cbd oil for anxiety long term

Is cannabis an effective treatment for anxiety disorders?

With the growing legalization of medical cannabis throughout the United States, researchers are often tasked with answering the question of whether cannabis can be useful in alleviating conditions like anxiety-related disorders. Typically, cannabis use will likely worsen anxiety symptoms and interfere with evidence-based treatments, such as exposure therapy. However, preliminary research may suggest some positive benefits. For novice users looking to medical cannabis as an alternative method for anxiety reduction, using CBD is often a recommended starting point, so long as it is managed under the care of both a medical provider and mental health professional.

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The rise of medical cannabis in the United States has left many wondering whether jumping on the cannabis bandwagon is right for them. Often portrayed as a user-friendly substance that can help “mellow out” our responses to everyday life stressors, using medical cannabis for anxiety symptoms and disorders has been of interest to those seeking alternative treatment methods. Considering its controversial history, inconsistent research findings, and the current federal regulations around cannabis in the United States, answering the question, “will medical cannabis treat my anxiety?” is not so simple. Let’s explore the science behind cannabis, cannabis use, and the legal ramifications to getting a bit closer to answering the question “should I start using cannabis?

What is cannabis?

Cannabis, sometimes referred to as “marijuana,” is made up cannabinoids, which are naturally occurring compounds found in the Cannabis sativa plant. Cannabinoids act on cannabinoid receptors in the brain that make up the endocannabinoid system, which plays an important role in a host of bodily processes, including memory, perception of pain, mood, and appetite 1 . The two most commonly known and studied cannabinoids are tetrahydrocannabinol (THC) and cannabidiol (CBD), with the former being the principal psychoactive component of cannabis and the latter being a non-intoxicating compound 2,3 .

As a plant, cannabis can be manipulated to exhibit certain characteristics in the form of varying “strains”, including the two most polarized: sativa and indica. Sativa strains of cannabis have higher levels of psychoactive THC and lower levels of non-intoxicating CBD, while indica strains are the more “mellow” of the two with lower levels of THC and higher levels of CBD. However, strains are often blended to allow for more varied cannabis effects, while ingestion types and dosage also vary, making the consumption of cannabis a multifaceted practice 4 .

Cannabis – Fact v. Fiction

Given its tumultuous history and inaccurate and exaggerated portrayals in films and media, particularly as a result of the ongoing “War on Drugs” implemented by former president Richard Nixon in the 1970s, many misunderstandings, misinterpretations, and misrepresentations exist around cannabis and its effects. Some of the more common being:

  • Cannabis is a harmful drug that can lead to significant memory loss, lung disease, psychosis and/or death
  • Cannabis is a “gateway” drug and leads to more severe substance use
  • Cannabis is a highly addictive drug that is abused by many

In contrast, it is not uncommon for the benefits of cannabis use to be overstated by supporters, which can be misleading to those looking for alternative methods to alleviate difficulties with mood and anxiety. Recent surveys of the general population show that anxiety management is the second most endorsed reason for medical cannabis use 5 . Reports such as these suggest that those struggling with anxiety may be reaching for cannabis to treat their symptoms, which underscores the importance of reviewing the objective findings available on this topic. Common misconceptions among those in favor of cannabis use include:

  • There is conclusive evidence that cannabis can treat anxiety
  • There are minimal negative side effects of cannabis
  • Cannabis is safe for long-term use

What does the research say?

  • THC in cannabis has been shown to be more anxiety-inducing, while CBD has shown to be more anxiety-reducing
  • For chronic recreational users, cannabis use can lead to significant health risks, as well as increased anxiety particularly during withdrawal
  • Individuals suffering from PTSD or chronic pain have reported a reduction of anxiety-related symptoms when using cannabis medically
  • Small sample sizes and significant limitations in the research make it difficult to conclusively state the benefits of cannabis use in treating anxiety

Debunking some common myths, research on the risks of cannabis use has not shown a direct causal link between cannabis use and psychosis or death. Additionally, while cannabis is the most widely-used illicit drug and accompanies the use of other substances, determining its capacity as a “gateway” drug to more harmful psychoactive drugs has mixed findings 6 . However, a systematic review of research suggests that high doses of cannabis use can lead to addiction, psychosis-related health disorders in predisposed individuals, impaired cognition, and overall adverse effects on health outcomes and quality of life in long-term recreational users 2 . Such patterns of use have also been linked to cannabis use disorder (CUD) and cannabis withdrawal syndrome, which are characterized by a host of symptoms including irritability and anxiety 7,8 . In contrast, a meta-analysis of 23 randomized control trials found no evidence of higher adverse outcomes when patients were prescribed medical cannabis 9 . In fact, a study of 244 medical cannabis patients with chronic pain found that patients experienced a 64% decrease in opiate use, decreased amount and intensity of side effects of adjunct medications, and improved quality of life 10 .

