Everything You Need to Know About CBD Oil for Anxiety
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CBD has shown promise for easing social anxiety and helping people with anxiety disorders. Here's what you need to know.
Anxiety is a common problem
Since when did anxiety become less the exception and more the norm? Since Covid-19.
Virtually everyone is dealing with anxiety of varying degrees these days. Even people who rarely experienced this uncomfortable sense of fear, dread, and uneasiness pre-pandemic may be getting a taste of what those with anxiety disorders can face every day: sweaty palms, racing heart, a sense of impending doom, even panic attacks.
Anxiety is a normal response to certain threats. But “irrational” fear and worry that interferes with daily life may indicate an anxiety disorder. (Not sure where you fall? Here are signs you might have an anxiety disorder.)
Nearly one-third of adults in the U.S. reported symptoms of an anxiety disorder in June 2020, compared to 8 percent in the second quarter of 2019, according to the Centers for Disease Control and Prevention (CDC). Certain groups were especially hard hit, the CDC found, including 18- to 24-year-olds, Blacks, Latinos, essential workers, unpaid caregivers for adults, and people who were already being treated for anxiety, depression, or post-traumatic stress disorder (PTSD).
Dog_Trumpet/Getty ImagesCan CBD help with anxiety?
Meanwhile, cannabidiol (or CBD) is being touted as a treatment for a number of health issues, including anxiety. Most of the evidence is from studies in animals and not humans. However, some research suggests CBD could be helpful for certain types of anxiety in healthy people who haven’t been diagnosed with mental illness, and for anxiety in people with certain psychiatric conditions.
“There appears to be great interest—and increasing use—among people taking CBD to assist in managing mental health issues like anxiety, stress, and insomnia,” says Jerome Sarris, PhD, a professor of integrative mental health and head of the Healthy Minds Research Program at Western Sydney University’s NICM Health Research Institute in New South Wales, Australia. “Clinical trials are needed, however, to be able to more firmly conclude about whether the use of CBD in those with generally good mental health is beneficial beyond a placebo-effect,”
“What hasn’t been studied is anxiety as its own condition versus as a symptom of a disease,” notes Jahan Marcu, PhD, founding partner of cannabis consultancy Marcu & Arora and editor-in-chief of the American Journal of Endocannabinoid Medicine.
What’s the evidence?
“What CBD is probably best studied for is acute stress related to public speaking challenges,” says Marcu.
A small study of healthy men, published in 2019 in Brazil Journal of Psychiatry, found that a 300-mg dose relieved anxiety during a public speaking test. Another study, in people at high risk of psychosis, found that those who were taking 600 milligrams of CBD per day had a lower cortisol response to social stress.
The two studies to date of inhaled CBD have found it was effective at much lower doses, notes Marcu, in the 16 mg to 32 mg range. “It does seem like in healthy volunteers that CBD might be helpful,” he says.
A small study published in the Journal of Psychopharmacology found that 400 mg of CBD was linked to a decrease in anxiety for people who had generalized socialized anxiety disorder (SAD). In a study published in a 2019 issue of The Permanente Journal, participants with anxiety and/or sleep problems took 25 to 175 mg of CBD daily. Although sleep issues didn’t change dramatically over the three-month testing period, anxiety levels decreased, according to the report.
“There is some emerging evidence supporting the use of CBD in various psychiatric disorders such as schizophrenia, while potentially also being of use for social anxiety,” says Sarris, adding that researchers around the world are studying CBD. “There are lots of clinical trials going on at the moment. We will have a better idea in coming years.”
How CBD may work for anxiety
Researchers aren’t totally clear how CBD affects the brain.
“The main brain pathway being modulated by CBD which may affect mood and anxiety involves the ‘endocannabinoid’ system,” Sarris says. “This is involved in regulating mood and pain. And it appears that CBD interacts beneficially with this biological pathway.”
The endocannabinoid system (ECS) consists of cannabinoid-like compounds in the body known as endocannabinoids; the cell surface receptors that bind to them; and the enzymes that make endocannabinoids and break them down. Things that are good for you—getting enough sleep, exercising—help keep the ECS in shape. You can even get a boost of endocannabinoids from singing in a choir, notes Greg Gerdeman, PhD, a cannabis neuroscientist and educator.
On the other hand, lack of sleep and unrelieved stress and anxiety can weaken the ECS. So it’s less effective in helping us to manage stress.
“People having different levels of activation in their endocannabinoid system may be more or less resilient to stress, and may differ in their abilities to recover from the stress of psychological trauma,” Gerdeman says. “The challenge of this is knowing to what extent it’s actually happening in humans, and what dose of CBD is required to accomplish this.”
CBD could also ease anxiety by affecting levels of the “feel good” brain chemical serotonin, Marcu notes. It acts on the same receptor targeted by selective serotonin reuptake inhibitors (SSRIs) like Prozac and Zoloft, which are first-line treatments for anxiety as well as depression. (Learn more about using CBD for depression.)
Best forms of CBD for anxiety
Inhaling CBD by vaping or smoking CBD-rich hemp is the quickest way to feel its effects, but these consumption methods come with their own health risks. They can cause potential lung damage. There are possible harmful ingredients in vape oil, including legal additives like propylene glycol, that can be dangerous when heated and inhaled.
If you’re considering using CBD vape oil—or any CBD oil or CBD edible, for that matter—experts agree you should only use products sold at licensed dispensaries in states where marijuana is legal.
