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The anxiety-reducing effects of cannabidiol treatment in teenagers with social anxiety disorder

Fear and anxiety are adaptive responses that are essential for our ability to cope with threats to our survival. However, when fear and anxiety become excessive, it can be extremely disabling. One condition where this occurs is general social anxiety disorder, or SAD. SAD is a common anxiety condition which has detrimental impacts on a person’s social life (Bergamaschi, 2011). SAD is characterised by excessive anxiety in social situations, or where a person may feel judged, for example speaking at meetings, or public speaking. SAD has a profound impact on sufferers and this is particularly serious for teenagers who may stop going to school and withdraw from any social communication. People who suffer from anxiety disorders in general may have a diminished sense of wellbeing, may be more likely to experience relationship breakdowns, unemployment and have an elevated suicide risk. There is a huge economic burden associated with anxiety related disorders (Blessing et al., 2015). Although SAD is a common anxiety disorder, there is an absence of good quality research into this debilitating condition, meaning that the cause of SAD and the treatment of the disorder are not fully understood.

The treatment of SAD with currently available medications is problematic with only around 30% of patients showing a recovery without ongoing symptoms (Blanco et al., 2002). The current range of pharmacological medications are limited by adverse side effects. Blessing and colleagues note the high priority to develop novel alternative medications for the benefit of patients and to relieve the substantial burden on society.

Cannabidiol as a treatment option
Cannabidiol, otherwise known as CBD, is a constituent of cannabis. CBD has shown potential in the treatment of chronic pain, nausea, epilepsy and psychosis (Mastaka, 2019). Additionally, CBD has properties that reverse anxiety-like behaviour in humans and animals and as such has been regarded as a potential treatment option for SAD.

SAD is a common anxiety condition which has detrimental impacts on a person’s social life.

Recreational and medicinal users of illegally available cannabis have reported side effects of panic and anxiety. One constituent of cannabis, D9-tetrahydrocannabinol (THC), causes the euphoria and mind-altering effects of cannabis, but detrimentally, THC has been proven to increase anxiety levels in cannabis users. CBD, which acts very differently on the body to THC, does not have the psychoactive effects of THC, and in contrast CBD has been proven to induce an anti-anxiety effect and works to reduce anxiety.

In relation to SAD, the benefits of CBD over alternative medications is that CBD is fast acting and does not have the side effects associated with medications traditionally used to treat SAD. Bergamaschi and colleagues report that up to 1500 of CBD mg/day is well tolerated by patients with no reports of slowed responses, poor mood, nor any detrimental impacts on the heart and breathing rates. One of the current medication options for SAD might be benzodiazepines. Unlike treatment with CBD, benzodiazepines may impair function, cause dependence and withdrawal symptoms (Bergamaschi, 2011).

People who suffer from anxiety disorders in general may have a diminished sense of wellbeing, may be more likely to experience relationship breakdowns, unemployment and have an elevated suicide risk.

Existing evidence supporting cannabidiol
Blessing and colleagues published a paper in 2015 that reviewed the existing evidence for the use of CBD to treat anxiety-related disorders. It appraised the evidence from a broad range of studies to include preclinical evidence, human experimental studies and epidemiological studies (Blessing, et al.). The findings indicated that animal studies support the use of CBD to treat anxiety related disorders. The team also found that human studies are supportive of the anti-anxiety effects of CBD, but there was a need for further research in this area to support the use of CBD as a treatment option for specific anxiety related conditions, and also to investigate which are the optimum levels of dosing.

The results present the first clinical evidence of the positive effects of CBD on teenagers suffering with SAD.

A small trial investigating the effects of CBD on participants with SAD who were public speaking (which induces similar anxiety effects to SAD), found that those people who were treated with CBD had reduced anxiety and improved comfort when they were speaking (Bergamaschi et al). The authors recognised the need for a large trial to further test the effects of CBD on anxiety.

SAD is characterised by excessive anxiety in social situations, or where a person may feel judged, for example speaking at meetings, or public speaking.

