People have been using CBD (and cannabis in general) for anxiety disorders for a long time. Aside from pain and inflammation, anxiety is one of the best known conditions for which cannabis is an effective treatment.
According to the Anxiety and Depression Association of America (source):
- National prevalence data indicate that nearly 40 million people in the United States (18%) experience an anxiety disorder in any given year.
- Approximately 8% of children and teenagers experience an anxiety disorder with most people developing symptoms before age 21.
- Only about one-third of those suffering from an anxiety disorder receive treatment, even though the disorders are highly treatable.
- According to the World Health Organization (WHO), 1 in 13 globally suffers from anxiety.
- The WHO reports that anxiety disorders are the most common mental disorders worldwide with specific phobia, major depressive disorder and social phobia being the most common anxiety disorders.
In this article we'll go over the biology of human anxiety, what an anxiety disorder looks like, how the endocannabinoid system plays a role in modulating anxiety, and how to use cannabis and CBD for anxiety.
As always, feel free to skip ahead to a particular section using the table of contents below.
About Anxiety Disorders
Anxiety is a normal part of everyday life. To never feel anxiety would put you in a precarious and dangerous situation as an animal. Anxiety helps us function during high-stakes, high-pressure situations. Without it, we'd never be properly afraid or avoidant of situations that warrant it.
Animals are anxious all of the time. Next time you're outside, watch a squirrel, a wild bunny, or a deer. They're constantly on high alert, and for good reason. They're consistently running the risk of being eaten, run over, or having their food stolen. Anxiety is a great adaptation for these situations.
Anxiety begins to turn into a disorder when there are no credible reasons for you to feel anxious, yet you can't shake that feeling of tenseness and worry. When you're unable to free yourself from anxiety, even in an environment that's secure, safe, and comfortable, your anxiety has taken control and you are suffering from an anxiety disorder.
Anxiety disorders take a few different shapes, and that's what we're going to go over next. After that we'll talk about where anxiety comes from, and what the symptoms of anxiety feel like.
Types of Anxiety Disorders
Anxiety is characterized by persistent and intrusive thoughts that interfere with normal daily functioning and activities. This definition is applicable to several different types of anxiety disorders.
Generalized anxiety disorder (GAD): This type of anxiety is the most common of all anxiety disorders, and is characterized by excessive, long-lasting, and debilitating worries about nonspecific life events and situations. Most of the time, patients can't identify a cause of anxiety.
Panic disorder: This is an escalation of another anxiety disorder, or a disorder in and of itself. It's defined by sudden and brief episodes of terror. Panic attacks often land sufferers in the emergency room complaining of a heart attack. They also come with shaking, confusion, dizziness, nausea, and rouble breathing. While the peak of a panic attack happens 10 minutes after onset, they often last for hours. Many panic attacks happen out of the blue, without a trigger, and lead to sufferers altering their behavior drastically to avoid future episodes.
Phobia: Phobias are irrational fears of normal, every-day objects and situations. There's always a specific target for the phobia leading the person to jump through hoops to avoid it. Even if subjects know their fears are irrational, they cannot tamp down their anxiety.
Social anxiety disorder: This is a mental disorder characterized by an overactive fear of judgement by peers, or an irrational, excessive fear of public embarrassment. This phobia has been known to get so bad that individuals with social anxiety can be severely isolated.
Obsessive-compulsive disorder (OCD): While not typically thought of as an anxiety disorder by lay people, this psychological disorder is characterized by repetitive, distressing, and intrusive thoughts and actions. Anxiety occurs when they're unable to perform these rituals, or upon thinking about future rituals. Most sufferers know what they're thinking or doing is unreasonable, but it provides such a calming effect they're unable to stop.
Post-traumatic stress disorder (PTSD): PTSD is linked heavily to military service members. but it can be brought on by a host of other situations that can happen in life. It often comes with flashbacks, night terrors, and can lead to dangerous situations for friends and family.
Separation anxiety disorder: This anxiety disorder is suffered by more than just pets and children. It's characterized by symptoms of anxiety when separated by the person or place that provides comfort and security. This disorder can easily escalate to a full-blown panic attack.
Anxiety can also manifest as a symptom of any number of chronic illnesses, disorders, and ailments. In this case, anxiety can be treated directly, or the underlying cause can be treated first.
Causes of Anxiety Disorders
Anxiety can originate from a number of different sources. Here are a few of the most common causes of anxiety disorders in adults and children alike (source).
Most commonly, anxiety is a result of outside forces, but destructive psychological habits can create a feedback loop making anxiety worse. Self-medicating anxiety with recreational alcohol does the same. Additionally, many people's cause for anxiety include more than one of the above originations.
