CBD for Anxiety: What the Science Says

By | last updated September 22, 2022

Medically reviewed by
Kimberly Langdon, MD

Evidence Based 27

Anxiety is one of the most common reasons people turn to cannabidiol (CBD). The great news is that out of CBD’s many uses, it’s also backed by some of the highest quality research evidence.

In fact, multiple clinical studies are showing that CBD may reduce anxiety in people with anxiety disorders and even healthy adults. 

Keep reading to learn more about how CBD can help with anxiety, the best way to use it, and other useful tips.

What Does the Clinical Research Say?

There’s a large, ever-growing volume of peer-reviewed evidence showing that CBD may help with occasional anxiety and specific anxiety disorders.

Anxiety Disorders

One of the first major studies on using CBD for anxiety came out of Brazil in 2011. Twenty-four people with social anxiety disorder (SAD) were given placebo or CBD capsules (600 mg) before doing a simulated public speaking test. Another 12 healthy people also did the test without any treatment. 

The CBD group experienced less anxiety, cognitive impairment, and discomfort during the test. In fact, their response was similar to the healthy group (1).

Meanwhile, a 2019 study of 37 Japanese teenagers with SAD and a similar condition called avoidant personality disorder found that CBD oil (300 mg) reduced anxiety (2). In the same year, a Colorado study found that CBD improved anxiety in 72 adults with anxiety or sleep issues (3).

Another 2019 study of 11 people with post-traumatic stress disorder (PTSD) — a type of anxiety disorder — found that adding CBD to standard therapy helped reduce the symptoms (4).

More recently, a 2022 Australian study of 31 people with treatment-resistant anxiety disorders found that CBD reduced anxiety severity and depressive symptoms (5). 

Finally, a 2020 review of multiple studies on the use of CBD for anxiety concluded that “CBD has a promising role as alternative therapy in the management of anxiety disorders.” (6)

Anxiety in Healthy Adults

So far we’ve discussed studies of people with anxiety disorders, but what about healthy adults? 

In one 2019 study, 57 healthy men took placebo or CBD capsules (150, 300, or 600 mg) before a simulated public speaking test. Compared to placebo, the 300 mg group had significantly less anxiety during the test (7). 

This study highlights that CBD may also help healthy individuals who experience occasional anxiety but don’t have an anxiety disorder. 

Did you know? According to recent surveys of thousands of CBD users in the US, UK, and France, anxiety, relaxation, and stress relief are the most common reasons people take CBD (8, 9, 10). The British survey also found that “I feel more calm” was the most commonly reported effect of CBD (8).

THC-Induced Anxiety

There’s also evidence that CBD could counteract anxiety and other side effects of tetrahydrocannabinol (THC), the main active ingredient in marijuana. Anxiety and panic attacks are the most common side effects of cannabis use (11).

In one 2022 study, 159 regular cannabis users smoked one of three cannabis cultivars: THC-rich, CBD-rich, or balanced THC: CBD. People using the balanced and CBD-rich strains reported less paranoia and anxiety than those smoking the THC-rich cultivar (12).

Meanwhile, a 2013 review paper concluded that “Studies examining the protective effects of CBD have shown that CBD can counteract the negative effects of THC” (13). 

How Does CBD Help With Anxiety?

CBD seems to lower anxiety by interacting with various receptors and molecules in the brain. 

CBD and Serotonin

First and foremost, multiple studies suggest that CBD’s anxiolytic (anxiety-reducing) effects come from its interaction with serotonin 5-HT1a receptors (14). For example, a 2008 study in mice found that blocking these receptors prevented CBD’s effects (15). We also know from research that 5-HT1a receptors are abundant in parts of the brain related to stress and anxiety (14).

CBD & Anandamide

Another way that CBD may relieve anxiety is by increasing the levels of anandamide, one of the two main endocannabinoids produced by our bodies. CBD does this by inhibiting FAAH, an enzyme that breaks down anandamide (14).

Anandamide is known to play a role in anxiety. One 2015 genetic study found that people who have higher anandamide levels because of a variation in the FAAH gene may experience less overall anxiety (16).

Another 2008 study of depressed women found that low anandamide levels were associated with anxiety (17). Studies in mice also show that stress can deplete anandamide and that this reduction is associated with anxious behavior, which is reversed by FAAH inhibitors (18). 

CBD’s effects on anandamide may also lower anxiety by promoting adult neurogenesis — the formation of new neurons in the adult brain. In one 2013 mouse study, CBD reduced anxiety in stressed mice by increasing anandamide, which in turn increased neurogenesis in the brain’s hippocampus (19).

