A United States cross sectional study (1) in 2018 found that anxiety was in the top three reasons for taking CBD oil alongside pain management and depression. The most recent psychiatric morbidity survey (2000) indicates that there are 3 million people in the UK suffering from an anxiety disorder. This makes it a common problem yet there are often limited options when it comes to anxiety treatment inside overburdened GP practices. This is why a plant based, side effect free solution to the problem of anxiety is encouraging many sufferers to give it a try. The big question is does it really work?
What is CBD?
CBD’s prominence in the media has risen over the past few years. It has become much talked about in the wellness world but if you haven’t heard……
CBD is short form for cannabidiol, a compound found in the Cannabis Sativa L plant. There are a number of these compounds present in Cannabis Sativa (over 100) collectively known as cannabinoids. Once the word Cannabis is mentioned there follows a raft of connotation linked to its recreational drug use. It’s important to note that CBD is not a psychoactive compound. The psychoactive compound found in the Cannabis plant is tetrahydrocannabinol (THC) which is extracted from what we call the marijuana plant. CBD for sale in the UK comes from the hemp a cannabis family member that is low in THC and high in CBD. It is not legal to sell CBD oil with THC content over 0.2% so there is zero chance of feeling high no matter how much you consume as it is non intoxicating.
So in short:
- CBD short for Cannabidiol is a compound found in the Cannabis plant family.
- It is found in high concentration in the hemp plant.
- Cannabidiol will not get you high.
- It has been studied for various therapeutic uses including as an anxiolytic.
How does it work inside the body?
When we look at how CBD works inside the body it is relatively easy to understand why it is fast becoming an over the counter option for anxiety and panic that some studies have hinted may be as effective as an SSRI.
CBD works with our own regulatory and protective system called the endocannabinoid system. This system comprises two main receptor sites CB1 and CB2 that can be found in the brain, organs, glands, connective tissue and immune cells. The endocannabinoid system is thought to regulate many physiological functions such as mood, memory, sleep, pain and stress response.
When it comes to anxiety CBD seems to work with the receptor site CB1 that regulates neurotransmitters in the brain. This impact on CB1 receptors influences the production of serotonin, dopamine, 5HTP and GABA. It is also thought to maintain balance in the body (homeostasis) through a process called lipogenesis.
It is CBD’s effect on the neurotransmitter serotonin that seems to play a significant role in managing anxiety. Low serotonin is proven to cause anxiety and conventional pharmaceutical treatment would be to administer an SSRI (Selective Serotonin Reuptake Inhibitor). The SSRI targets a serotonin receptor called 5-HT1A which in turn increases the available serotonin in the brain. By increasing the availability of serotonin, anxiety symptoms are reduced.
It is thought that CBD may work in the same way. A Spanish study (2) on animals showed that CBD improved Serotonin transmission faster than an SSRI
The hippocampus is another area in the brain that might point to potential with CBD and anxiety. The hippocampus is a main area of the brain responsible for important functioning such as memory and cognition. In brain scans the hippocampus is often smaller in anxiety sufferers and successful treatment is associated with the creation of new neurons (neurogenesis). In animal study (3) repeated CBD doses showed positive effect on hippocampal neurogenesis.
Research (4) also shows that both SSRI’s and CBD can promote neurogenesis.
Whilst there are many anecdotal cases of CBD managing anxiety symptoms, there are a lack of double blind, clinical trials. Lots of study is conducted with animals and not human beings. Despite this, there is no doubt that indications point towards further trials.
The National Centre for Drug Abuse in the United States document that CBD reduces stress and anxiety in animal studies. Behavioural signs of stress improved as did physiological signs such as rapid heart rate. (8)
In 2017 a comprehensive study (5) pulled together the varying research available to answer the question whether CBD played a future role in psychiatric disorders. Although evidence was inconclusive for depressive disorders, researchers noted positive results for anxiety disorders and the need for further randomised controlled human trials.
The Human Studies
The two most notable human studies are as follows.
In 2011 the Journal of psychopharmacology published a human study (6) on CBD and its potential in cases of generalised social anxiety. The results showed a positive outcome with brain scans showing cerebral blood flow patterns that were consistent with an anti-anxiety effect.
A small study (7) of generalised social anxiety sufferers showed a decrease in anxiety markers whilst speaking publicly. Researchers concluded that CBD “significantly reduced anxiety, cognitive impairment and discomfort in speech performance” as compared to the placebo group who had “higher anxiety, cognitive impairment and discomfort in their speech performance”.
Animal studies certainly show us how CBD works in the brain and human studies indicate that CBD has an anti-anxiety effect. Larger scale human trials are certainly needed to validate CBD as an anxiolytic. There are many anecdotal cases, reviews and advocates of CBD for anxiety (myself included). When you see teenagers prescribed beta blockers for panic disorder it motivates you to take a plant based solution seriously. A solution that seems to regulate brain chemical and promote neurogenesis in the same way as a chemical prescription from the Doc with a myriad of side effects and addiction issues.
As ever I would recommend a number of interventions to help with feelings of anxiety. These may include cognitive behavioural therapy, mindfulness based stress reduction, diet and lifestyle changes and deep relaxation techniques. If we could use a plant based supplement that worked much like a SSRI alongside the interventions we know already work well we get closer to offering a safe and effective treatment plan for anxiety and panic disorder.