Symptoms of anxiety, like pain, are pretty self explanatory. Most people know what anxiety feels like without ever having to be told. Either way, there are a few symptoms of anxiety that are not totally self-evident (source).
Note that the above symptoms must be severe enough to interfere with your daily functioning (source). How you experience anxiety is unique to you and you won't experience all of the above.
Depending on the type of anxiety disorder you have, not all of the above symptoms may apply to you. This is especially true for individuals with panic disorders. These attacks of anxiety come with extreme symptoms, often to the point that the suffer believes to be dying. This is not a symptom most people with other anxiety disorders would feel unless their disorder is exacerbated enough to turn into a full-blown panic attack.
The Research: Anxiety & The Endocannabinoid System
The oral use of cannabis to treat anxiety is one of the most common uses of the plant in the world. The prevalence of cannabis and CBD for anxiety means that the endocannabinoid system plays a part in regulating our emotions. In this section, we're going to learn how.
As of today, numerous studies confirm that cannabinoids help modulate mood states and can reduce anxiety (study). It is thought that the endocannabinoid system may become pathologically activated in anxiety disorders. Particularly, the concentration of CB1 receptors in brain organs such as the amygdala, hippocampus, and anterior cingulate cortex means that these areas can be affected by the consumption of cannabinoids.
The prefrontal cortex and hippocampus are supposed to play important roles in mood and anxiety. Terpenes and cannabinoids help boost levels of dopamine and serotonin in the hippocampus and prefrontal cortex respectively. In 2010, a group of researchers found CBD to be antipsychotic, anxiolytic, and antidepressant (study).
How Cannabis Hemp/CBD Compares to Modern Medicine
Anxiety affects millions of people each year, and modern treatments are plentiful. Before going over how cannabis and CBD can help your anxiety, let's go over all of the available treatments so you're aware of all your options.
For anxiety, these options include several different types of therapy, many kinds of medication, alternative therapies, and some new treatments in the works. First let's start with therapy.
The treatment of an anxiety disorder should always be coupled with some kind of behavioral therapy - even if it's simple mindfulness at home. The kind of therapy best for you is going to be best determined by research and trial and error. The different types of therapy deployed for anxiety are as follows:
- Regular talk therapy - a therapist helps you develop strategies and coping skills to address anxiety-inducing stress events in your life. Usually once skills are developed, treatment is terminated.
- Long-term psychotherapy - Different from regular talk therapy, or counseling, psychotherapy lasts longer and covers more issues and topics in the persons life to determine patterns of behavior. The ultimate goal is to help the patient regulate their emotions, manage stress better, and understand the behaviors they take part in that contribute to their anxiety. The most effective psychotherapies used for anxiety include Cognitive Behavioral Therapy (CBT), Prolonged Exposure Therapy (PE), and Dialectical Behavioral Therapy (DBT).
- CBT is a short-term therapy aimed at helping people identify negative thoughts that lead to anxiety. Patients learn new ways to process and reframe experiences that lead to anxiety. The process usually takes 10-15 weeks. A popular type of CBT is Acceptance and Commitment Therapy (ACT), where a therapist encourages patients to participate in positive behaviors while having negative thoughts. The goal is to improve daily functioning despite the presence of anxiety.
- PE is used mainly to treat PTSD and other phobias. The goal is to help patients overcome the distress they feel when thinking of past traumatic events or confronting their fears. The patient is carefully reintroduced to these events or fears while being guided through using coping techniques like mindfulness. In the end, patients should realize that the traumatic memories are no longer dangerous/their phobia was never dangerous and does not need to be avoided. Treatment lasts usually up to 16 weeks.
- DBT, the preferred treatment for Borderline Personality Disorder, teaches patients how to regulate their emotions, manage stress in a healthy manner, be more mindful, and be better at interpersonal relationships and communication. Treatment lasts for more than a year.
- Eye Movement Desensitization Reprocessing Therapy (EMDR) - Psychotherapy that ameliorates the emotional disturbances brought on by traumatic memories. It's similar to PE, in that it helps patients process traumas so they can heal and move on. Patients pay attention ot back and forth movement or sound while recounting anxiety producing memories. This is continued until the memory is less distressing. Many patients report a reduction of anxiety symptoms after just a few treatments.
- Family Therapy - This is a type of group therapy that includes the patients immediate family members. It's especially useful when conflict resolution in the family unit contributes to the patient's anxiety. The goal is to help the family learn how to not make their loved-one's anxiety worse.
These are the major types of therapies employed for all of the anxiety disorders. Now let's talk about prescription medication.