Cannabidiol to treat SAD: new findings
Professor Masataka and colleagues have recently published their exciting clinical trial investigating the effects of CBD on teenagers experiencing SAD in Frontiers in Psychology. This trial shows promising results concerning the treatment of SAD with CBD. Masataka and colleagues recruited 37 Japanese teenagers with SAD who were randomly allocated to receive treatment with either CBD, or a placebo for four weeks treatment. The placebo treatment contained olive oil and the CBD treatment contained 300mg of CBD oil. The treatment was administered by a clinical psychologist, unaware of the teenagers’ treatment allocation, at the participants’ home. Anxiety was measured before and after treatment using the Fear of Negative Evaluation Questionnaire and the Liebowitz Social Anxiety Scale. The teenage participants were followed up for 6 months after their treatment for brief health checks. In this trial neither the researchers nor the teenage participants were aware whether they had received the placebo treatment or treatment with CBD.

Fig 1. Scores of Fear of Negative Evaluation Questionnaire (FNE) in the participants who received CBD and in the participants who received placebo. The participants were evaluated before and after treatment. Error bars represent SDs. * indicates significant difference from pretreatment measurement. Fig 2. Scores of Liebowitz Social Anxiety Scale (LSAS) in the participants who received CBD and in the participants who received placebo. The participants were evaluated before and after treatment. Error bars represent SDs. * indicates significant difference from pretreatment measurement.

Masataka and colleagues’ trial revealed exciting findings. The results present the first clinical evidence of the positive effects of CBD on teenagers suffering with SAD. The teenagers who received the treatment with CBD had reduced anxiety when compared with the teenagers who received the placebo treatment. Although this study did not plan to specifically record any side effects of treatment, none of the teenagers who participated had any significant health complaints following the trial. An additional finding of interest was that 53% of the teenagers who received treatment with CBD oil went on to take the decision to receive treatment (medication and Cognitive Behavioural Therapy) from a hospital whilst none of the teenagers in the placebo group sought any additional treatment. This finding means that the patients who received CBD felt the capacity to overcome their anxieties concerning the stigma of their condition and engaging with therapists, to access existing treatments. The fact that teenagers suffering with SAD who were treated with CBD were making positive steps towards ongoing treatment is a very encouraging sign and is worthy of note.

Going Forward
Masataka and colleagues note that in children and adults, SAD has been shown to be one of the most common psychiatric disorders. Symptoms may begin as early as five years old and peak at the age of twelve. Left untreated the disorder can continue into adolescence and then into adulthood. In Japan it has been reported that there are a million teenagers with SAD who may withdraw into their living spaces for up to six months at a time. Professor Masataka is highly encouraged by the results of his trial of CBD in teenagers with SAD. Indeed, he is hopeful that the results of his present study will contribute to the development of sound scientific evidence and the development of further human clinical trials to advance the scientifically proper use of CBD in patients who are experiencing SAD. Professor Masataka recommends a further clinical trial of robust design, which compares treatment of SAD with CBD and the most commonly used pharmacological treatment option. A well-designed trial of this nature could provide the sound scientific evidence base to further support the safe and effective use of CBD in the treatment of SAD. The potential benefits of treatment with CBD for SAD are evident. Robust clinical trials are clearly needed to identify a definitive scientific evidence base to support treatment of SAD with CBD. In addition, there is a need to identify the most appropriate dosages of CBD in the treatment of this most debilitating of conditions, affecting many people worldwide.

Personal Response

Social anxiety disorder (SAD) is becoming increasingly common. How do you envisage the research into the use of cannabidiol developing and do you foresee that cannabidiol will become an acceptable treatment option for people who experience SAD?

research into the treatment of the debilitating condition of social anxiety disorder with cannabidiol.

I Took CBD Oil Every Day for My Anxiety—Here’s What Went Down

When I first learned about CBD oil, I’ll admit I was a bit skeptical. My mind immediately turned to weed and the unnerving experiences I’d had with heightened anxiety in college. For me, a person who’s already predisposed to overthinking, marijuana, no matter what the form, would typically put my mind into overdrive and result in a common yet dreaded side effect: Paranoia. But, let’s back up a bit. What even is CBD?

What Is CBD?

CBD is short for cannabidiol, which comes from the Cannabid sativa plant (also known as marijuana). It’s a naturally occurring substance used in oils and edibles to help calm and relax.

