CBD as an Anxiety Treatment
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Last year, much of the world went into lockdown as a response to the COVID-19 virus, with restrictions that included the shutdown of schools, shops, and workplaces. The lockdowns effectively stopped normal life with no social interaction outside of households by law, in the UK. Another result of the pandemic was that most industries began to suffer under the financial strains caused by the lockdowns. One sector that is still on track for a large increase, despite the COVID-19 chaos, is the cannabidiol (CBD) market, predicting a growth of just under 10 billion USD in the next seven years [1]. As COVID-19 case numbers decreases, the number of people experiencing mental health issues increases, making the demand for CBD products hardly surprising as they are proven successful in treating conditions like anxiety by certain studies [2]. In the six months before the UK’s first lockdown on the 26th of March 2020 [3], 10% of UK adults reported symptoms of anxiety or depression; by June 2020, this number had nearly doubled [4].
Anxiety is characterised by feelings of unease and recuring intrusive thoughts, [5] so it is no wonder that the daily reports of COVID case numbers and death tolls lead to many experiencing uncontrollable thoughts of panic and worry. Today, we seem to have put lockdown restrictions behind us, with our lives gradually going back to normal, but for those who suffer with anxiety – many because of the pandemic – wellbeing is a little further off. It is, therefore, crucial that different treatments, such as CBD, are explored to help improve the quality of life for so many. Later in this article, the benefits of CBD for reducing anxiety will be examined, but to do so, it must first be understood exactly what anxiety is.
There is more than one biological explanation for anxiety. Within the body, there is an extensive network of nerves that send messages to and from the brain and ultimately determine your actions and responses to stimuli. In the brain there are neurotransmitters, which transfer the messages received from the rest of the body to the brain, in chemical form, by travelling between nerve cells. One such neurotransmitter is serotonin. The transmission of serotonin is important in day-to-day life as it promotes feelings of well-being and happiness. A lack of serotonin can cause anxiety because there is incomplete transfer of messages in the brain between the nerve cells [6]. This can be treated with an anxiolytic, which is a type of drug that reduces anxiety. Prescribed medications such as Selective Serotonin Reuptake Inhibitors (SSRIs) are anxiolytics. SSRIs work by blocking the serotonin reuptake channels, forcing the serotonin to remain between nerve cells for longer. This reduces anxiety because the serotonin is available for longer between nerve cells and so can transmit more messages, meaning complete message transfer can occur [7,8]. In order for serotonin to transfer these messages, there must be an available serotonin receptor on the receiving nerve cell.
One type of serotonin receptor is 5-HT1A, located on the end of nerve cells in the brain. Preclinical studies have provided us with consistent evidence that points to 5-HT1A receptors being directly activated by serotonin, showing them to be the receiving site for anxiolytics. When these receptors are activated, anxiety is reduced, preventing the uncontrollable panic and worry that comes with it [9]. CBD has been discovered to activate the 5-HT1A receptors in the same way that serotonin does, producing the same anxiolytic effect [10]. CBD’s purported ability to reduce anxiety holds a lot of potential for the treatment of different anxiety disorders.
Social anxiety disorder (SAD) shows itself in several ways: worry about embarrassing yourself in public, fear of talking with strangers, and fear of being judged negatively by others, to name a few [11]. This form of anxiety can be debilitating with only around 30% of sufferers achieving full recovery [12]. Clinical studies by Crippa et al. found that just one dose of CBD significantly reduced anxiety and discomfort in a public speaking performance [13]. With this pre-treatment of CBD, negative self-evaluation – often associated with SAD – was nearly completely removed during the public speaking performance. The benefits of CBD as an anxiolytic are numerous; for example, it lacks the withdrawal effects that can be seen in SSRIs, where patients must be tapered off this medication, but with CBD as repeated anxiety treatment, tolerance or dependence does not occur [14].
Anxiety shows itself as a symptom in various other mental illnesses, for example, PTSD. PTSD occurs following a traumatic event which leads to a conditioned fear expression, shown in the form of nightmares and flashbacks which cause panic and distress [15]. Already in this article, it has been discussed that CBD’s ability to activate 5-HT1A and induce anxiolytic effects, but further clinical studies have shown that this event reduces the conditioned fear expression [16]. The results of the studies show that CBD may prevent long term effects of a traumatic event by stopping persistent fear memories and helping remove the distress element that is associated with them, leading to fewer nightmares and decreased anxiety [17].
With the number of anxiety sufferers reaching new highs, it is clear that the pandemic has had a devastating effect on mental health. This information should not be ignored and to tackle the growing mental health crisis in the aftermath of the pandemic, more treatments need to be utilised outside of the pre-existing methods. Research suggests that CBD may prove successful in reducing anxiety, so implementing it as a form of medication is a great approach. Then, as seen with COVID-19 cases, perhaps the number of anxiety sufferers can also decline.
