RUNNING HEAD: CBD AS TREATMENT FOR ANXIETY DISORDER
CBD as a Possible Alternative as a Treatment for Anxiety
Ethan Gail
English 101 – Professor Jones
UNR
Abstract
This paper examines the possible psychological benefits that Cannabidiol has to offer and how they can be administered medically, as well as the science that supports the claims. This paper explores the benefits of using CBD in contrast to traditional prescription medicines and how they can possibly compare, if not outweigh, the positive effects that go along with the daily dosage. This paper will provide possible evidence as to why CBD should be more commonly used medicinally to treat anxiety, and how it is applied to modern medicine. This paper describes the experimentation used in trying to prove the psychological benefits involved with CBD using controlled experiments involving patients with clinically diagnosed anxiety and how it affects them in terms of their anxiety levels, within the experiment.
Keywords: Cannabidiol, anxiety, medicine, prescription drugs
CBD as Treatment for Anxiety Disorder
Anxiety is something experienced by many individuals. For those experiencing the influences of chronic anxiety, its effects can feel devastating, debilitating, and often hopeless. When anxiety become unmanageable, extreme measures may be necessary for its effective management. Those seeking efficacious treatment of anxiety, should be aware that alternative treatments other than traditional treatment methodologies such as psychotherapy and antipsychotic prescription treatments are available. Many of these treatments are showing great promise in the long-term and effective treatment of anxiety.
Anxiety can be defined as a disorder characterized by feelings of excessive agitation, trepidation, and concern, often accompanied by compulsiveness and obsessive doubt. A sustainable alternative and modern approach to the treatment of such persistent feelings, is Cannabidiol. Cannabidiol (CBD) is a viable alternative for those individuals diagnosed with clinical anxiety. Research is showing even higher effectiveness for those that have had negative effects even with the use of prescription medicine. As prescription pills are the conventional method for treatment, alternatives can arise as a dominant method of treatment, although it may not be originated with such treatment methods.
Cannabidiol (CBD) is a constituent of the Cannabis genus of flowering plants, with no psychoactive effects, contrary to THC. Clinical studies have shown overwhelming evidence that CBD is a possessor of a wide variety of therapeutic properties, including neuroprotective, antipsychotic, antiemetic, etc. properties. It has been suggested that the endocannabinoid system is possibly involved in fighting depression. (Hill and Gorzalka, 2005). “This is supported by several pieces of evidence showing that endocannabinoids and CB1 receptors are widely distributed in brain areas that are often related to affective disorders and that their expression is regulated by antianxiety drugs.” (Devane, 1998; Hill MN, Carrier EJ, McLaughlin RJ, Morrish AC, Meier SE, Hillard CJ et al. (2008). A thorough review of the effects due to CBD across a wide dosage range found that it was highly tolerated by humans. Subjects were able to take up to 1500 mg/day (orally), with no documented or reported vital abnormalities, psychomotor hinder, or negative mood effects.
Anxiety and fear are adaptive responses essential to coping with hazards to survival. Yet exorbitant or constant fear may be maladjusted, leading to aliment. Symptoms arising from excessive fear and anxiety occur in a number of neuropsychiatric disorders, including generalized anxiety disorder (GAD), social anxiety disorder (SAD), post-traumatic stress disorder (PTSD), and obsessive–compulsive disorder (OCD), panic disorder (PD). It should be noted that as of the most recent update made to the Diagnostic Statistical Manual (DSM-V), PTSD and OCD are no longer classified as anxiety disorders; although, extreme anxiety is fundamental to the symptomatology of both PTSD and OCD. “These anxiety-related disorders are associated with a diminished sense of well-being, elevated rates of unemployment and relationship breakdown, and elevated suicide risk.” (Blessing, Steenkamp, & Manzanares; 2015) Anxiety is a crippling mental illness that not only destroys someone’s mental health and overall sense of well-being, but notably also their physical relationships and obligations, such as remaining employed, maintaining healthy relationships, and fulfilling responsibilities. More often than not, anxiety, especially when untreated, can contribute to and/or coexist with depression. This often escalates with detrimentally negative effects, and in extreme cases can lead to suicidal ideation and even suicide. People who have these illnesses need a proper treatment to reverse the effects and help them get past what they are dealing with.