Although some positive outcomes have been shown in those using cannabis for medical purposes, an analysis of the therapeutic utility of cannabis for treating anxiety symptoms has proven much more challenging. For example, we know that cannabis can have both anxiety-inducing and anxiety-reducing properties:

  • THC shows a greater tendency toward anxiety-induction.
  • CBD shows slight anxiety-reduction properties.

Specifically, THC has been shown to increase anxiety in animal studies 11,12 while CBD has demonstrated decreased anxiety in similar studies as well as in the treatment of anxiety caused by high levels of THC 13,14 . Similar opposing effects of CBD and THC were found in a neural activation study of 15 healthy men 15 . Despite these findings, sweeping conclusions remain unclear, making it difficult to parse out how different strains of cannabis use effect and interact with anxiety.

Although research has linked increased risk of panic attacks and panic disorder to cannabis use in some 16,17 , encouraging findings point to cannabis use as possibly alleviating anxiety in others, particularly through the use of CBD. For example, a double-blind randomized design study of 24 people with social anxiety disorder found that one 600 mg dose of CBD reduced performance anxiety and cognitive impairment in a speech performance 18 . A promising 2015 literature review showed that there is evidence that CBD is not only useful in social anxiety disorder, but in generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, and posttraumatic stress disorder 19 . A 2019 study found anxiety scores decreased with CBD over a month in 72 patients with anxiety and sleep concerns 20 . Another study from 2019 found perceived symptom improvement in 888 Canadian users of medical cannabis 21 In Washington, over 11,000 sessions recorded using the app StrainprintTM (which provides users of medical cannabis a way to track changes in symptoms) demonstrated a 50% reduction in depression and a 58% reduction in anxiety and stress following cannabis use with high CBD/low THC levels 22 . However, other studies have shown that individuals with social anxiety are more likely to abuse marijuana and that these individuals are more likely to experiences problems related to their cannabis use 19 . Additionally, a 2017 meta-analysis found no relevant association between cannabis use and anxiety symptoms in a general population sample 23 .

Results from studies investigating the administration of a synthetic form of cannabis (Nabilone) found a reduction of treatment-resistant nightmares in 72% of 47 patients with PTSD 24 . Nabilone has been demonstrated to have similar anxiety reduction in other anxiety disorders as well 25 . Furthermore, a systematic review of cannabis use in individuals diagnosed with PTSD found evidence of reduced restlessness, irritability, and sleep difficulties as well as reports of greater emotion regulation, reduced feelings of anxiety, and improved functioning overall 26 .

Other related articles about cannabis that you might find interesting:

Legal regulations for medical cannabis

Once a well-established and widespread treatment modality, the federal government began placing sanctions on the sale and cultivation of cannabis in 1937, with concerns about its psychoactive effects leading to its prohibition and classification as a Schedule I controlled substance in 1970 2 . Today, cannabis containing THC continues to be considered a prohibited substance under federal law, however, state legislators have found loopholes in the governing of cannabis use for both medical and recreational use. Beginning with California’s “Compassionate Use Act” (Prop 215) in 1996, today only four states – Idaho, Kansas, Nebraska, and South Dakota – have opted to not follow on the lingering smoke trail that is the legalization of cannabis in some capacity. Thirty-two states, along with Washington D.C., Guam, Puerto Rico, and the U.S. Virgin Islands, have departed from the federal government to impose their own individual laws and restrictions around the sale and use of medical cannabis, but the conditions for which medical treatment is approved varies from state to state 27 .

