There’s no doubt that last year was stressful, and with COVID still a part of our lives, people now, more than ever, are looking for stress and anxiety relief. Hemp and CBD are now synonymous with relief from stress and anxiety. Anecdotal evidence shows that hemp and CBD can help people relax. So then, what’s the actual science behind hemp and CBD helping with stress and anxiety? It’s clear that a new anti-anxiety medication class, without risk of abuse or dependence and free from side effects, must be developed. And the big ‘green’ hope is that the hemp plant might hold the key.
Anxiety disorders are a group of mental health conditions. Mental disorders such as anxiety often manifest into physiological reactions in the body. Some of these reactions are tightness in the chest, shortness of breathing, muscle tightness, sleep disturbance, excessive sweating, agitation, uneasiness, irritability, and difficulty concentrating.
Avoidance behavior is a popular strategy among those who deal with anxiety. If you’ve panicked crossing a bridge, there’s a good chance you’ll never reach the other side of that river again. And for the socially nervous, not going to that wedding or after-work drinks or party is a typical strategy.
The more situations we dodge, the smaller our worlds eventually become and this is where Doctors diagnose anxiety disorders. An estimated 264 million people worldwide have some anxiety disorder with approximately 40 million of them residing in the United States.
Anxiety disorders include:
- Generalized Anxiety Disorder (GAD) – when the anxiety sets in about a wide range of situations or issues
- Social Anxiety Disorder (SAD) – the fear of being negatively judged or rejected in social cases
- Panic Disorder – the sudden feelings of terror resulting in panic attacks
- Obsessive-compulsive Disorder (OCD) – unwelcome repetitive thoughts and behavior
- Phobias – an intense fear triggered by a situation or thing
- Post-traumatic Stress Disorder (PTSD) – anxiety including flashbacks that occur after some traumatic event.
Is There a Cure?
There’s no one approach to curing anxiety disorders. Cognitive-behavioral therapy (CBT), is often coupled with anti-anxiety drugs like benzodiazepines or antidepressants for a more immediate calming effect. Also known as tranquilizers, benzodiazepines include Xanax and Valium. While they may lure patients into a state of anxiety-free calm, they can result in addiction.
STRESS, ANXIETY & THE ENDOCANNABINOID SYSTEM
Coping with stress or unwinding from a hectic day is one of the significant reasons millions of people use hemp or CBD. The reason is due to the direct activation of their endocannabinoid system (ECS).
Fatty ligands called endocannabinoids are part of the ECS. These endocannabinoids bind to a vast network of cannabinoid receptor sites (CB1 and CB2) throughout the central nervous system, brain, organs, and immune system. The ECS is continuously working to keep all our physiological systems in balance.
Life is full of external stressors. Thankfully the ECS works as a mediator to ensure our organisms don’t develop some illness as a result. The ECS also plays a crucial role in regulating fear, anxiety, and how we cope with stress.
How Hemp and CBD Works With the ECS
Activating CB1 receptors in the brain and central nervous system calms feelings of anxiety. Explaining why consuming CBD tends to chill people out. The signaling of CB1 receptors and the endocannabinoid anandamide helps mice forget frightening experiences. That’s something of clinical interest for treating anxiety disorders where frightening past events become indelibly marked in a patient’s memory, fueling future feelings of anxiety.
However, chronic stress can eventually impair our endocannabinoid system. Prolonged exposure to stress deregulates CB1 receptor signaling in brain regions involved in emotional processing. Chronic stress also increases fatty acid amide hydrolase (FAAH). This enzyme breaks anandamide down in the body. This process results in lower concentrations of the ‘feel-good’ endocannabinoid.
With weakened endocannabinoid signaling, we are more vulnerable to developing anxiety and depression. One study showed a clear inverse relationship between the endocannabinoid, anandamide, and levels of anxiety severity in women with major depression. In basic terms, the lower our anandamide levels are, the more anxious we may become.
Thus, boosting CB1 signaling could be a potential therapeutic target for protecting against and treating anxiety disorders. This is a theory explored in a preclinical study on mice with low anandamide levels caused by stress-induced anxiety. Researchers observed how inhibiting FAAH reversed the animals’ anandamide deficiency, which in turn reduced their anxious behavior.
CBD: A MULTI-TARGETED APPROACH TO ANXIETY
Drug companies worldwide are experimenting with synthetic FAAH inhibitors, hoping they’ll become the next big thing in anti-anxiety medication. Cannabidiol (CBD), the non-intoxicating compound found in hemp, inhibits anandamide and delays its metabolism by FAAH. Several studies confirm that CBD enhances CB1 signals. This promotes new neurons in the hippocampus, which scientists believe further contributes towards the compound’s anxiolytic effect.
However, CBD’s anti-anxiety action extends beyond increasing endocannabinoid signaling. Animal studies show how CBD interacts with serotonin 5-HT1A receptors in the brain. These receptors are a target for anti-anxiety medication.
CBD given to rats lowered their heart rate and arterial pressure and reduced anxiety levels. However, these results didn’t repeat when scientists gave the rats a 5-HT1A antagonist. This blocked CBD from interacting with the serotonin receptors. What remains unclear is whether CBD elicits this effect by directly binding with 5-HT1A receptors or indirectly facilitating 5-HT1A serotonin signaling.
Neuroimaging in healthy subjects given 400mg of a CBD isolate suggested that the relaxation they reportedly experienced happened due to activity in the limbic and paralimbic brain system. These areas of the brain are associated with emotional processing and memory, and cognitive processes.