One of the top prescription medicines that doctors will give their patients in treatment for anxiety is Alprazolam (Xanax), which could be used as a counterargument, claiming that prescription medicines have better results, which would explain why they are the leading remedy as to curing, or at least helping, anxiety. Reports of conflicting effects due to this commonly prescribed antidepressant included an increase of feelings of suicide (Blessing et al, 2015), self-harm, increase in panic attacks, violence toward others (Gupta, S., Gersing, K. R., Erkanli, A., & Burt, T. (2016), and in some reports even dilusions and hallucinations mimicking the symptomology of schizophrenia (Levin R, Almeida V, Peres FF, Calzavara MB, da Silva ND, Suiama MA et al. (2012). During a 2003 experiment by the FDA and “Black Box”, in which the long-term effects of antidepressant/anxiety medication on individuals under 18 were tested and analyzed, these claims were further validated. These results were astoundingly negative, and the black box warning, based on an analysis of various placebo-controlled experiments, concluded that suicidal thoughts were twice as likely while taking the prescription medicine when compared to a placebo, about 4% contrast to 2%, respectively. There were no actual completed suicides involved in the study.
Due to these findings, significant concerns pertaining to the effectiveness and ethical implications of long-term use of anti-depressants and anti-anxiety medications are rapidly arising in the medical community. “Current evidence indicates CBD has considerable potential as a treatment for multiple anxiety disorders” (Blessing et al, 2015). The psychological mechanisms involved in cognitive conditioning include a type of learning in which discrete intrinsic and extrinsic cues are observed and applied to predict occurrences of threatening or rewarding stimuli, and CBD plays a role in the regulation of these different responses of fear, drug memory processes, and emotional rumination (Lee, J. L. C., Bertoglio, L. J., Guimarães, F. S., & Stevenson, C. W. (2017). “Two primary brain systems organize defensive responses to threatening stimuli: one responsive to innate threats and the other responsible for the association between neutral and aversive stimuli, although the neural circuit mechanisms underlying the regulation of anxiety and learned fear show considerable overlap.” (Lee et al, 2017)
In this study, the subject is applied to an ‘innocuous unconditioned stimulus’ (UC), a small cue such as a sound or color variation. Upon further inspection of the UC, the subconscious reaction to this can lead to elicit fear, or drug seeking responses causing withdrawals and are a major trigger of anxiety. The continuous retrieval of the CS can destabilize the memory trace, allowing these memories to be updated through consolidation, thus reimagining the memory pathways and eventually the memories themselves, and forgetting the trigger to the anxiety. CBD administered to subjects has been shown to drastically reduce the activity of fear memory in acute doses, even as small as 5-10 mg per day as a consistent dosage for as little as 90 days. CBD has also been shown to inhibit the expression of fear in later memory retrieval testing. In one observed study, daily ingestion of CBD for 14 days prior to fear memory retrieval, suggested that chronic CBD dosage aggravated fear-based learning, which was in contrast to another study that showed no direct effects of CBD on fear conditioning when administered for 21 days. The definitive proof based on substantial evidence-based research validates that CBD has several positive effects on the management of anxiety and effective treatment is irrefutable and the potential for the treatment of mental health disorders in yet to be discovered.
Cannabidiol (CBD) is one such drug that shows therapeutic potential for “a broad range of neurological and psychiatric diseases”. Effects of CBD in test of anxiety are directly linked to receptors and regions in the brain. The midbrain dorsal periaqueductal gray (DPAG) is essential to causing the feeling of anxiety. This DPAG, when stimulated, causes feelings of distress and dread, and injections of CBD directly into the DPAG blocked and inhibited negative responses to anxiety. CBD dosage has a bell-shaped curve, with higher doses being rendered ineffective, in contrast to predetermined optimal and medium level doses (Campos AC, Moreira FA, Gomes FV, Del Bel EA, Guimarães FS, 2012). In another study, 16 participants were given a single, 600 mg dose of CBD, and 16 were given a placebo. These 32 participants were studied using a longitudinal study and were required to have been clinically diagnosed with generalized anxiety disorder. To evaluate the effects of paranoid and anxious thinking, a 3-D virtual reality (VR) was used, which recreated a social experiment of being present on a London Underground train, which for a person with GAD would be a certain trigger. Around 40% of the general population (GP) “endorse persecutory items on the State Social Paranoia Scale (SSPS), a scale developed specifically for the VR environment” (Freeman et al., 2005b). The hypothesis of the test was that subjects who were administered a 600 mg dose of CBD given a 130-minute gap prior to the VR would have decreased anxiety and paranoid thinking. The conclusion of this experiment proved prevalent. The subjects that were administered the CBD had variously less amounts of anxiety and paranoia levels. As read by the SSPS results, anxiety and paranoia thought were slightly lower than the placebo subjects (Hundal, H., Lister, R., Evans, N., Antley, A., Englund, A., Murray, R. M., Morrison, P. D, 2018). This substantiates that CBD could be an effective treatment for social anxiety, claustrophobia, and other OCD-inclusive anxiety disorders.