Most commonly used as an analgesic, appetite stimulant, and for controlling nausea and vomiting, medical cannabis is primarily recommended for individuals battling chronic conditions. The most common across states being cancer, HIV/AIDS, chronic pain, anorexia and wasting syndrome, seizure disorders (e.g., epilepsy), skeletal muscle spasms (e.g., multiple sclerosis), and post-traumatic stress disorder. Anxiety, in particular, is only explicitly named by New Jersey and West Virginia as a symptom or disorder to be treated by medical cannabis; however, many states have an “other” option for which physicians could determine anxiety as a qualifying condition 27 .

Given the disagreement in regulations between federal and state governments around the sale and use of medical cannabis, particularly THC-laden cannabis, there exists technicalities around what is and is not prohibited. For example, it is illegal for physicians to “prescribe” medical cannabis to patients under federal law and are only allowed to certify or recommend medical cannabis treatment for patients with state-approved medical conditions. In addition, reimbursement is not permitted by either federal or private health insurance companies for alternative methods, like medical cannabis, therefore those recommended for such therapies are required to pay in full for their treatment 27 .

Clinical Trials

Below are current trials investigating the effects of cannabis use on anxiety. See the link for more information.

  • Title: Cannabidiol for the Treatment of Anxiety Disorders: An 8-Week Pilot Study
    Sponsor: McMaster University
    Link: https://clinicaltrials.gov/ct2/show/NCT03549819
  • Title: Anxiety, Inflammation, and Stress
    Sponsor: University of Colorado, Boulder
    Link: https://clinicaltrials.gov/ct2/show/NCT03491384
  • Title: Sublingual Cannabidiol for Anxiety
    Sponsor: Mclean Hospital
    Link: https://clinicaltrials.gov/ct2/show/NCT02548559
  • Title: Cannabinoid Medication for Adults with OCD (recently completed)
    Sponsor: New York State Psychiatric Institute
    Link: https://clinicaltrials.gov/ct2/show/NCT02911324

Conclusion & Recommendations

Given federal regulations of cannabis in the United States, along with the recent boom of the medical cannabis industry, research on its effects are considered to still be in its infancy and unable to keep up with the demands of those seeking alternative therapeutic treatments. With the complexity of both symptomatology of anxiety and the effects of cannabis use, answering the question of whether medical cannabis is a safe and effective method of treating anxiety is a difficult task. More rigorous and controlled research is needed to provide more conclusive answers, so for now, the response to those exploring the options of medical cannabis treatment for anxiety symptom is to “proceed with caution!”

If you are experiencing anxiety that is impairing your daily life, we strongly urge you to reach out to a mental health professional specializing in the treatment of anxiety-related disorders so they may accurately diagnosis your anxiety difficulties and discuss evidenced-based treatments best suited for you. Currently, cognitive behavioral therapy is the most effective and first-line treatment for most anxiety-related problems, and it comes without the possible cost of side effects. Using cannabis or other substances to manage anxiety without the care of a doctor or experienced professional will typically interfere with therapeutic interventions and likely worsen your symptoms in the long run. However, if you are considering using cannabis to alleviate your anxiety, the picture is complex and its usefulness may depend on the chronicity and severity of your anxiety, as well as your history with cannabis use, other substance use, and psychiatric illnesses.

All things considered, the following recommendations should be kept in mind for those interested in pursuing medical cannabis treatment:

How To Use CBD For Anxiety: Does CBD Oil Work for Stress Relief?

CBD or cannabidiol is part of the cannabis family- but with less than 0.3% THC, it is non-psychoactive and will not provide the euphoria that marijuana does. However, similarly to its close cousin, CBD does offer therapeutic properties that have shown efficacy with pain management, digestion issues, and mental health conditions like anxiety. If you struggle with anxiety, you may consider tinctures, oils, and supplements that can reduce the severity and frequency of your symptoms.

What Are Some Symptoms and Signs of Anxiety?

First, it may help to define what exactly anxiety is: Anxiety is your reaction to certain situations or perceived conditions, including those that are stressful, strange, or dangerous. There is a sense of unease, distress, and agitation associated with anxiety. It evokes uncomfortable feelings that are not altogether unhelpful, as anxiety often aids in being aware and alert, thus avoiding dangers or risks.

  • Agitation
  • Hopelessness
  • Feelings of despair
  • Fear
  • Nervousness
  • Feelings of danger
  • Irritability

Feelings of anxiety may be situational and could be treated with supplements, diet, or lifestyle changes. CBD provides another way to address anxiety quickly and effectively. It has been deemed safe for short and long-term use, making it a flexible option.

