Let's Talk About CBD for Anxiety & Depression
There's a lot of buzz about the calming powers of CBD. We went to the experts and dug into the research. Here are the facts.
In the world of herbal remedies CBD, short for cannabidiol, is like the second coming among enthusiasts. Praised for its healing prowess—for everything from pain and insomnia to gastrointestinal issues and inflammation—the cannabis-born compound is fast developing cult-like status. Not only are physical health benefits reported, but more and more people are turning to CBD to help with mental health conditions—particularly anxiety and depression. And the research is promising. A review in Frontiers in Immunology found that CBD creates a calm in the brain that’s visible on scans—doctors can actually see the angst dissipate. There’s still a lot to learn about CBD’s impact on mood, but we’ve got all the intel to help you weed through the field.
Our Pro Panel
We went to some of the nation's top experts in CBD to bring you the most up-to-date information possible.
Junella Chin, M.D.
Chief Medical Officer at Yesterday Wellness and Integrative Medical Cannabis Physician; co-author of Cannabis and CBD for Health and Wellness; Board Member of American Academy of Cannabinoid Medicine
New York City
Matthew Mintz, M.D.
Author of Medical Cannabis and CBD: A Physician's Guide for Patients; Internal Medicine and Primary Care Doctor
April Hatch, R.N.
Member of the American Cannabis Nurses Association; co-founder of Cannabis Care Team
Kansas City, MO
Experts believe careful CBD dosing may help temper the anxiety-induced racing thoughts that can cause disrupted sleep as well as panicked awakenings during the night. While CBD may not help someone with depression directly, it may benefit in other ways that can improve their mood or their ability to manage the condition overall. For example, sleep disruption and depression are closely linked. More than 90% of depressed patients complain about difficulties falling asleep, sleep disruption, or early morning awakenings. CBD can also be used to treat parasomnias, sleep disorders like jaw grinding, sleepwalking, or nightmares, and it cuts the time it takes to fall asleep.
This is one of the great mysteries; the optimal CBD dose is not an exact science. Doctors say there isn’t one universal dosage of CBD because different people (and different animals, for that matter) respond to different dosages of CBD. What experts also agree on, however, is that CBD works best when taken on a regular basis (daily). And the best way to know what works for you is to start on a low dose and titrate up if needed. It may not take as long as for someone with mild symptoms to feel the effects as someone who is dealing with more severe anxiety or depression. The goal is to find the lowest, most effective dose, so work with your doctor and give yourself time to figure it out.
Generally, it takes about 20 minutes for CBD to make its way to the bloodstream (though every person will react a little differently due to their individual biology, metabolism, and DNA, natch).
Experts believe the most effective form of CBD is an oil or tincture (alcohol-based solution) used sublingually (placed under the tongue). A sublingual preparation ensures the cannabinoids get distributed throughout the body. For patients who are feeling all kinds of jittery and need more immediate relief, some experts recommend vaping CBD through a dry-herb vaporizer, which heats up dried CBD flowers. These are relatively safe because they avoid the by-products produced from burning plant material and can be set to a desired temperature that allows you to get the most benefit from CBD you are consuming.
What Is CBD Again?
Maybe you’re already an expert on CBD, so feel free to skip to the section below; if you need a crash course, follow right along. CBD is one of two primary chemical entities (cannabinoids) found in the cannabis plant (the other one is tetrahydrocannabinol, THC). Unlike THC, which is what causes you to get high, CBD has no psychoactive effects (one reason why so many people are trying it). CBD derived from hemp differs from marijuana by its THC content. Hemp has less than the legal limit of 0.3% THC, while marijuana contains more than 0.3% THC.
To complicate matters, CBD is only FDA-approved for use in one medication, Epidiolex, which is used to treats the seizures associated with two rare forms of epilepsy. Because it’s largely unregulated, navigating the world of CBD can feel like a long, strange trip. And since you can’t be sure exactly what you’re getting, word to the wise: Consume with caution and always consult with your doctor.