There’s even evidence that CBD might interact with receptors of GABA (20), a calming neurotransmitter that plays a major role in anxiety (21).

How to Best Use CBD for Anxiety

The first question to ask yourself is whether you want instant anxiety relief or slower-acting, longer-lasting effects.

Vaping vs. CBD Oil

If you prefer rapid effects, vaping CBD is the best option because it works almost instantly. But it also wears off quicker, lasting about 1-4 hours (22). On the other hand, CBD oil takes 15-40 minutes to kick in but has longer-lasting effects — about 4-6 hours.

THC Sensitivity

The second consideration is your THC sensitivity. Some people are so sensitive to THC that even the small amounts (<0.3%) found in full-spectrum CBD can cause anxiety. That’s why you can find many online reports of anxiety and panic attacks from full-spectrum CBD products. I personally experienced anxiety when I took a large dose of full-spectrum CBD oil.

If you find that you’re sensitive to THC, you can either lower the dosage or use broad-spectrum CBD products, which contain undetectable amounts of THC. Another option is products made with pure CBD isolate.

But if you’re okay with THC, we recommend opting for full-spectrum extracts. They contain many cannabinoids, terpenes, and flavonoids that work synergistically with CBD, making it significantly more effective. In fact, studies have shown that full-spectrum CBD extracts are about 4 times more potent than pure CBD (23).

A Word on Gummies & Capsules

As for gummies and capsules, while they can be helpful, we don’t recommend them as your main source of CBD. CBD has low oral bioavailability, making capsules and gummies less effective than oils and vaped products (24).

How Much CBD Should I Take for Anxiety?

The correct CBD dosage is different for every person. It depends on many factors, including your genetics, body weight, symptom severity, and the type of product you’re taking.

The best approach is to “start low and go slow” (25). Begin with a small dose like 5-10 mg or the amount suggested by your product. You should watch how you feel for the next two hours; if you don’t notice any effects, you can try a higher dose next time.

Use this approach to work your way up to a dosage that provides the desired anxiety relief. 

As a final piece of advice, if you’re looking for consistent relief, it’s best to take CBD once or twice daily. Alternatively, you can also take CBD as needed, before or during an anxious event. 

Are There Any Side Effects?

CBD is a relatively safe compound with few and minor side effects. The most commonly reported ones include: (26)

  • Tiredness and sleepiness
  • Diarrhea and nausea
  • Low blood pressure
  • Lightheadedness
  • Changes in weight or appetite
  • Dry mouth

But these side effects were mostly reported by studies using high oral doses of pure CBD, so they’re less likely to happen in regular CBD users.

High doses of CBD may also inhibit enzymes that metabolize drugs, potentially causing drug interactions. One 2021 study of 6 anxiety disorder patients who were taking citalopram (a drug used to treat both anxiety and depression) found that daily high doses of pure CBD (starting at 200 mg and increasing to 800 mg) significantly increased citalopram’s blood levels after 4 weeks (27).

That’s why it’s always a good idea to talk to your doctor before taking CBD, especially if you’re taking prescription medication.

CBD for Anxiety: Worth a Try

The current evidence suggests that CBD may improve anxiety in both healthy individuals and people with anxiety disorders. Research also shows that it’s a fairly safe substance that holds a lot of promise.

Still, CBD is not a magical pill, and we agree with researchers that more high-quality studies are needed. If you’re interested in trying CBD for anxiety, we recommend using either CBD oil or a vape product.

If you’re ok with THC, you can use a full-spectrum formula; otherwise, go with broad-spectrum or pure CBD.