References:
[1] https://www.grandviewresearch.com/industry-analysis/cannabidiol-cbd-market
[3] https://www.instituteforgovernment.org.uk/sites/default/files/timeline-lockdown-web.pdf
[4] https://media.nature.com/original/magazine-assets/d41586-021-00175-z/d41586-021-00175-z.pdf
[5] https://www.apa.org/topics/anxiety
[6] https://www.hormone.org/your-health-and-hormones/glands-and-hormones-a-to-z/.
[7] https://www.verywellmind.com/how-are-ssris-used-in-social-anxiety-disorder-treatment-3024947
[9] Russo EB, Burnett A, Hall B, Parker KK. Agonistic properties of cannabidiol at 5-HT1A receptors. Neurochem Res 2005; 30:1037-1043.
[10] Zhou J, Cao X, Mar AC, et al. Activation of 5-HT1A receptors improve stress adaption. Psychopharmacology 2014; 231:2067-2075.
[11] https://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/symptoms-causes/syc-20353561
[12] Blanco C, Anita SX, Liebowitz MR (2002). Pharmacotherapy of social anxiety disorder. Biol Psychiatry 51: 109-120
[13] file:///C:/Users/faesk/OneDrive/Documents/Organic%20Labs/APO/Anxiety/-%20%20Cannabidiol%20Reduces%20the%20Anxiety%20Induced%20by%20Simulated%20Public%20Speaking%20in%20Treatment%20Naive%20Social%20Phobia%20Pati[1685].pdf
[14] Hayakawa K, Mishima K, Nozako M, Ogata A, Hazekawa M, Liu AX et al (2007). Repeated treatment with cannabidiol but not Delta9-tetrahydrcannabidiol has a neuroprotective effect without the development of tolerance. Neuropharmacology 52: 1079-1087
[15] https://www.nhs.uk/mental-health/conditions.
[16] Das RK, Kambok SK, Ramadas M, et al. Cannabidiol enhances consolidation of explicit fear extinction in humans. Psychopharmacology 2013; 226:781-792.
[17] Elms. L, Shannon. S, Hughes. S, Lewis. N. Cannabidiol in the treatment of post-traumatic stress disorder: a case series. J Alternative Compl Med 2019; 25: 392-7. https://doi.org/10.1089/acm.2018.0437.
Author: Kathleen Faes
Last year, much of the world went into lockdown as a response to the COVID-19 virus, with restrictions that included the shutdown of schools, shops, and workplaces. The lockdowns effectively stopped normal life with no social interaction outside of households by law, in the UK. Another result of the pandemic was that most industries began to suffer under the financial strains caused by the lockdowns. One sector that is still on track for a large increase, despite the COVID-19 chaos, is the cannabidiol (CBD) market, predicting a growth of just under 10 billion USD in the next seven years [1]. As COVID-19 case numbers decreases, the number of people experiencing mental health issues increases, making the demand for CBD products hardly surprising as they are proven successful in treating conditions like anxiety by certain studies [2]. In the six months before the UK’s first lockdown on the 26th of March 2020 [3], 10% of UK adults reported symptoms of anxiety or depression; by June 2020, this number had nearly doubled [4].
Anxiety is characterised by feelings of unease and recuring intrusive thoughts, [5] so it is no wonder that the daily reports of COVID case numbers and death tolls lead to many experiencing uncontrollable thoughts of panic and worry. Today, we seem to have put lockdown restrictions behind us, with our lives gradually going back to normal, but for those who suffer with anxiety – many because of the pandemic – wellbeing is a little further off. It is, therefore, crucial that different treatments, such as CBD, are explored to help improve the quality of life for so many. Later in this article, the benefits of CBD for reducing anxiety will be examined, but to do so, it must first be understood exactly what anxiety is.
There is more than one biological explanation for anxiety. Within the body, there is an extensive network of nerves that send messages to and from the brain and ultimately determine your actions and responses to stimuli. In the brain there are neurotransmitters, which transfer the messages received from the rest of the body to the brain, in chemical form, by travelling between nerve cells. One such neurotransmitter is serotonin. The transmission of serotonin is important in day-to-day life as it promotes feelings of well-being and happiness. A lack of serotonin can cause anxiety because there is incomplete transfer of messages in the brain between the nerve cells [6]. This can be treated with an anxiolytic, which is a type of drug that reduces anxiety. Prescribed medications such as Selective Serotonin Reuptake Inhibitors (SSRIs) are anxiolytics. SSRIs work by blocking the serotonin reuptake channels, forcing the serotonin to remain between nerve cells for longer. This reduces anxiety because the serotonin is available for longer between nerve cells and so can transmit more messages, meaning complete message transfer can occur [7,8]. In order for serotonin to transfer these messages, there must be an available serotonin receptor on the receiving nerve cell.
