Anxiety is a state of unease, a sense of restlessness. For someone with clinical anxiety, they can be fearful in normal non threatening situations daily. The chronic fearfulness can interfere with day to day life and lead to sleep disruptions and chronic disease.
Current approach to anxiety
The current armamentarium of a physician includes prescribing anti-anxiety agents, referring to a therapist, recommending relaxation techniques such as yoga, Tai Chi or meditation, or any physician’s all-time fallback choice which is to refer to a psychiatrist. Many medications take weeks to take effect and after all that, not all of them are effective requiring several trials of medications to get to one that may even partially work. A therapist is beneficial, however, cons include the patient not having enough time or resources. In some patients it may help in others, similar to medications, it does diddly squat. In addition, some patients must cope with anxiety through natural means due to the prohibitive nature of their occupation. Some highly sensitive occupations disallow any use of anti-anxiety agents which might be potentially sedating in a patient’s history which could cost them their jobs. Medications may be helpful in certain populations but it often takes time to find the right agent and the right dose.
The science and mechanisms behind anxiety
The mechanism of anxiety and its complexities are studied. At the chemical level, it is thought to be due to the lack of serotonin. Many anti-anxiety agents work at the level of the serotonin receptor. But the thought processes underlying anxiety are far more complex than at a single chemical level which likely is the reason why many medications do not work given the complexity of the emotional response.
Neuroimaging studies have elucidated that anxiety may be attributed to the involvement of an amygdala to prefrontal cortex circuit. Instead of the normal fear response one has to certain stimuli, the amygdala is overly responsive to the threat. This leads to an abnormal attentional and interpretive response level that is consistently fearful. Anxious patients perceive neutral events with negative connotations and lead to physiologic responses including increased heart rate, sweating, heavier breathing.
Cannabidiol is the non-intoxicating phytocannabinoid from the Cannabis sativa plant. It has a weak affinity for the CB1 receptor and one needs 100 times the amount to get the same euphoria as tetrahydrocannabinol. Cannabidiol is found to help with anxiety. It works at the level of the 5HT-1 receptor to exert its anxiolytic properties.
In one study of 24 patients with anxiety who were about to give a presentation, cannabidiol was given at 600mg. Their anxiety, cognitive impairment, and alert arousal response were much lower compared to the control group who had a placebo. The placebo group had much higher anxiety, greater discomfort, and alert responses (Bergamaschi, et al, “Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naive social phobia patients,” Neuropsychopharmacology, 2011, May, 36 (6): 1219-26).
Another study showed 400 mg CBD given to adults (Crippa, Neural basis of anxiolytic effects of CBD in social anxiety. J Psychopharm 2011)
In a pediatric case series report which can be read here -https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5101100/ – even 25mg a couple hours before bed helped sleep.