Cannabis and Social Anxiety Disorder
Social Anxiety Disorder (SAD) is characterized by learned
associations between cues and perceived threats where aversive and appetitive
memories become powerful motivators of behavior leading to inappropriate
conditioning in response to fear stimuli. (Lee 2017)
It is described as an overwhelming and debilitating fear of
public humiliation or judgement accompanied by “fear or anxiety specific to
social settings, in which a person feels noticed, observed, or scrutinized.” Their fear and anxiety “cause personal distress and
impairment of functioning in one or more domains, such as interpersonal or
occupational functioning.” Psychiatry.org
How Cannabis Help Social
Anxiety Disorder
Low doses of the cannabinoids THC, CBD, or a combination can
provide significant relief from many SAD symptoms, allowing patients with
severe social anxiety to fully enjoy social interactions without later
self-recrimination, sometimes for the first time in decades. One patient
described the experience, “I feel like I am able to ‘get out of my own way’ and
be fun, engaged, and interesting, without fear or self-consciousness.”
Research found that CBD’s ability to impact anxiety symptoms
may depend more on the Endocannabinoid System’s CB1 receptors than 5-HT1A
receptors, (Casarotto 2010) (Campos 2013) indicating that CBD’s anti-aversive impact may be indirect
rather than direct. (Bisogno 2001)
CBD was also shown to block the in-vitro uptake and
metabolism of anandamide. CBD is thought to affect parts of the brain
understood to be instrumental in anxiety, such as the limbic and paralimbic
regions. (Crippa 2004) (Fusar-Poli 2009)
A 2001 Brazilian double-blind, random-controlled human study
found CBD to be highly effective as a pretreatment before potentially
anxiety-provoking situations. Pretreatment with CBD “significantly reduced anxiety,
cognitive impairment, and discomfort in speech performance, and significantly
decreased alertness in anticipatory speech. The placebo group presented higher
anxiety, cognitive impairment, discomfort, and alert levels when compared with
the control group. Significant increases in anxiety measures within the placebo
group were nearly eliminated in the CBD group. No significant differences were
observed between CBD and healthy controls in measures of cognitive impairment,
discomfort, and alertness.” (Bergamaschi 2011)
Studies modeling the processing of fear memories – a significant
area of debilitation for SAD patients – found that CBD reduces learned fear
responses through aiding the extinction of fear, while also affecting
mechanisms involved in the expression of fear and by disturbing the processing
of fear-related memories, with lasting results. (Bitencourt 2008) (Song 2016)
Repeated use of CBD as a treatment does not appear to create
a tolerance to its effects. (Hayakawa 2007)
CBD does not exhibit biphasic effects associated with THC in
treating anxiety. Both THC and CBD have been shown to relieve anxiety at low
doses, but THC can trigger anxiety at higher doses, while CBD does not. (Lee 2017)
Dosing with Cannabis for Social Anxiety Disorder
It is important to talk to a trusted medical professional
who knows the endocannabinoids system, cannabinoids, and your specific
condition, about proper dosing. The most common use of cannabinoids is a low
dose of THC or CBD taken sublingually or inhaled, before a potentially
anxiety-provoking event.
THC is effective for SAD at 1 – 5 mg when taken sublingually
(or swallowed for a more potent effect) and CBD cannabis is effective orally
and sublingually at 5 – 10 mg. Both sublingual and swallowed THC cannabis
products are effective for SAD. Combinations of low-dose oral THC and CBD
appear to be mildly synergistic in some patients, so caution is advised. THC
and CBD together, is recommended to reduce the dose of each. Special caution
should be taken with successive doses of oral THC cannabis to avoid an additive
overdose, as this can be anxiety-provoking.
Pretreatment with CBD has proven helpful in anticipating and
relieving anxiety associated with particular social situations. CBD can be used
without psychoactive effects if taken in a spray or sublingually in a ratio of
10:1 CBD:THC or higher, in doses of 5 mg CBD in the morning and again
mid-afternoon. It can be used throughout the day, as needed, but it is advised
that the last dose of the day occur before 5p.m. as CBD may be wake-promoting.
1 to 2.5 mg of vaporized or inhaled THC can be great for
faster onset than with oral administration, that’s a puff or two. Use the
lowest effective dose to avoid the development of tolerance, and wait 10 to 15
minutes before using more, if necessary.
Almost any type of cannabis can be used to relieve anxiety,
provided that the dose is tightly constrained. A microdose approach enables the
use of cannabis varieties that are less sedating.
For social anxiety related to phobias, avoid any strains
which are high in the terpene Pinene, since pinene tends to counter the memory
effect associated with THC and may even trigger anxiety.
High CBD varieties appear to be extremely effective for social
anxiety. Low doses of cannabis varieties containing both THC and CBD that are high
in Limonene, may also be helpful for SAD. THC-dominant varieties high in
terpinolene can be helpful at very low doses. Low doses of linalool, the
terpene found in a few cannabis varieties and the herb lavender, can be found
in Bubba Kush, and has been shown to be quite effective for relieving
anxiety. (Linck 2010)
Information about Cannabis and Social Anxiety Disorder was taken from the amazing book:
Cannabis Pharmacy: The Practical Guide to Medical Marijuana by Michael Backes, Andrew Weil, M.D. and Jack McCue, M.D.
You can find this book here...
ProjectCBD.org is another great resource for information for Cannabis and SAD https://www.projectcbd.org/cbd-for/anxiety