What is CBD

A bit of online digging led me to realize that the active ingredient in Charlotte’s Web Everyday Plus Hemp Oil, the product I’d been offered to test, was the chemical compound CBD, which stands for cannabidiol. Unlike THC, the other crucial compound in hemp and marijuana plants, CBD (when derived from the hemp plant) does not produce the psychoactive effects that make you feel “high”; instead, emerging science has hinted that CBD may actually ease anxiety, and therefore, makes you less likely to freak out.  

For example, one study comparing the effects of THC and CBD found that, while THC increased anxiety by activating the neurotransmitters involved in the “fight or flight” response, CBD actually repressed autonomic arousal—or the nervous system response associated with sudden increases in heart rate or respiration.   In other words, CBD may be ideal for people looking to relax and unwind.

While the science behind CBD’s effectiveness for treating anxiety, pain, and insomnia is still in its infancy,   Charlotte Figi’s inspiring story sounds promising. Figi, a 6-year-old girl diagnosed with a rare and resistant form of epilepsy known as Dravet syndrome, was placed on hospice care and given a “do not resuscitate” order when her parents, desperate and frustrated with pharmaceutical medication, considered medical marijuana; specifically, a strain low in THC and high in CBD. Charlotte is now nearly seizure-free since she began supplementing with Charlotte Web’s CBD oil, which the brand named after Figi.

Legal and Safety Things To Know About CBD

The current CBD industry is like the internet’s early years. the Wild West. Legally, speaking, a Harvard Medical School blog post reads, “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.”   With heightened interest around CBD, it’s important to note that because CBD is currently unregulated, it’s difficult to know what you’re getting (whether that’s a tincture—commonly referred to as CBD oil, which is often combined with a carrier oil like coconut oil—topical products like creams and balms, sprays, or capsules), despite product labels and brand promises, the blog post further reads. It’s also important to note that people experience CBD differently. For the most part, the National Institute of Medicine says that while most people can tolerate CBD, side effects do exist. They might include dry mouth, drowsiness, and reduced appetite, among others.  

That said, those interested in exploring the potential benefits of CBD should consult with their doctor (especially if you are pregnant, nursing, or currently taking medication) and be mindful of your dosage, writes Consumer Reports. And before you buy, Megan Villa, co-founder of the hemp-focused website and shop Svn Space, told Shape magazine to seek out a certificate of analysis. “Ask for a COA for the batch number of the product you have, since these products are made in batches,” she said. “You need to match the batch number to the COA that pertains to it.” Then, scan the report for potency (i.e. does the number of milligrams of CBD that the product label touts match the lab report?), contaminants and pesticides, and mold (which should live under the “Microbiological Testing” part of the report). Go a step further and note whether the testing lab is GMP (Good Manufacturing Principles) certified, and whether the lab is registered with the Food and Drug Administration (FDA). Shape magazine also suggests purchasing CBD products made from domestically-grown hemp, and reading up on the difference between full- and broad-spectrum and CBD isolate.

With that, I threw caution to the wind and asked for a sample. Here’s what happened—including what it feels like—when I took one full dropper of Charlotte’s Web’s Everyday Plus Hemp Oil in the mint chocolate flavor every morning for seven days.

My First Impression

It was actually a bad bout of jet lag after a trip to California that inspired me to finally test out the CBD oil (I’ll admit that my weed-based reservations kept me from trying it for the first few months). Knowing that the oil had also helped people with sleep issues, I squeezed one full dropper of the Everyday Plus oil onto my tongue, per the instructions, and waited.

Thirty minutes later, I was surprised by how subtle the effect was. While I expected a hazy nodding-off effect similar to melatonin’s, the oil simply relaxed my body ever so slightly—my heart stopped pounding against my chest, my legs stopped kicking beneath my sheets, my mind stopped racing. I wasn’t sure if it was the oil or the late hour, but eventually, physical relaxation gave way to mental relaxation, and I drifted off to sleep.

Reflecting the next morning, I was most surprised by the fact that I never felt “high” in any way—there was never a moment of It’s kicking in; I can feel it now like with pain medications or even anti-anxiety drugs. Considering it takes time, consistency, and the right dosage to experience the full effect, I continued taking the oil once a day for the next six days. Here’s what went down.

It Made Me Less Anxious and Edgy

Rather than overthinking a sternly worded email or analyzing a social interaction, I found it easier to recognize the irrationality of these thoughts and actually let them go.