One type of serotonin receptor is 5-HT1A, located on the end of nerve cells in the brain. Preclinical studies have provided us with consistent evidence that points to 5-HT1A receptors being directly activated by serotonin, showing them to be the receiving site for anxiolytics. When these receptors are activated, anxiety is reduced, preventing the uncontrollable panic and worry that comes with it [9]. CBD has been discovered to activate the 5-HT1A receptors in the same way that serotonin does, producing the same anxiolytic effect [10]. CBD’s purported ability to reduce anxiety holds a lot of potential for the treatment of different anxiety disorders.
Social anxiety disorder (SAD) shows itself in several ways: worry about embarrassing yourself in public, fear of talking with strangers, and fear of being judged negatively by others, to name a few [11]. This form of anxiety can be debilitating with only around 30% of sufferers achieving full recovery [12]. Clinical studies by Crippa et al. found that just one dose of CBD significantly reduced anxiety and discomfort in a public speaking performance [13]. With this pre-treatment of CBD, negative self-evaluation – often associated with SAD – was nearly completely removed during the public speaking performance. The benefits of CBD as an anxiolytic are numerous; for example, it lacks the withdrawal effects that can be seen in SSRIs, where patients must be tapered off this medication, but with CBD as repeated anxiety treatment, tolerance or dependence does not occur [14].
Anxiety shows itself as a symptom in various other mental illnesses, for example, PTSD. PTSD occurs following a traumatic event which leads to a conditioned fear expression, shown in the form of nightmares and flashbacks which cause panic and distress [15]. Already in this article, it has been discussed that CBD’s ability to activate 5-HT1A and induce anxiolytic effects, but further clinical studies have shown that this event reduces the conditioned fear expression [16]. The results of the studies show that CBD may prevent long term effects of a traumatic event by stopping persistent fear memories and helping remove the distress element that is associated with them, leading to fewer nightmares and decreased anxiety [17].
With the number of anxiety sufferers reaching new highs, it is clear that the pandemic has had a devastating effect on mental health. This information should not be ignored and to tackle the growing mental health crisis in the aftermath of the pandemic, more treatments need to be utilised outside of the pre-existing methods. Research suggests that CBD may prove successful in reducing anxiety, so implementing it as a form of medication is a great approach. Then, as seen with COVID-19 cases, perhaps the number of anxiety sufferers can also decline.
References:
[1] https://www.grandviewresearch.com/industry-analysis/cannabidiol-cbd-market
[3] https://www.instituteforgovernment.org.uk/sites/default/files/timeline-lockdown-web.pdf
[4] https://media.nature.com/original/magazine-assets/d41586-021-00175-z/d41586-021-00175-z.pdf
[5] https://www.apa.org/topics/anxiety
[6] https://www.hormone.org/your-health-and-hormones/glands-and-hormones-a-to-z/.
[7] https://www.verywellmind.com/how-are-ssris-used-in-social-anxiety-disorder-treatment-3024947
[9] Russo EB, Burnett A, Hall B, Parker KK. Agonistic properties of cannabidiol at 5-HT1A receptors. Neurochem Res 2005; 30:1037-1043.
[10] Zhou J, Cao X, Mar AC, et al. Activation of 5-HT1A receptors improve stress adaption. Psychopharmacology 2014; 231:2067-2075.
[11] https://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/symptoms-causes/syc-20353561
[12] Blanco C, Anita SX, Liebowitz MR (2002). Pharmacotherapy of social anxiety disorder. Biol Psychiatry 51: 109-120
[13] file:///C:/Users/faesk/OneDrive/Documents/Organic%20Labs/APO/Anxiety/-%20%20Cannabidiol%20Reduces%20the%20Anxiety%20Induced%20by%20Simulated%20Public%20Speaking%20in%20Treatment%20Naive%20Social%20Phobia%20Pati[1685].pdf
[14] Hayakawa K, Mishima K, Nozako M, Ogata A, Hazekawa M, Liu AX et al (2007). Repeated treatment with cannabidiol but not Delta9-tetrahydrcannabidiol has a neuroprotective effect without the development of tolerance. Neuropharmacology 52: 1079-1087
[15] https://www.nhs.uk/mental-health/conditions.
[16] Das RK, Kambok SK, Ramadas M, et al. Cannabidiol enhances consolidation of explicit fear extinction in humans. Psychopharmacology 2013; 226:781-792.
[17] Elms. L, Shannon. S, Hughes. S, Lewis. N. Cannabidiol in the treatment of post-traumatic stress disorder: a case series. J Alternative Compl Med 2019; 25: 392-7. https://doi.org/10.1089/acm.2018.0437.
Author: Kathleen Faes
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