Can cbd oil work for anxiety

How To Use CBD To Help Alleviate Anxiety

Dr. Bindiya Gandhi is an integrative medicine physician with expertise in functional and holistic medicine based in Atlanta, Georgia.

Commissions we earn from partner links on this page do not affect our opinions or evaluations. Our editorial content is based on thorough research and guidance from the Forbes Health Advisory Board.

Table of Contents

  • CBD for Anxiety
  • How to Use CBD for Anxiety
  • CBD Dosage for Anxiety
  • Potential Risks and Side Effects

While delta-9-tetrahydrocannabinol (THC) can have a bad rap for being intoxicating and anxiety-inducing, cannabidiol (CBD) can actually be used to relieve anxiety. Research supports this benefit, with several studies reinforcing the positive effects CBD can have on various anxiety conditions. In fact, 51% of U.S. adults who use CBD do so to help alleviate their anxiety, according to a recent Forbes Health survey of 2,000 U.S. adults conducted by OnePoll.

CBD isn’t yet legally cleared as an anxiolytic, or anxiety relief medication. Therefore, it’s up to you—and, ideally, a doctor who specializes in cannabis administration—to determine whether CBD is a safe treatment for your anxiety.

Here’s what the science says regarding CBD’s anxiolytic properties, along with experts’ dosage guidelines and advice on how to take CBD safely.

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CBD for Anxiety

The Food and Drug Administration (FDA) has yet to approve any CBD-based medications for anxiety. However, many studies indicate the substance can be an effective anxiolytic.

CBD for Generalized Anxiety

In 2011, a small trial-tested CBD on participants with generalized social anxiety disorder (SAD) and healthy control patients undergoing a simulated public speaking test (SPST), which is a common anxiety testing method [1] Bergamaschi MM, Queiroz RH, Chagas MH, et al. Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naïve social phobia patients. Neuropsychopharmacology. 2011;36(6):1219-1226. . Compared to a placebo, CBD significantly reduced anxiety and discomfort in the participants with SAD. In fact, their reduced anxiety levels were comparable to those of the control participants.

Eight years later, a 2019 test compared the efficacy of three CBD doses (150 milligrams, 300 milligrams and 600 milligrams) and a placebo in men taking an SPST [2] Linares IM, Zuardi AW, Pereira LC, et al. Cannabidiol presents an inverted U-shaped dose-response curve in a simulated public speaking test. Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999). 2019;41(1):9-14. . Compared to a placebo, 300 milligrams of CBD significantly reduced participants’ anxiety during the speech, but the 150-milligram and 600-milligram doses did not. These results highlight how dosage can be highly variable and that more CBD isn’t necessarily more effective.

Meanwhile, another 2019 study tested CBD in much lower doses than most other clinical studies—some participants consumed 25 milligrams a day while others consumed 50 milligrams or 75 milligrams a day [3] Shannon S, Lewis N, Lee H, Hughes S. Cannabidiol in Anxiety and Sleep: A Large Case Series. Perm J. 2019;23:18-041. . Researchers thought higher doses might be too expensive for participants to maintain in their normal lives and that low doses would still prove effective. Indeed, anxiety decreased within the first month for most participants and remained low. Sleep quality also improved, although it fluctuated more than anxiety. Only three patients reported side effects.

CBD for Anxiety and Depression

In 2020, researchers tested the effects of CBD oil at varying doses across 397 patients with a variety of ailments [4] Gulbransen G, Xu W, Arroll B. Cannabidiol prescription in clinical practice: an audit on the first 400 patients in New Zealand. BJGP Open. 2020;4(1):bjgpopen20X101010. . Participants with non-cancer pain or mental health-related symptoms experienced significant improvement in anxiety and depression, as well as in their abilities to complete their usual activities. The use of CBD oil suggested significant pain relief in these groups as well.

CBD for PTSD and Phobia Therapy

A small 2019 study of 11 patients found that, when consumed orally and administered alongside routine psychiatric care, CBD decreased patients’ posttraumatic stress disorder (PTSD) symptom severity [5] Elms L, Shannon S, Hughes S, Lewis N. Cannabidiol in the Treatment of Post-Traumatic Stress Disorder: A Case Series. J Altern Complement Med. 2019;25(4):392-397. .

Other studies suggest CBD can reduce PTSD symptoms when consumed with THC [6] Bitencourt RM, Takahashi RN. Cannabidiol as a Therapeutic Alternative for Post-traumatic Stress Disorder: From Bench Research to Confirmation in Human Trials. Front Neurosci. 2018;12:502. . When taken together, the two compounds create what’s known as the “entourage effect,” where THC enhances the effects of CBD as CBD tempers the effects of THC, resulting in a more well-rounded experience [7] Ferber SG, Namdar D, Hen-Shoval D, et al. The “Entourage Effect”. Terpenes Coupled with Cannabinoids for the Treatment of Mood Disorders and Anxiety Disorders. Curr Neuropharmacol. 2020;18(2):87-96. .