Medication should be used only in conjunction with psychotherapy. Most of the medications are basically safe, but they all come with side effects, and many come with dependence issues that are important to consider. Here are the different classes of medication used to treat anxiety disorders:
Antidepressants - These are medications used to treat symptoms of depression but can also used to treat anxiety symptoms. In particular, selective serotonin reuptake inhibitors (SSRIs like Lexapro, Paxil, and Pexeva) and selective norepinephrine reuptake inhibitors (SNRIs like Cymbalta and Effexor XR) are the primary class of antidepressant used to treat anxiety.
Buspirone - This drug (brand names BuSpar and Vanspar) has a high efficacy for Generalized Anxiety Disorder and is particularly effective at reducing the cognitive and interpersonal problems associated with anxiety. Unlike benzodiazepines, buspirone does not have a sedative effect or interact with alcohol. Additionally, there is a very low risk of developing a dependence. Its side effects can include dizziness, nervousness, and headaches.
Benzodiazepines - Benzodiazepines (Librium, Xanax, Valium, and Ativan) are sedatives that demonstrate short-term effectiveness in the treatment of Generalized Anxiety Disorder and can help with sleep disturbances. Long-term use of these medications is discouraged because they can be habit forming. Also, they can reduce the effectiveness of therapies such as PE.
Beta Blockers - Also known as beta-adrenergic blocking agents (Lopressor and Inderal), they block the neurotransmitter epinephrine (adrenaline). Blocking adrenaline slows down and reduces the force of heart muscle contraction resulting in decreased blood pressure. They also increase blood flow by increasing the diameter of blood vessels.They're mostly used to treat the somatic symptoms of anxiety (heart rate and tremors) but they're not very effective at treating the generalized anxiety, panic attacks or phobias.
Other Current Treatments
There are additional treatments available for the treatment of anxiety, but they're recommended only in conjunction with other treatments, or as a supplemental therapy to other treatments. They're non-invasive, not at all dangerous, and have additional positive effects on quality of life.
- Stress Management - This treatment is characterized by a collection of activities focused in which an individual consciously produces the relaxation response in their body. Mostly it's focused on breathing control. When a patient can show down their breathing, their blood pressure plummets and they feel less stressed. Activities include: progressive relaxation, guided imagery, biofeedback, and self-hypnosis and deep-breathing exercises.
- Meditation - A form of mindfulness, this is a mind and body practice where patients are instructed to be mindful of their thoughts, feelings, sensations, environment, and situation in a way that avoids judgement.
- Yoga - Useful in reducing anxiety and depression symptoms, yoga combines mindfulness with stretching and physical postures that range in difficulty.
The Universal Plant also recommends other forms of exercise (as your able) to help reduce anxiety and stress.
New treatments have emerged for treating anxiety that aren't clinically accepted or do not have enough evidence to promote as a currently acceptable treatment for anxiety. These treatments include:.
Neurostimulation - Since anxiety is associated with abnormal patterns of activity in the brain, one way to treat anxiety is to directly target abnormal nerve cell activity. Neuromodulation or brain stimulation therapy is a non-invasive and painless therapy that stimulates the human brain. In some recent clinical trials, patients that did not respond to more traditional forms of treatment (i.e. medication) showed a reduction in symptoms of depression and anxiety. There are two main types of neuromodulation:
- Repetitive transcranial magnetic stimulation (rTMS) - This is where a large-amplitude, low-duration current is applied to the brain areas that regulate mood. This electrical current (which is not at all painful) typically only affects brain regions that are 5 cm deep into the brain, allowing doctors to selectively target which brain regions to treat. A typical treatment session lasts 30-60 minutes. Sessions are administered 4-5 times a week for about 6 weeks. Neuromodulation has very few side effects but they may include headaches, slight tingling or discomfort in the area in which the coil is placed. rTMS may be administered alone or in combination with medication and/or psychotherapy.
- Deep Transcranial Magnetic Stimulation (dTMS) - In this procedure, specialized coils target deeper brain regions than rTMS. The coil used in dTMS was approved by the FDA in 2013 for treating depression but is currently being studied for the treatment of anxiety disorders such as OCD. The procedure is administered for 20 minutes for 4-6 weeks.
Acupuncture - A treatment derived from traditional Chinese medicine, it involves inserting very thin needles into the body in specific areas. To date there is very little evidence that acupuncture can significantly treat generalized anxiety, although there are currently ongoing research trials for PTSD.