Further evidence, such as the findings of a study done in 1993 by Zuardi, Cosme, & Graeff, reports that public speaking anxiety was significantly less with 300 mg of CBD applied to subjects versus a placebo. In this study there were 10 subjects that were given the CBD and 10 that were given the placebo. An important consideration to be noted regarding the results of this study, is that the CBD compared to the placebo had little to no effect on performance or anticipatory anxiety. This must be noted because these are the most prominent types of anxiety involved in the experiment. (Zuardi et al., 1993). n a subsequent study, involving the same researches (Zuardi et al, 2017) initiated people who met various criterions for anxiety disorders, specifically social. The participants that were administered the 600 mg dose of CBD prior to speaking publicly, reported less feelings of anxiety, which was measured by the “Visual Analogue Mood Scale (VAMS)” (Bergamaschi, MM, Queiroz, RH, Chagas, MH. 2011). The subjects also recorded that they felt significantly less feelings of negative self-evaluation of their performance and comfort.
In conclusion, CBD has shown to be a very prominent alternative to traditional anti-anxiety medicine. Upon analyzing various results testing these claims, it is shown time and time again that these allegations never cease to prove themselves. The overwhelming evidence that supports these claims is irrefutable, as seen in the evidence supported above as well as the various tests administered. On top of the psychological benefits that coincide with Cannabidiol, there are countless benefits that go along with the treatment. Due to the non-regulation of Cannabidiol, this could be an over the counter alternative available to anyone seeking help dealing with the crippling mental illness know as anxiety. CBD could possibly replace traditional medicines such as Xanax in the following years to come as Cannabis becomes legal in all forms and further research is done.
References
Blessing, E., Steenkamp, M., Manzanares, J. Neurotherapeutics (2015) 12: 825. https://doi-org.unr.idm.oclc.org/10.1007/s13311-015-0387-1
Campos AC, Moreira FA, Gomes FV, Del Bel EA, Guimarães FS (2012b). Multiple mechanisms involved in the large‐spectrum therapeutic potential of cannabidiol in psychiatric disorders. Philos Trans R Soc Lond B Biol Sci 367: 3364–3378.
Lee, J. L. C., Bertoglio, L. J., Guimarães, F. S., & Stevenson, C. W. (2017). Cannabidiol regulation of emotion and emotional memory processing: Relevance for treating anxiety‐related and substance abuse disorders. British Journal of Pharmacology, 174(19), 3242-3256. doi:10.1111/bph.13724
Levin R, Almeida V, Peres FF, Calzavara MB, da Silva ND, Suiama MA et al. (2012). Antipsychotic profile of cannabidiol and rimonabant in an animal model of emotional context processing in schizophrenia. Curr Pharm Des 18: 4960–4965.
Gupta, S., Gersing, K. R., Erkanli, A., & Burt, T. (2016). Antidepressant regulatory warnings, prescription patterns, suicidality and other aggressive behaviors in major depressive disorder and anxiety disorders. Psychiatric Quarterly, 87(2), 329-342. doi:10.1007/s11126-015-9389-8
Hill MN, Carrier EJ, McLaughlin RJ, Morrish AC, Meier SE, Hillard CJ et al. (2008). Regional alterations in the endocannabinoid system in an animal model of depression: effects of concurrent antidepressant treatment. J Neurochem 106 (6): 2322–2336.
Hill MN, Gorzalka BB (2005). Is there a role for the endocannabinoid system in the etiology and treatment of melancholic depression? Behav Pharmacol 16 (5–6): 333–352.
Hundal, H., Lister, R., Evans, N., Antley, A., Englund, A., Murray, R. M., Morrison, P. D. (2018). The effects of cannabidiol on persecutory ideation and anxiety in a high trait paranoid group. Journal of Psychopharmacology, 32(3), 276-282. doi:10.1177/0269881117737400
Zuardi, AW, Cosme, RA, Graeff, FG. (1993) Effects of ipsapirone and cannabidiol on human experimental anxiety. J Psychopharmacol 7: 82–88.
Bergamaschi, MM, Queiroz, RH, Chagas, MH. (2011) Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naive social phobia patients. Neuropsychopharmacology 36: 1219–1226.