Some studies also suggest CBD can enhance the effects of exposure therapy—which assists patients in dissociating certain cues with a fear response—and cognitive behavioral therapy [8] Das RK, Kamboj SK, Ramadas M, et al. Cannabidiol enhances consolidation of explicit fear extinction in humans. Psychopharmacology (Berl). 2013;226(4):781-792. [9] Blessing EM, Steenkamp MM, Manzanares J, Marmar CR. Cannabidiol as a Potential Treatment for Anxiety Disorders. Neurotherapeutics. 2015;12(4):825-836. .

How to Use CBD for Anxiety

Without clear FDA guidance, optimal CBD use for anxiety varies from person to person. You may find one method works better for you over another. You can consume CBD in the following forms:

  • Oils and tinctures, which come in dropper bottles and are consumed by mouth
  • Gummies, which are chewable, sweet and often fruit-flavored
  • Sprays, which come in bottles with a nozzle to be sprayed in the mouth
  • Capsules, softgels or tablets, which are taken individually by mouth like a pill
  • Vapes, which heat CBD oil without igniting it, resulting in an inhalable vapor
  • Flowers, which are dried hemp plants that are typically ignited and smoked
  • Creams and gels, which introduce CBD topically (through the skin) as a more localized treatment

You may have to try different forms to determine what works best in addressing your anxiety. For instance, when it comes to the absorption of CBD in your bloodstream, vaping and smoking are more effective than edibles like gummies.

CBD Dosage for Anxiety

You also have to find the right CBD dosage for your anxiety. Experts suggest starting small and working your way up depending on how your body reacts.

Many clinical trials jump right to testing high doses. Successful doses evaluated for anxiety relief specifically include:

  • 600 milligrams in patients with SAD in a speech simulation [10] Bergamaschi MM, Queiroz RH, Chagas MH, et al. Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naïve social phobia patients. Neuropsychopharmacology. 2011;36(6):1219-1226.
  • 300 milligrams in male patients in a speech simulation [11] Linares IM, Zuardi AW, Pereira LC, et al. Cannabidiol presents an inverted U-shaped dose-response curve in a simulated public speaking test. Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999). 2019;41(1):9-14.

However, other trials suggest much lower doses are also quite effective in treating anxiety.

  • 25 to 75 milligrams for generalized anxiety and/or sleep problems [12] Shannon S, Lewis N, Lee H, Hughes S. Cannabidiol in Anxiety and Sleep: A Large Case Series. Perm J. 2019;23:18-041.
  • 33 to 49 milligrams a day for PTSD, in addition to routine psychiatric treatment [13] Elms L, Shannon S, Hughes S, Lewis N. Cannabidiol in the Treatment of Post-Traumatic Stress Disorder: A Case Series. J Altern Complement Med. 2019;25(4):392-397.

Another study involving hundreds of patients noted success with doses from 40 milligrams to 300 milligrams a day, further supporting the idea that CBD dosage varies significantly, depending on a person’s symptoms and physiology.

Potential Risks and Side Effects

The World Health Organization deems CBD a safe and generally well-tolerated substance. Studies report very few adverse effects, if any.

However, taking CBD while on other medications may pose a risk, as these substances may interact and cause unwanted effects, such as weight gain, drowsiness, upset stomach and change in appetite.

Cheryl Bugailiskis, M.D., a cannabis specialist at Heally, a telehealth platform for alternative medicine, also warns people with preexisting liver injuries and people taking medications that can cause liver injuries should practice caution when using CBD.

What happened when I took CBD for a week to help with my anxiety

Steven Phan: You gotta lean back. No, tongue back!

Benji Jones: That’s me, trying CBD at a shop in New York City. Lately, I’ve seen this stuff everywhere: At the local health food store, but also at Urban Outfitters, Sephora, and CBD shops like this one. And if you look at some of the branding, it kind of makes sense.

CBD products claim to help with everything from anxiety to insomnia to muscle pain. It almost sounds too good to be true. And maybe it is. To find out, I set up a little experiment. For one week, I took CBD three times a day, while tracking my anxiety with a scorecard. I also chatted with an expert before and after to sort through the results. Here’s what I learned.

CBD is a distant cousin of THC, the psychoactive chemical in marijuana. They both come from the cannabis plant, but CBD isn’t psychoactive. Meaning it doesn’t get you high. Now, of course, getting high isn’t the only reason why cannabis is popular. People also use it to relieve pain, control seizures, and lessen anxiety. But as researchers like Dr. Yasmin Hurd are discovering, it’s likely CBD, not THC, that’s behind these benefits.

Dr. Hurd: “It can activate some serotonin receptors, and the serotonin system is associated with alleviating anxiety.”

Jones: Hurd has been studying the effects of CBD for over 10 years. And she’s found that it can reduce anxiety in people with a history of heroin addiction. Now, fortunately, I don’t have a history of addiction, but I do see a therapist for chronic anxiety. And CBD could still help.

Dr. Hurd: “Both under normal conditions and in people who have anxiety disorders, enough research has started to show that it does have an anti-anxiety effect.”

Jones: So, back at the shop, I tried all kinds of product. From sweets to lotions and sprays. And while Hurd couldn’t recommend a specific dose for me, she did say that 300 milligrams a day should be enough to feel something. Because participants in clinical trials typically take anywhere from 300 to 600 milligrams. So, those chocolates and sprays? They weren’t going to cut it. Instead, I went for something else.