References

  1. Bergamaschi, Mateus M., et al. “Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naive social phobia patients.” Neuropsychopharmacology 36.6 (2011): 1219-1226.
  2. Masataka, Nobuo. “Anxiolytic effects of repeated cannabidiol treatment in teenagers with social anxiety disorders.” Frontiers in psychology (2019): 2466.
  3. Shannon, Scott, et al. “Cannabidiol in anxiety and sleep: a large case series.” The Permanente Journal 23 (2019).
  4. Berger, Maximus, et al. “Cannabidiol for Treatment-Resistant Anxiety Disorders in Young People: An Open-Label Trial.” The Journal of Clinical Psychiatry 83.5 (2022): 42111.
  5. Elms, Lucas, et al. “Cannabidiol in the treatment of post-traumatic stress disorder: a case series.” The Journal of Alternative and Complementary Medicine 25.4 (2019): 392-397.
  6. Skelley, Jessica W., et al. “Use of cannabidiol in anxiety and anxiety-related disorders.” Journal of the American Pharmacists Association 60.1 (2020): 253-261.
  7. Linares, Ila M., et al. “Cannabidiol presents an inverted U-shaped dose-response curve in a simulated public speaking test.” Brazilian Journal of Psychiatry 41 (2018): 9-14.
  8. Moltke, Julie, and Chandni Hindocha. “Reasons for cannabidiol use: a cross-sectional study of CBD users, focusing on self-perceived stress, anxiety, and sleep problems.” Journal of cannabis research 3.1 (2021): 1-12.
  9. Fortin, Davide, et al. “Reasons for using cannabidiol: a cross-sectional study of French cannabidiol users.” Journal of Cannabis Research 3.1 (2021): 1-5.
  10. Wheeler, Meghann, et al. “CBD (cannabidiol) product attitudes, knowledge, and use among young adults.” Substance use & misuse 55.7 (2020): 1138-1145.
  11. Niesink, Raymond JM, and Margriet W. van Laar. “Does cannabidiol protect against adverse psychological effects of THC?.” Frontiers in psychiatry 4 (2013): 130.
  12. Gibson, Laurel P., et al. “Effects of cannabidiol in cannabis flower: implications for harm reduction.” Addiction Biology 27.1 (2022): e13092.
  13. Niesink, Raymond JM, and Margriet W. van Laar. “Does cannabidiol protect against adverse psychological effects of THC?.” Frontiers in psychiatry 4 (2013): 130.
  14. Melas, Philippe A., et al. “Cannabidiol as a potential treatment for anxiety and mood disorders: molecular targets and epigenetic insights from preclinical research.” International Journal of Molecular Sciences 22.4 (2021): 1863.
  15. Campos, Alline Cristina, and Francisco Silveira Guimarães. “Involvement of 5HT1A receptors in the anxiolytic-like effects of cannabidiol injected into the dorsolateral periaqueductal gray of rats.” Psychopharmacology 199.2 (2008): 223-230.
  16. Dincheva, Iva, et al. “FAAH genetic variation enhances fronto-amygdala function in mouse and human.” Nature communications 6.1 (2015): 1-9.
  17. Hill, Matthew N., et al. “Serum endocannabinoid content is altered in females with depressive disorders: a preliminary report.” Pharmacopsychiatry 41.02 (2008): 48-53.
  18. Bluett, R. J., et al. “Central anandamide deficiency predicts stress-induced anxiety: behavioral reversal through endocannabinoid augmentation.” Translational psychiatry 4.7 (2014): e408-e408.
  19. Campos, Alline C., et al. “The anxiolytic effect of cannabidiol on chronically stressed mice depends on hippocampal neurogenesis: involvement of the endocannabinoid system.” International Journal of Neuropsychopharmacology 16.6 (2013): 1407-1419.
  20. Bakas, T., et al. “The direct actions of cannabidiol and 2-arachidonoyl glycerol at GABAA receptors.” Pharmacological research 119 (2017): 358-370.
  21. Lydiard, R. Bruce. “The role of GABA in anxiety disorders.” Journal of Clinical Psychiatry 64 (2003): 21-27.
  22. Borodovsky, Jacob T., et al. “Smoking, vaping, eating: Is legalization impacting the way people use cannabis?.” International Journal of Drug Policy 36 (2016): 141-147.
  23. Pamplona, Fabricio A., Lorenzo Rolim Da Silva, and Ana Carolina Coan. “Potential clinical benefits of CBD-rich cannabis extracts over purified CBD in treatment-resistant epilepsy: observational data meta-analysis.” Frontiers in neurology (2018): 759.
  24. Millar, Sophie Anne, et al. “Towards better delivery of cannabidiol (CBD).” Pharmaceuticals 13.9 (2020): 219.
  25. Lucas, Catherine J., Peter Galettis, and Jennifer Schneider. “The pharmacokinetics and the pharmacodynamics of cannabinoids.” British journal of clinical pharmacology 84.11 (2018): 2477-2482.
  26. Huestis, Marilyn A., et al. “Cannabidiol adverse effects and toxicity.” Current neuropharmacology 17.10 (2019): 974-989.
  27. Anderson, Lyndsey L., et al. “Citalopram and cannabidiol: in vitro and in vivo evidence of pharmacokinetic interactions relevant to the treatment of anxiety disorders in young people.” Journal of clinical psychopharmacology 41.5 (2021): 525-533.

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