While normally I’d be slightly tripped up by little things like an overly crowded subway car or a full inbox at work, the CBD oil seems to have taken the edge off of my anxiety a bit. Rather than overthinking a sternly worded email or analyzing a social interaction, I found it easier to recognize the irrationality of these thoughts and actually let them go. In some ways, I feel more like myself. With that said, I’ve still experienced some social anxiety when meeting new groups of people—I’d be interested to see what taking the full recommended dose would do.

I’m More Focused At Work

I work well under pressure, but being extremely busy at work has almost made me less productive—I’m constantly distracted by email, Slack, and the people around me, to the point where getting my work done becomes difficult. This week, however, I’ve found it easier to put my blinders on, block out all distractions (especially social distractions), and focus on one task at a time. I think this is partly related to the lessened anxiety—I feel more frazzled and off task when my anxiety is running high. It almost feels like a newfound sense of clarity and calm that enables me to focus.

I’m Falling Asleep Faster

I assume this is also a side effect of feeling less anxious, but I seem to fall asleep faster; within the 20-30-minute range rather than my normal 45 minutes to one hour (or longer). Not only do I seem to be skipping or at least shortening the whole tossing-and-turning phase of my sleep cycle, but I’m able to snap out of the overthinking that often keeps me up at night. Of course, there’s no telling whether a big life event would disrupt this newfound bliss, but I’d like to think it’s helped on a day-to-day basis.

The Verdict

Would I say that CBD oil has fundamentally changed my life? No. But per the Charlotte’s Web website, this is the typical first experience. “Anyone who has ever started a new vitamin or supplement routine knows the short answer to how long it takes to kick in is—’it depends.’ For many newcomers, they’re not sure what to imagine, or some anticipate a huge change right away. For most of us, though, dietary supplements take time.”

With that said, I’m definitely intrigued enough by the subtle effects to continue taking the oil and to possibly up the dosage to the recommended two full droppers of the 30mL bottle per day. Plus, I take comfort in knowing that it’s an all-natural product that’s responsibly grown on family farms in Colorado. Something that’s safe, legal, requires no prescription, and makes me less anxious, less scatterbrained, and more focused? I’m definitely on board.

Explore the World of CBD

Go deep on the subject of CBD with this book that includes case studies, interviews with doctors, an overview of the latest cannabis research, and how scientists are exploring cannabis for various medical uses. There is also an explainer about the difference between CBD products made from industrial hemp versus in a lab, and products made from the whole marijuana plant.

Charlotte’s Web inaugural CBD oil product comes in two flavors; Olive Oil and Mint Chocolate. It’s also its most potent. According to its website, its Original Formula Hemp Extract Oil comes with “the most hemp extract and cannabidiol (CBD) content per serving.”

Gretchen Lidicker puts a lifestyle spin on the world of CBD as the author draws on the “knowledge of leaders in the health and wellness world” to explain why CBD has become a top beauty and wellness trend for top athletes and celebrities. The book also includes recipes and recommendations for how to choose a top-quality CBD product.

This travel-friendly roll-on is packed with CBD and fragrant essential oils, including lavender, bergamot, and chamomile, for an easy de-stress quick fix. The result? “That elusive feeling of wakeful calm,” reads the Sagely Naturals website.

With this book, CBD is explained from A to Z and breaks down the good, bad, and ugly of a fledgling industry that is poised for rapid growth. CBD: 101 Things You Need to Know About CBD Oil covers what it is, why people take it, who it’s for (and who it isn’t for), its myriad forms, and more.

Charlotte’s Web’s body cream combines aloe, coconut oil, and shea butter with 300 mg of CBD per ounce. It’s also available in an unscented version, and both are made with GMO-free and sustainably grown ingredients.

Sagely Naturals’s Relief and Recovery Capsules includes 10 mg of CBD per capsule, with the addition of turmeric and vitamin E.

Charlotte’s Web’s Extra Strength Capsules feature 18 mg of CBD per capsule. The website offers capsules as a convenient and precise way to take CBD—on the go, stash them in your gym bag, pocket, etc.

One editor explains how she took CBD oil every day for a week to help her anxiety, plus the difference between CBD and weed. ]]>