CBD has a promising role as alternative therapy in the management of anxiety disorders. However, more studies with standardized approaches to dosing and clinical outcome measurements are needed to determine the appropriate dosing strategy for CBD and its place in therapy.
Journal of the American Pharmacists Association
Published: November 19, 2019
The evidence reviewed above demonstrates the potential utility of the phytocannabinoid cannabidiol and pharmacological inhibitors of FAAH, to elevate levels of the endocannabinoid anandamide, for the treatment of anxiety-related disorders in the future. Such cannabinoid-related medicines could be used in various ways to treat these disorders. Given their acute anxiolytic effects, cannabidiol and FAAH inhibitors could be used as adjuncts to first-line SSRI or SNRI treatment, which have a delayed therapeutic response. Such drugs could be an improvement over benzodiazepines, which have abuse liability, a less favourable side effect profile and can interfere with extinction, which forms the theoretical basis for exposure therapy used in the psychological treatment of certain anxiety-related disorders [1, 10]. In this respect, cannabinoids could be combined with existing or novel psychological therapies to facilitate extinction enhancement and/or fear memory reconsolidation disruption, both of which may result in a lasting reduction of fear. Cannabinoid-related medicines could also be given as anxiolytics on their own but further research is needed to determine their effects when given repeatedly as the few studies that have examined this issue have found mixed results [107, 108, 109, 110]. The potential for certain adverse effects should also be examined more thoroughly given the reports of cannabinoid use being linked to executive dysfunction [111, 112]. Nevertheless, based on the evidence reviewed here, further research on cannabinoid regulation of fear and anxiety appears to be warranted and below we suggest various lines of enquiry for future work in this area.
The anxiolytic effects of CBD have been extensively demonstrated in animal studies and in healthy volunteers subjected to anxiety induced by several procedures, including the simulation of public speaking (Zuardi et al., 1993; Blessing et al., 2015). A pioneering study that investigated the effects on SAD patients showed that CBD reduces anticipatory anxiety (Crippa et al., 2011). Moreover, CBD was found to exert a significant effect on increased brain activity in the right posterior cingulated cortex that is thought to be involved in the processing of emotional information. A subsequent study (Bergamaschi et al., 2011) experimentally demonstrated a reduction in the anxiety provoked by simulated public speaking by a single dose of CBD in patients with SAD, although the findings were preliminary. Based on these findings, the current study was conceived to extend the published research into a more systematic study on the effect of CBD on teenagers with SAD with avoidant personality disorder for a longer period. Its results are consistent with those obtained by the previous research and indicate that intervention with CBD for a 4-week period reduced the level of symptoms in teenagers with SAD, as measured by FSE and LSAS.
In all, the results of the current study provide evidence for anxiolytic effects of repeated CBD administration in teenagers with SAD. At the same time, however, the author acknowledges several limitations of the current study. No assay of the blood level of CBD was undertaken. A more detailed baseline sociodemographic evaluation could have been performed to ensure the pretreatment similarity of the treatment groups. Measurements need to be performed at additional times between the baseline and the end of the study. These measures would be essential to show, for example, if CBD could produce rapid improvement of social anxiety (a putative advantage over paroxetine). Moreover, possible side effects should be evaluated systematically. Clearly, these are issues for future research that should also be long-term studies with a positive control (e.g., paroxetine) to better assess the potential usefulness of CBD in the therapy of SAD.