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cannabidiol and anti anxiety

8. How can I be sure that what I am reading about CBD (articles, etc.) is providing truthful information?

5. Is there current research in the US for CBD? Are other countries using CBD?

Only for the FDA approved product.

Cannabidiol, or CBD, is a natural compound that has gained popularity in recent years. Here are some frequently asked questions about CBD answered by two mental health professionals who are working in this area:

CBD is cannabidiol. It is one of almost 200 cannabinoids that can be found in marijuana plants. Unlike many other cannabinoids, CBD is not psychoactive and has a different pharmacologic profile than other psychoactive cannabinoids. CBD can be extracted from both marijuana plants and from hemp.

Purified CBD extract (GW Pharmaceuticals) was approved by the FDA in 2018 as a treatment for 2 rare forms of epilepsy – Dravet syndrome and Lennox-Gastaut syndrome – as a Schedule 5 compound. The brand name is Epidiolex.

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CBD stands for cannabidiol. It is the second most prevalent of the active ingredients of cannabis (marijuana). While CBD is an essential component of medical marijuana, it is derived directly from the hemp plant, which is a cousin of the marijuana plant. While CBD is a component of marijuana (one of hundreds), by itself it does not cause a "high." According to a report from the World Health Organization, "In humans, CBD exhibits no effects indicative of any abuse or dependence potential…. To date, there is no evidence of public health related problems associated with the use of pure CBD."

CBD has been touted for a wide variety of health issues, but the strongest scientific evidence is for its effectiveness in treating some of the cruelest childhood epilepsy syndromes, such as Dravet syndrome and Lennox-Gastaut syndrome (LGS), which typically don’t respond to antiseizure medications. In numerous studies, CBD was able to reduce the number of seizures, and, in some cases, it was able to stop them altogether. Videos of the effects of CBD on these children and their seizures are readily available on the Internet for viewing, and they are quite striking. Recently the FDA approved the first ever cannabis-derived medicine for these conditions, Epidiolex, which contains CBD.

The bottom line on cannabidiol

Side effects of CBD include nausea, fatigue and irritability. CBD can increase the level in your blood of the blood thinner coumadin, and it can raise levels of certain other medications in your blood by the exact same mechanism that grapefruit juice does. A significant safety concern with CBD is that it is primarily marketed and sold as a supplement, not a medication. Currently, the FDA does not regulate the safety and purity of dietary supplements. So, you cannot know for sure that the product you buy has active ingredients at the dose listed on the label. In addition, the product may contain other (unknown) elements. We also don’t know the most effective therapeutic dose of CBD for any particular medical condition.

CBD is readily obtainable in most parts of the United States, though its exact legal status is in flux. All 50 states have laws legalizing CBD with varying degrees of restriction, and while the federal government still considers CBD in the same class as marijuana, it doesn’t habitually enforce against it. In December 2015, the FDA eased the regulatory requirements to allow researchers to conduct CBD trials. Currently, many people obtain CBD online without a medical cannabis license. The government’s position on CBD is confusing, and depends in part on whether the CBD comes from hemp or marijuana. The legality of CBD is expected to change, as there is currently bipartisan consensus in Congress to make the hemp crop legal which would, for all intents and purposes, make CBD difficult to prohibit.

CBD may offer an option for treating different types of chronic pain. A study from the European Journal of Pain showed, using an animal model, CBD applied on the skin could help lower pain and inflammation due to arthritis. Another study demonstrated the mechanism by which CBD inhibits inflammatory and neuropathic pain, two of the most difficult types of chronic pain to treat. More study in humans is needed in this area to substantiate the claims of CBD proponents about pain control.

Cannabidiol (CBD) has been recently covered in the media, and you may have even seen it as an add-in booster to your post-workout smoothie or morning coffee. What exactly is CBD? Why is it suddenly so popular?

Merikangas, K. R., He, J. P., Burstein, M., Svendsen, J., Avenevoll, S., Case, B., et al. (2011). Service utilization for lifetime mental disorders in U.S. adolescents: results of the National Comorbidity Survey-Adolescent Supplement (NCS-A). J. Am. Acad. Child Adolesc. Psychiatry 50, 32–45. doi: 10.1016/j.jaac.2010.10.006

SAD is characterized by excessive anxiety in situations where a person might feel judged, such as performance situations, and situations involving interpersonal contact with others (American Psychiatric Association, 2000). This is the fear of social situations that may cause humiliation or embarrassment. While it is one of the common anxiety disorders (Craske et al., 2017), it is a relatively new area of research, and thus, its etiology, effects, and treatment are not clearly understood. Even prevalence rates reported in the literature vary across studies (Antony and Rowa, 2008). For instance, lifetime prevalence estimates for SAD based on large community samples in the United States range from 3 to 13%. In addition, some studies report that SAD has a higher incidence in females than in males (Kessler et al., 2005).

Craske, M. G., Stein, M. B., Eley, T. C., Milad, M. R., Holmes, A., Rapes, R. M., et al. (2017). Anxiety disorders. Nat. Rev. Dis. Prim. 3:17024. doi: 10.1038/nrdp.2017.24

Author Contributions

The participants were invited to attend an assessment interview for possible participation in the present study. None of them were under CBT. Assessment of all of them was undertaken by psychiatrists who were trained in administering the Structured Clinical Interview for DSM-IV (SCID I and II; Liebowitz, 1987; Di Nardo et al., 1994; First et al., 1997). The participants completed the first battery of self-report measures before attending the assessment interview. The baseline period for them was a minimum of 3 weeks showing stable FNE scores (Watson and Friend, 1969; the primary outcome measure). Subsequently, after the assessment interview, they rated themselves on the FNE and LSAS (Liebowitz, 1987) over the succeeding weeks (preintervention). All of the participants had a stable FNE score over the 3 consecutive weeks and were therefore scheduled for intervention within a week after the third-baseline measuring point.

Subsequent analyses of simple main effects (using Bonferroni correction), which were performed because of the significant interactions between MEASUREMENT and PARTICIPANT, revealed that the mean score of the CBD group was lower in the postintervention measurement than in the preintervention measurement (p = 0.02), while no such difference was found in the placebo group (p = 0.29). Scores of the participants in the CBD group were lower than those of the placebo group in the postintervention measurement (p = 0.0002), but the scores were not statistically significantly different from one another in the preintervention measurement (p = 0.71).

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.

Figure 2 presents the results of the measurements with LSAS of the level of the symptoms that are associated with SAD. The results were strikingly similar to those shown in Figure 1. The main effect was statistically significant for MEASUREMENT (F1,35 = 10.35, p = 0.003, η p 2 = 0.023) but not for PARTICIPANT (F1,35 = 0.45, p = 0.57, η p 2 = 0.011). The interaction between these factors was significant (F1,35 = 39.16, p < 0.001, η p 2 = 0.528). The mean LSAS score (SD) of the CBD group was 74.2 (7.5) in the preintervention measurement and 62.1 (8.7) in the postintervention measurement and that of the placebo group was 69.9 (10.3) in the preintervention measurement and 66.8 (11.2) in the postintervention measurement.