CBD and Anxiety

CBD has blossomed into the public consciousness as a part of the rising public and professional interest in using Medical Cannabis to treat or mitigate a variety of conditions. Many mistrust the rise of CBD in the popular culture for very valid reasons: it is being sold without much regulation, the medicinal claims are commonly misrepresented, the dosing is unclear, and the purity of the products are questionable at best, according to a recent JAMA Study (although there is some criticism about that study, especially due to its conflicts of interest).

Part of the problem is that CBD has become popularized as a health and wellness product but without the clinical and pharmacology information being brought to public awareness as well. In this next series, I am going to discuss CBD and its clinical uses both in practice and research as a clinically useful medication. In this series, I will review the use of CBD in the treatment of anxiety, insomnia, Autism, dependence and addiction, the treatment of pain, and how we use it clinically to decrease side effects with Medical Cannabis.

Although much has been said about CBD in epilepsy and pain, relatively less has been said about the use of CBD for anxiety, how it might be dosed, and its effectiveness. A recent study, published in the Permenente Journal titled “Cannabidiol in Anxiety and Sleep: A Large Case Series”, provides some insight into the question.

In this study, 72 participants were evaluated for CBD’s effects on anxiety (N = 47) and sleep (N = 25), who were treated for at least 1 month in duration (most were followed for 3 months). Individuals with anxiety were assessed using the Hamilton Anxiety Rating Scale (HARS) and those with insomnia were assessed using the Pittsburg Sleep Quality Index (PSQI), both as self-report assessment tools. Individuals with a diagnosis of PTSD, schizophrenia, or agitated depression were excluded.

The doses used for this study were surprisingly small compared to other studies in the literature, which evaluated daily CBD doses ranging from 300mg/day to 800mg/day. The patients were dosed to effect and the dose ranged from 25mg/day up to 175mg/day of CBD to treat anxiety and sleep.

The results were that around 79% showed improvement in anxiety and sleep scores after 1 to 3 months of treatment, while 15% showed worsening symptoms. Study participants showed an average decrease in HARS anxiety score from 23.87 to 16.36, while sleep disturbance participants showed a decrease in their PSQI sleep score from 13.08 to 9.33, both over 3 months. For anxiety, these HARS score improvements show an improvement from being categorized as moderate to severe anxiety to mild anxiety. The PSQI scores indicate significant improvements to sleep but are not categorized in the same manner as the HARS scores are.

Unfortunately, this is a small study and their statistics provided no insight into the power nor the significance of these results, thus more study is absolutely required. However, it does show promise for the use of CBD in the treatment of anxiety and at doses that are relatively reasonable as compared to higher doses required for the treatment of pain and epilepsy (~25mg/kg/day).

In clinical practice, we have moderately good estimates on the dosing for CBD for pain and epilepsy but much less so for anxiety. If we can have a better idea as to how CBD affects anxiety, we can develop better clinical and dosing strategies for treating PTSD, anxiety, depression, and insomnia, even if they are not certified conditions, but are still useful in treating the person as a whole.

Ethan Carruthers