CBD & ANXIETY: OUTSIDE THE LAB
In certain US states where medicinal use of pot is legal, doctors are prescribing their patients with CBD-rich hemp strains for anxiety disorders. For the rest of us limited to online CBD purchases, CBD oil from hemp is our potential anti-anxiety relief.
EVIDENCE WITH LIMITATIONS
Thousands of positive customer testimonials are available. Mainstream medical institutions are beginning to take CBD seriously as an anti-anxiety treatment with some randomized clinical trials. What we’ve noticed is that CBD by itself may not be the answer, but a combination of the 100 plus cannabinoids in whole plant hemp can help.
Because anxiety is such a general term, most research conducted has concentrated on just one type of anxiety disorder: social anxiety disorder. A well-established protocol for measuring an anti-anxiety drug’s effectiveness is its administration to socially anxious individuals before taking part in a public speaking test. Doctors prescribed those with social anxiety disorders a one-off dose of 600mg pure CBD or a placebo. The healthy subjects performed the test without any medication.
This hefty dose of CBD allowed the socially anxious participants to perform the task with significantly reduced anxiety, cognitive impairment, and discomfort in their speech performance. It also redued their stress levels before the test. In comparison, the placebo group did not perform as well, experiencing high levels of anxiety. No difference in pressure or performance was noted between the CBD group and the healthy subjects. This suggests a one-off, high dose of CBD before public speaking may allow the socially anxious to perform just as well as someone without a social anxiety disorder.
However, giving a single 600mg dose of purified CBD does not reflect doctors’ clinical experiences prescribing medical cannabis to patients with anxiety disorders. As well as the millions of people worldwide taking hemp-based CBD oil for anxiety-related conditions.
PURIFIED VERSUS WHOLE PLANT CBD
With a race on to find a new anti-anxiety drug potentially worth billions of dollars, there’s extreme financial gain to be enjoyed from developing medication based on whole-plant hemp. Pure CBD, while potentially more lucrative and easier to study in clinical trials, has its therapeutic drawbacks that aren’t present in full-spectrum CBD-rich hemp extracts. Anyone who tried CBD says that a high dose is generally necessary to get any therapeutic effect. Animal studies demonstrate how purified CBD has a bell-shaped dose-response. Whereby it only shows significant therapeutic benefit at a substantial dose, with little efficacy at lower or higher doses.
This inverted bell-shaped dose-response was confirmed in the context of social anxiety when healthy volunteers undertaking a simulated public speaking test experienced an anxiety reduction when given 300mg of CBD, but no change with either 150mg or 600mg, suggesting a narrower therapeutic window compared to CBD-rich hemp.
Just last year, a randomized placebo study was published. Japanese teenagers with social anxiety and avoidant personality disorder took 300mg of pure CBD or a placebo daily over four weeks. Not only did CBD significantly decrease their anxiety, but half of the participants given CBD expressed a wish to seek therapy or further treatment at the end of the study. At the same time, none of the placebo groups mentioned such a desire.
In an open-label retrospective study in 2019, 72 psychiatric patients with anxiety or sleep disorders were given between 25-175mg of CBD a day. Alongside existing psychiatric medications. After two months of treatment, 78.1% of patients reported feeling less anxious, and 56.1% experienced improved sleep.
A CLINICIAN’S EXPERIENCE
These results validate the experiences of clinicians who regularly prescribe medical cannabis to patients with anxiety. “For me, it’s an excellent choice for treating stress in people,” says Dr. Rebecca Moore, a UK-based consultant psychiatrist who diagnoses patients at The Medical Cannabis Clinics in London.
“I’ve seen some beautiful results. People who’ve had anxiety their entire life, who are doing all the right things in their diet, exercise, and supplements, still have crippling anxiety. Within a few months, they don’t have any anxiety at all. They don’t understand what’s happened to them.
Dr. Moore found hemp – particularly CBD-rich oil – to benefit users with all types of anxiety disorders. In general, patients need smaller doses than used in published preliminary studies. Occasionally with some help from as little as 30mg of whole plant tincture or oil per day.
CBD vs. Prescription Drugs
Patients arrive at Dr. Moore’s clinic because they find the anti-anxiety drugs don’t work, and they struggle with the addictive side effects. “I’ve had people come in,” says Dr. Moore, “on four or five different prescriptions, who have managed to stop them all and be on a whole plant hemp product. People who were on multiple antidepressants, plus benzodiazepines, plus a sleeping pill at night, plus an anti-hypertensive, and they stopped all of them.”
It’s in her treatment of PTSD using cannabinoids where Dr. Moore has seen some of the fascinating changes in patients. “I think particularly with trauma memories, it’s so interesting the way it seems to impact on people’s recollection of their memory. People talk about feeling like their trauma memories no longer exist. And then I’ve had lots of people say they then start to remember positive memories, which they weren’t able to access before.”
Right now, several clinical trials to study the effectiveness of CBD for anxiety are in the research phase. This includes one using 25mg of full-spectrum CBD soft gel capsules over twelve weeks; A phase II clinical trial evaluates the efficacy of CBD for social anxiety, which will also measure changes in endocannabinoid levels. And a Harvard Medical School research project will compare whole-plant and single-extract CBD solutions for stress.
Unfortunately, with clinical research moving at a slow pace, we’re a long way from official approval of CBD as an anti-anxiety medicine.
An effort to minimize any damage to our endocannabinoid system caused by coronavirus stress may make us more vulnerable to anxiety. Incorporating high-quality, whole-plant CBD oil into our self-care routine is a great place to start.