You may also choose to augment your CBD protocols with other homeopathic and highly effective ways of coping with bouts of anxiety. Some of the recommendations include these:

To instantly relieve feelings of anxiety, try deep breathing. Be mindful of each breath, breathing in through your nose and out through the mouth. Try this in conjunction with meditation daily for a healthful and calming ritual that may reduce incidents of anxiety.

Another homeopathic approach to anxiety is aromatherapy. Invest in a simple diffuser and your favorite high-quality essential oils. Some scents that can help with feelings of anxiety? Try lavender, bergamot, peppermint, and cinnamon scents to help take the edge off when feeling anxious or uncomfortable. Be wary of using aromatherapy around pets, as some fragrances can be toxic for dogs and cats.

Did you know that your diet can play a role in feelings of anxiety? It is true- refined carbohydrates- like cookies and fried food- can cause your blood sugar to spike, leading to feelings of anxiousness and edginess. This crash can create a lot of internal stress and distress; instead, snack on avocado, walnuts, and eggs for energy and excellent mood regulation. Other dietary changes to reduce anxiety may include limiting caffeine or sugar after a particular time of day.

Take a walk! Walking and physical exertion may be the best way to fight feelings of anxiety as they occur. Get some of that distressful and uncomfortable energy out with a brisk walk or jog. It is suggested that 20 minutes of vigorous exercise that gets your heart rate up and blood flowing can have the same antidepressant effects as many prescription medications- with a lot fewer side effects! Plus, it is helpful for holistic health and wellbeing; get moving!

Have you ever tried practicing mindfulness? This is a unique approach to treating feelings of trauma, anxiety, and depression that can become ingrained and instinctual over time with regular practice. When something triggers uncomfortable feelings, it can help to note your surroundings, sensations, and mindset immediately and complete a quick reality check by revisiting who you are and how you feel. This sounds a bit ambiguous, but ask yourself basic questions like ‘what do I see?’ or ‘am I warm or cold?’ can distract from the discomfort and bring you back to a more peaceful state of mind.

If you are interested in pursuing mindfulness practice, numerous online videos and tutorials can explain more. There are also some great books on the market to help walk you through learning to be mindful. Once you are mindful, you live more in the moment and can experience more joy from living and alleviate the plagues of anxiety and depression.

Comparatively, talk therapy can also help with anxiety. Therapists and counselors may be able to tease out the inherent triggers of your feelings, thus allowing you to be more aware and more adept at coping with these stressful and often unexpected situations. Your therapist may be able to identify if medications are a viable treatment option- as well as determine your candidacy for supplements like CBD.

It bears repeating that you should always consult with your practitioner or provider when adding supplements like CBD to your daily routine or making significant changes to your exercise and diet. It is promising that cannabidiol products can offer relief of anxiety for many- while curbing the uncomfortable side effects of pharmacological solutions.

Some specific ways that CBD may help with your anxiety include the following:

Improved Sleep

One reason for anxiety is poor sleep. Sleep hygiene is a critical component of holistic health and wellness; are you getting good rest? CBD activates the serotonin in the brain, which induces a sense of calm and relaxation. This may be why CBD helps so many get a good night’s sleep. By reducing the symptoms of anxiety-like agitation and perseveration, you may be lulled to sleep more quickly and for longer than without CBD. It is seemingly a win-win situation when considering the other benefits of cannabidiol products.

Better Mood

Doesn’t everyone want to be in a bit of a better mood? CBD shows great potential at treating mood-related disturbances and disorders, so why not take it for a simple boost? It is estimated that nearly 16 million people in the US live with depression. Some seek treatment; others do not. CBD has been used successfully with individuals living with depression by releasing serotonin in the brain.

CBD oil affects depression by impacting the hippocampus in the brain’s limbic system. This is the emotion controller in your brain that manages feelings of pleasure, fear, and anger. It also controls basic emotions like nurturance, hunger, or libido.

When you struggle with symptoms of depression, this causes the hippocampus to become smaller. CBD stimulates the growth of new neurons- which may alleviate depression. Many that regularly take CBD oil or other cannabidiol products to treat their symptoms of depression or mood disorder report that it has a similar effect as some prescription antidepressants, like Paxil and Zoloft. This does not mean that consumers should discontinue their current antidepressants instead of CBD- it is always best to discuss such choices with your primary medical provider.