Psychoactive drugs - We're excited that this even makes the radar. Usually psychoactive drugs aren't even considered, but there has been recent interest in using psychoactive substances in conjunction with psychotherapy. The two drugs that have received increased attention have been cannabis (marijuana) and methylenedioxymethamfetamine (MDMA, known as ecstasy or molly). While there have been only a few randomized clinical trials for these drugs, certain forms of cannabis have demonstrated positive effects on anxiety. CBD has been very effective for Social Anxiety Disorder, and THC has been shown to help PTSD patients. MDMA has shown some positive effects for PTSD, but should only be used as an adjunct to psychotherapy, again under clinical care.
The Verdict on Using CBD for Anxiety Compared to Current Treatments
Current treatments for anxiety consist of options that don't need to involve addictive drugs or dangerous procedures. Still, most treatments involving the consumption of a substance involves drugs with adverse side effects.
Additionally, therapy is expensive, and alternative treatments may not be covered by your insurance. For these reasons, we consider trying CBD a must for sufferers of anxiety who don't have the resources for therapy, or the stomach for pills.
Cannabis has been effective at treating anxiety for centuries, has no dangerous side effects, and can be used in conjunction with other treatments. We recommend coupling CBD with therapy if possible, but we've seen readers have incredible results using CBD alone. Other's may need additional behavioral therapy to see the full effects. CBD may not be as effective as drugs like Xanax (whose effectiveness at lowering anxiety never ceases), but they're a heck of a lot safer.
Next let's talk about how to actually take cannabis to treat your anxiety (or CBD for anxiety).
Tips For Treating Anxiety Disorders With Cannabis
So we know that cannabis can be effective at treating anxiety disorders, and we know why and how. Now let's talk about cannabis specific information that will help you choose a CBD product for your specific anxiety disorder.
Strains, Terpenoids, & Cannabinoids For Anxiety
According to the Cannabis Health Index, many cannabis-using patients suffering from anxiety prefer wide-leaf varieties of cannabis. In dispensaries, these varieties are called cannabis indicas. Indica's are reported as being sedating, relaxing, and grounding - all effects useful in the treatment of anxiety disorders.
CBD cannabis varieties appear to be extremely effective for treating social anxiety, and maybe even phobias and panic disorders. The strains Zeta and Cookies are good for improving mood and stimulating motivation while soothing anxiety.
The terpene limonene is a known anxiolytic and increases levels of dopamine in the hippocampus, and serotonin in the prefrontal cortex, leading to the reduction of anxiety symptoms. Limonene is found in Tangerine Dream and OG Kush. "Purple" varieties high in the terpenes linalool and myrcene are calming, lightly sedative, and can help you sleep. Cannabis Pharmacy recommends avoiding myrcene if suicidal ideation is present in the patient.
If you can add THC to your routine, we recommend trying to consume theme separately, as it has been shown to possibly more effective if consumed this way instead of in a strain with both THC and CBD.
Best CBD Delivery Methods For Anxiety Disorders
For anxiety, oral and inhalation methods are most recommended. Orally, a digestible edible or sublingual tincture will suffice. The immediate onset of inhalation methods are indicated for fast relief of symptoms, especially during a panic attack. The oral delivery method is good for longer-lasting effects needed during the daytime.
CBD Dosage For Anxiety
While dosing is important in treating almost any condition with cannabis, it's especially important for anxiety disorders, as too much cannabis can make anxiety symptoms worse.
How much is too much? Well, CBD dosage for panic disorders and phobias have ranged in clinical studies, reaching dosages of up to 600 mg every day. It's probably you won't need a dose this high. Cannabis Pharmacy postulates that a dose of 50mg per day of CBD will work for most people.
Generally, THC dosage for most people suffering from anxiety is around 1 to 3 mg. Now let's talk about oral medication and inhalation medication specifically.
We recommend starting with a dose of 2-5 mg and titrating up slowly from there until you feel the effects. This number includes all cannabinoids present in the medicine, so if you're doing a CBD/THC combo, that's 2-5 mg total, not each. When taken orally, CBD can be used without psychoactive effect in conjunction with THC if taken in a spray or sublingually at a ratio of CBD:THC of 10:1 or higher, in doses of 5 mg in the morning and afternoon.
For vaporizing or smoking cannabis with THC, 1 - 2.5 mg to start with, and then titrating up, is recommended for THC. Wait 10-15 minutes before inhaling more medicine. If consuming raw cannabis flower, 2.5 mg of cannabinoids corresponds to a matchstick-head-sized piece of flower.
Recommended Hemp/CBD Products for Anxiety
The products listed below aren't the only medications that can be effective in treating anxiety. For a larger selection of products, see our recommended products page.
More Posts About Cannabis Hemp/CBD & Anxiety
Want more? See the list below for more posts about using CBD for anxiety.
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