CBD oil, CBD tinctures, CBD pills, CBD capsules, and other CBD edibles take longer to work—people may start feeling the effects from a half hour to two hours after consuming them—but their effects are longer-lasting, says Martin A. Lee, co-founder and director of Project CBD, a California nonprofit that promotes CBD research, and author of Smoke Signals: A Social History of Marijuana–Medical, Recreational, and Scientific.
CBD edibles can be more effective for chronic, long-lasting anxiety, Lee notes.
You can get CBD into your system faster by holding a CBD tincture or CBD oil under your tongue for at least two minutes, which allows it to be absorbed into the bloodstream more readily, notes Bonni Goldstein, MD, medical director and owner of Cannacenters, a medical practice in Los Angeles, and author of Cannabis is Medicine: How Medical Cannabis and CBD are Healing Everything from Anxiety to Chronic Pain.
CBD’s effects vary from person to person and CBD can interact with many commonly used drugs. Otherwise it’s generally considered safe. Potential side effects include sleepiness, fatigue, irritability, changes in appetite, nausea, and diarrhea.
Can it cause anxiety? Or make it worse?
Low doses of CBD can make some people feel more alert, while larger doses can lead to sleepiness, Dr. Goldstein notes. But for the great majority of people, taking CBD doesn’t cause anxiety or worsen it. (Here are 18 everyday things that can trigger anxiety.)
Consult your health care provider
If you’re interested in trying CBD for anxiety, experts have two key pieces of advice: Tell your health care provider about it. And make sure you are getting a safe product that contains what the label says it does, which is often easier said than done.
Dr. Goldstein and other experts recommend using only CBD products sold in licensed dispensaries where marijuana is legal and regulated. If this isn’t an option, seek out products that have been tested by an independent lab (also known as third-party testing). The manufacturer should be able to show you a current Certificate of Analysis (COA), which includes the product’s tested content of CBD, THC, and other cannabinoids. The COA should also show that the product is free from toxic substances like heavy metals, pesticide residue, and mold.
If you’re planning on using a product regularly, Dr. Goldstein says, it may be worthwhile to take it to a lab yourself to have it tested.
How much CBD oil to use for anxiety
Investigators are still figuring out the best CBD doses for various indications, including anxiety, Sarris and other experts say.
“We need further research on what the ideal dose of CBD is for the individual,” Sarris says. “Commonly, people are consuming between 10 mg to 70 mg for general mental health usage. However, for other more serious psychiatric disorders, clinical trials are using 400 mg to 800 mg. This can be expensive, and people’s responses to CBD do vary. So it’s important to work in concert with a health professional to work out what dose is appropriate.”
What CBD formulation is best for anxiety?
CBD oil, CBD edibles, and other products come in three forms:
- full spectrum, meaning they contain all of the other compounds found in the plant, including THC and terpenes
- broad spectrum, with all of these compounds except THC
- CBD isolate, which contains only CBD
If you’re concerned about failing a drug test for marijuana due to trace levels of THC in a CBD product, your best bet is to stick with broad spectrum products or isolates without THC, which is what drug tests look for. But keep in mind: With regular use, it is possible for even small amounts of THC to build up in the body, raising the possibility of a positive drug test.
If this isn’t an issue, it may be worth trying a full-spectrum product, experts say.
“Other compounds from full-spectrum cannabis extracts, such as certain terpenes, may also be of benefit,” says Sarris. That’s because of “additional anxiety-reducing, muscle-relaxing, and sleep-assisting properties.”
The bottom line
If you’re considering CBD for anxiety, discuss it with your doctor, and buy only third-party-tested products—ideally in states where marijuana is legal and cannabis products are regulated.
- National Institutes of Mental Health: "Anxiety Disorders"
- Centers for Disease Control and Prevention:, "Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020"
- Anxiety and Depression Association of America: "Understand the Facts"
- BMC Psychiatry, "Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review"
- Jerome Sarris, PhD, MHSc, professor of integrative mental health and Healthy Minds Research Program lead at NICM Health Research Institute at Western Sydney University in New South Wales, Australia
- Jahan Marcu, PhD, founding partner of cannabis consultancy Marcu & Arora and editor-in-chief of the American Journal of Endocannabinoid Medicine
- Greg Gerdeman, PhD, cannabis neuroscientist and educator
- Martin A. Lee, co-founder and director of Project CBD, author of Smoke Signals: A Social History of Marijuana–Medical, Recreational and Scientific
- Bonni Goldstein, MD, medical director and owner of Cannacenters, author of Cannabis is Medicine: How Medical Cannabis and CBD are Healing Everything from Anxiety to Chronic Pain
- Neuropsychopharmacology: "Cannabidiol Reduces the Anxiety Induced by Simulated Public Speaking in Treatment-Naïve Social Phobia Patients"
- Journal of Pscyhopharmacology: "Neural basis of anxiolytic effects of cannabidiol (CBD) in generalized social anxiety disorder: a preliminary report"
- The Permanente Journal: "Cannabidiol in Anxiety and Sleep: A Large Case Series"
- Brazilian Journal of Psychiatry: "Cannabidiol presents an inverted U-shaped dose-response curve in a simulated public speaking test"
- Psychopharmacology: "Effects of short-term cannabidiol treatment on response to social stress in subjects at clinical high risk of developing psychosis"
- Drug and Alcohol Dependence: "Pharmacodynamic effects of vaporized and oral cannabidiol (CBD) and vaporized CBD-dominant cannabis in infrequent cannabis users"
- Psychopharmacology: "Cannabidiol enhances consolidation of explicit fear extinction in humans."