Less Pain

Is your anxiety a result of chronic pain? CBD can help. It is prevalent to use CBD for chronic pain, such as topicals, oils, and tinctures. CBD alleviates inflammation, which makes it especially effective at chronic pain related to your back, arthritis, and neuropathy by acting on the endocannabinoid receptors in the brain. CBD has shown success in relieving the pain of fibromyalgia and cancer, too. This shows promise as an alternative to medications, like opioids, which have a great propensity for dependence and abuse. Perhaps the most compelling feature of CBD is that it is devoid of the side effects that can cause interactions and complications.

CBD Dosage Information

There are many different ways to glean the healing properties of CBD. CBD oil on the skin is most effective at targeted pain like arthritis. You can use a tincture and put drops of CBD on your tongue. Industry experts suggest placing the dropper under the tongue for faster delivery of the cannabidiol into the body. You will likely begin to feel effects in minutes.

You might also use CBD edibles, such as gummy candy or baked treats, for a more extended, time-released type of CBD use. This would be an effective plan for people with chronic issues like neuropathy or mood disorders. Are you familiar with vaping? You may choose to vaporize your cannabidiol, but make sure to buy quality CBD vape juice from sellers in the USA for the best products. This allows for the fast delivery of CBD while also giving you some control over how much you ingest.

Cannabidiol Tips for Consumers

There is a lot to learn about CBD, so it makes sense to do a little research online before buying cannabidiol products to treat your anxiety. Plus, you should always consult and report changes to your routine- such as adding a CBD supplement- to your provider or doctor.

How Do You Use CBD Safely and Adequately?

Consider these CBD tips:

Non-psychoactive Cannabidiol products, including CBD oil, are legal in every state of the United States. It is widely available in capsules, drops, lotions, and gummies and is typically sold in smoke shops, drug stores, and online.

Always read the label of the CBD products you buy for dosing information- it will vary significantly from one item to the next. It helps to keep a journal of what products you use and how much- as well as how it makes you feel. This may help narrow down the market to the most effective items for your anxiety.

Remember that CBD also contains many amino acids and omega-3 fatty acids, so it is a worthwhile supplement even if you do not suffer from depression. Consider incorporating CBD products as part of your daily regimen.

Ensure that the CBD oil and products you buy are extracted from hemp. CBD products extracted from marijuana plants are illegal in most states, and these will not be permitted to be shipped from one state to the next.

The side effects of CBD are mild when compared to other medications and treatment options, and topical CBD products do not enter the bloodstream, eliminating most side effects and risks. As with anything, however, there are a few side effects and symptoms that may merit discontinuing CBD use, but that is not alarming.

  • Fatigue
  • Diarrhea
  • Significant changes in appetite or weight
  • Also, be aware of potential interactions when using CBD products as they may interact with:
  • Specific over-the-counter drugs
  • Some psychiatric medications
  • Dietary supplements

Your doctor will provide more information, but if your current meds or supplements caution consumers of a “grapefruit warning” on the label, it could indicate that CBD and grapefruit- or derivatives- could cause metabolic interference also elevate the risk of liver toxicity.

The market for CBD remains largely unregulated, so make sure that you know what you are buying before you make the purchase. Look for local distributors with transparent labeling, so you know exactly how and how much to ingest. Always opt for high-quality CBD products made in the USA.

Using CBD For Anxiety Conclusion

If you struggle with anxiety, CBD provides an alternative that can augment your existing regimen or that may be an all-natural option for those sensitive to medication. Always discuss changes in your routine with your provider, but CBD is an over-the-counter, safe supplement that can relieve symptoms of anxiety gently and naturally. From tinctures and edible baked goods to topical oils and body lotions that deliver therapeutic levels of cannabidiol to the system, there is another alternative to defeat depression and alleviate anxiety for sufferers. Consider the many advantages of CBD for yourself!

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Disclaimer:

Please understand that any advice or guidelines revealed here are not even remotely a substitute for sound medical advice from a licensed healthcare provider. Make sure to consult with a professional physician before making any purchasing decision if you use medications or have concerns following the review details shared above. Individual results may vary as the statements made regarding these products have not been evaluated by the Food and Drug Administration. The efficacy of these products has not been confirmed by FDA-approved research. These products are not intended to diagnose, treat, cure or prevent any disease.