were included in the review. Of these plants, 21 had human clinical trial evidence, with the other 32 having solely preclinical evidence...
Support for efficacy was found for chronic use of the following herbs in treating a range of anxiety disorders in human clinical trials:
Piper methysticum, Matricaria recutita, Ginkgo biloba, Scutellaria lateriflora, Silybum marianum, Passiflora incarnata, Withania somniferum, Galphimia glauca, Centella asiatica, Rhodiola rosea, Echinacea spp., Melissa officinalis and Echium amoenum.
Acute anxiolytic activity was found for Centella asiatica, Salvia spp., Melissa officinalis, Passiflora incarnata and Citrus aurantium. Bacopa monnieri has shown anxiolytic effects in people with cognitive decline. The therapeutic application of psychotropic plant-based treatments for anxiety disorders is also discussed, specifically Psychotria viridis and Banisteriopsis caarti (ayahuasca), Psilocybe spp. and cannabidiol-enriched THC Cannabis spp.
Drugs used to "treat" Anxiety Disorders
Anxiety-related disorders affect a huge segment of our population—40 million adults (18%) in the United States age 18 and older. In response, Big Pharma has developed numerous drugs to treat anxiety-related disorders, from selective serotonin reuptake inhibitors (SSRIs) like Prozac and Zoloft to tranquilizers ( benzodiazepines - such as Valium and Xanax).
While these drugs can be effective for many patients, some don’t respond favorably. Certain patients don’t see much improvement, or they can’t tolerate the side effects. Moreover, tranquilizers like Valium and Xanax can be highly addictive.
Clearly, alternative treatments are warranted. Could CBD, the most prominent non-psychoactive constituent in cannabis, provide a viable alternative for currently available anxiety medications?
Quite possibly!
CBD has the potential to play a significant role in treating a myriad of anxiety-related disorders.
While more research, including large randomized-control trials, is clearly warranted to examine the long-term effects and potential for CBD, its demonstrated efficacy and highly favorable safety profile (particularly when compared to currently available drugs) make it a viable alternative or adjunct to currently available pharmaceuticals.History of Medical Marijuana
- More than 400 years ago, cannabis was used to treat depression and stress relief in India. Specifically, CBD-rich medical marijuana has a long history of being used to treat health problems, including anxiety. The drug’s popularity as a medicine spread through Asia, the Middle East and Africa. Ancient physicians prescribed marijuana for everything – pain relief and even childbirth.
- In the 18th Century, American journals began recommending hemp seeds and roots to treat inflamed skin and venereal disease. Queen Victoria used cannabis to help discomfort for menstrual cramps. An Irish doctor, William O’Shaughnessy, first popularized marijuana’s medical use in England and America. He found it to ease the pain and discomfort for nausea in cases of rabies, cholera and tetanus.
- Yet, the increase in demands to feel the “high” produced by cannabis with stronger levels of THC eventually led to marijuana being used recreationally, as opposed to medically. For many years, marijuana production to increase the levels of THC led to the decrease in CBD levels to trace amounts.
- The 19th Century increase in usage of morphine ultimately led to the U.S. government introducing the Pure Food and Drug Act in 1906, created by the Food and Drug Administration. Although it didn’t apply to the use of marijuana, it caused a major shift in the U.S. drug policy.
- In 1914, the Harrison Act was created in the United States, which made drug use a crime. By 1937, 23 states had outlawed marijuana.
- In 1937, the Federal Government passed the Marihuana Tax Act, which made nonmedical use of marijuana illegal.
- By the 1970s, strong anti-drug policies were in full swing. Yet, in 1996, California became the first state to legalize medical marijuana use. A dozen states soon followed.
- In 1998, the British government licensed GW Pharmaceuticals to grow cannabis and develop a consistent plant to extract use for clinical trails. GW’s co-founder Geoffrey Guy, MD, was convinced that by using CBD-rich plants, GW could make medicine of cannabis that had little or no psychoactive effect.
- In 2009, medical professionals began to discover and test new strains with more CBD than THC. CBD-rich strains were generally not available to cannabis consumers across the United States at this time. Studies analyzed CBD-rich cannabis to determine the medical benefits and disadvantages for patients.
Worldwide, Uruguay became the first country to remove its prohibition entirely on marijuana in 2013. Colombia and Costa Rica have bills in Congress that would allow for medical marijuana usage. Jamaica recently passed a law to make it possible to supply marijuana for medical and religious purposes.
THC - CBD Which medication works best?
The relationship between cannabis and anxiety is a complicated one. For some, a small puff of cannabis provides unrivaled relief of worry, panic, stress, and other anxiety-related symptoms. Unfortunately others experience heightened paranoia and exacerbated anxiety with marijuana. This common reaction can be attributed to a strain’s THC content, but what many people don’t realize is there are many strains now that have little to no THC. These low-THC, high-CBD strains are changing the game for anxiety sufferers, but that doesn’t mean there aren’t strains rich in THC that can’t also help.For those looking to treat anxiety disorders with cannabis, treatment relies heavily on the appropriate dose. Research proves that THC begins to raise anxiety levels after a certain threshold is passed. Those using medical marijuana to treat anxiety will need to find strains with high compounds of CBD when purchasing medical cannabis.
Leafly.com offers some great ideas on which strain is best for different anxiety disorders such as PTSD, OCD, Insomnia, Social Anxiety or generalized Anxiety. Although the cannabinoids provide a wide range of therapeutic treatment, they may affect the users differently. It is best to talk to a trusted medical marijuana professional and find a strain, or CBD-THC ratio, that works best for you. Most patients would recommend using a strain that is high in CBD to relieve anxiety. Some patients prefer the psychoactive effect of THC to help with their ailments.
All or some of these side-effects can cause a full on panic attack. While THC is known for helping individuals to relax, research shows that there is a threshold; low amounts of THC can relieve stress, but too much can cause it.
Knowing that our bodies can react to THC in this way shows the impact that cannabis has on our endocannabinoid system and degrees of anxiety. If you are using cannabis for anxiety relief, steer clear of too much THC. You can get the relief you need by using strains high in CBD.
Resources:
https://www.projectcbd.org/condition/10/Anxiety
https://www.ncbi.nlm.nih.gov/pubmed/25004388
https://www.ncbi.nlm.nih.gov/pubmed/23653088
https://www.ncbi.nlm.nih.gov/pubmed/28061971
https://www.ncbi.nlm.nih.gov/pubmed/14583744
https://www.ncbi.nlm.nih.gov/pubmed/20829306
https://www.ncbi.nlm.nih.gov/pubmed/28268256
https://www.ncbi.nlm.nih.gov/pubmed/27768570
https://www.leafly.com/news/health/cbd-for-treating-anxiety
https://www.leafly.com/news/strains-products/what-are-the-best-cannabis-strains-for-anxiety
http://www.anxietysocialnet.com/anxiety-and-medical-marijuana
http://herb.co/2017/07/19/anxiety-relief-cannabis/