Phan: The tinctures, right? This is where you really get into the higher-strength things.”

Jones: I decided to err on the side of caution and take 250 milligrams each day, broken out into three doses: 50 milligrams in the morning, 100 milligrams at midday, and another 100 milligrams at night. That way, it wouldn’t hit me all at once.

Jones: All right, today is the day! I have my CBD here. I’m kind of nervous. All right, here we go.

Now, mind you, this was a Wednesday. A workday. Side note: The reason I’m taking CBD this way is that there are tons of capillaries under your tongue. So, anything you put there can be absorbed directly into your bloodstream. Whereas when you ingest CBD, like with that chocolate, a lot of it is broken down by your stomach. Which means you probably won’t feel much.

Anyway, several hours later, I took my last dose of the day.

If anything, I just feel extremely tired.

That was the first thing I noticed: that CBD was making me drowsy. Really drowsy. Which Hurd said is a pretty normal side effect at high doses. Though we’re not exactly sure why. But as I discovered the next night, it’s also great for hangovers.

I had some alcohol, and I’m certainly not going to have trouble sleeping. I think I’m going to eat a slice of pizza.

The next morning, I felt…great. And according to Hurd, that’s because CBD also has some anti-inflammatory effects. But what about anxiety, what I was really in this for? Each morning, I filled out the anxiety scorecard that Hurd gave me. It was a rough estimate of my daily emotional state, based on numbered responses to statements like, “I feel at ease.” But day to day, it was harder to figure out whether CBD was helping.

Just walking home on Friday night after three days of CBD, and I’m reporting that I’m mostly just tired and feeling lethargic. Not in a bad way; it kind of feels like I have a warm blanket around me, so I don’t hate it.

But over the weekend, I finally got the relief I was looking for, even more quickly than I had expected.

So, I happened to take CBD right before I had to do something stressful. It’s Sunday, but I had a task that I was not looking forward to. And I took 100 milligrams, and I pretty quickly felt my nerves calming down. And I was like, OMG, this is totally working, which is really great because I’m looking for that quick relief like everyone is.

Now, of course, this could have been a placebo. I mean, all of this could have been placebo. So, a few days later, I tried it again in a similar high-stress situation.

Not going to lie, I actually feel a little bit more calm. It kind of puts me into a dissociative state, where I’m slowing down a little bit. I actually get physical pain in my heart region when I’m anxious, which I know sounds terrible. But just 30 minutes after taking my 100-milligram dose for the evening, I feel an absence of that. I will say that I’ve also been listening to the “Lion King” soundtrack, so there are confounding variables. But yeah, I feel a lot better right now.

At that point, I had just one day left.

All right, I’m about to take my last dose of CBD! I must say, I’m kind of excited to stop having to take this three times a day. I think part of it is scheduling and remembering. But also, yeah, I’ve also just been so much more tired. I don’t feel like my anxiety was just washed away. I felt like there were a few times where it really helped in certain instances. And, overall, kind of lowered the intensity of how I was feeling because I felt lethargic. But yeah, I don’t want to be tired anymore.

Afterward, I looked over my anxiety scorecards. And sure enough, it showed that I was feeling slightly less anxious on my last day, compared to my first. Especially when I looked at statements like this. Yeah, that’s a big one for me. I wanted to run these results by Hurd.

Dr. Hurd: “How do you feel?”

Jones: Um, to be honest, I don’t feel that different. I think that the biggest change that I noticed is…I was just tired all the time. I feel this kind of slo-mo lethargia that makes me feel, like, a little bit disassociated with reality. And I think that is what made me feel a little less anxious at times.

Dr. Hurd: So, perhaps…taking it at night only might be best because it can make you a bit sleepy, and everyone has a different sensitivity. If you take it at night you get past the initial sedative effects… and then you don’t have to worry about taking other things like caffeine to try to stay awake.

Jones: And what about those moments of instant relief? Was that in my head, or could CBD act that fast?

Dr. Hurd: “Yeah, absolutely. It can act that quickly. For us, in our studies, people did — shortly after getting CBD — report reduced anxiety.”

Jones: But if there was one takeaway from our conversations, it was this:

Dr. Yasmin Hurd: Ironically, even though it’s now this huge fad in our society, we still don’t have a very good handle on how it’s working.

Jones: In other words, we don’t know: what size dose you should take, how, exactly, it changes your brain, or how it impacts different people in different ways. That’s because until late 2018, nearly all CBD was classified as an illegal substance. Which made it really difficult for scientists to study. And while research is starting to catch up… in some ways, it’s too late.

Dr. Hurd: It’s one of the first times in history that the public is determining whether something is medicine, not scientists and physicians.

Jones: As for me, will I continue using CBD? Yes — but likely only for those moments when I need instant relief. Because, while it seems to benefit a lot of people … I’m not yet fully convinced. But also because, this bottle? It costs more than $130! And if I’m going to spend that much, I want to be absolutely sure it works.

EDITOR’S NOTE: This video was originally published on August 20, 2019.