How Does CBD Impact the Brain?
Understanding how CBD affects the brain starts with a lesson about the endocannabinoid system (ECS), basically the biggest system in the body that you’ve never heard of. It controls just about every internal function we have. Movement, pain sensation, immune responses, temperature, mental functioning like perception, mood, and memory—you name it.
The ECS is like Big Brother, constantly keeping an eye on things so when something’s not working right, it can take action. For example, let’s say your body generates a whole lot of heat after a workout. In this case, endocannabinoids bind to receptors, which then alert the ECS that it’s time to get your body to cool down by producing sweat.
Now, here’s how CBD comes into play. When you take CBD, you’re basically supporting the work the ECS is already doing to help your body function on the regular. Researchers believe CBD works to alleviate symptoms of anxiety and depression by binding to one of the main receptors within the ECS, the CB1 receptor.
Found mostly in the brain, the CB1 receptor is thought to tame central nervous system inflammation and help modulate the effects of serotonin, a neurotransmitter that oversees mood. In fact, the way many antidepressants work is by increasing serotonin in the brain.
Additionally, anxiety and stress inhibit GABA, a naturally occurring brain chemical that directs neurons to slow down or stop firing. This neurotransmitter essentially tells the body to chill out by helping to induce sleep, relax muscles, and create a sense of calm. Some scientists believe CBD can help modulate GABA so the body returns to its regularly scheduled programming.
How Effective Is CBD for Anxiety & Depression?
While there’s a solid amount of scientific research that shows CBD can be effective for anxiety in animals, as well as anecdotal evidence and case reports that show it may be beneficial for alleviating anxiety in humans, there is less data on the effectiveness of CBD for depression, though there have been some promising animal studies. For example, a 2018 study on rats published in NeuroscienceNews showed that just a single dose of CBD helped to reduce symptoms of depression for up to one week. Researchers believe CBD helps repair neural circuitry in the prefrontal cortex and hippocampus, which get damaged as a result of depression.
Also keep in mind, anxiety and depression have a complicated relationship. Both are conditions related to poor sleep, pain, and mood regulation. When we experience more anxiety, we experience more pain, and when we are feeling more depressed, we feel more anxious. It’s a chicken/ egg-like scenario. Here’s where CBD may fit in:
CBD is thought to positively influence the processes that regulate our mood, sleep, and pain perception, among others. These processes need to function properly, so we feel better, sleep more soundly, and experience less pain. Anxiety and depression are conditions related to poor sleep, pain, and poor mood regulation because the endocannabinoid system isn’t working to the best of its ability.
Experts believe careful CBD dosing may help temper anxiety-induced racing thoughts that can cause disrupted sleep as well as panicked awakenings during the night. (In some people, though, too much can make anxiety worse, so be sure to dose slowly and carefully).
Sleep disruption and depression are also closely linked. More than 90% of depressed patients complain about difficulties falling asleep, sleep disruption, or early morning awakenings. CBD may improve their mood or their ability to manage the condition overall. CBD can also be used to treat parasomnias, sleep disorders like jaw grinding, sleepwalking, or nightmares, and it also cuts the time it takes to fall asleep.
CBD may also have a positive interaction with serotonin receptors in the brain. In a study on mice published in CNS & Neurological Disorders, researchers found that when depressed rodents were given CBD, it impacted the way their brains’ chemical receptors responded to serotonin, producing an antidepressant effect.
Additionally, CBD can have benefits in social settings. Researchers found CBD decreased anxiety in patients with social phobia by lowering activity in the amygdala and increasing prefrontal cortex activation, the two areas of the brain involved with regulating anxiety. And, it may also help reduce major angst before a stressful event, such as public speaking. Studies, including one published in Neuropsychopharmacology, have shown that CBD administered before a public speech significantly reduced overall anxiety, cognitive impairment, and performance anxiety.
While the research and anecdotal evidence is promising, because CBD is unregulated, it’s difficult to study, and any given sample can differ from the next, which means it’s also tricky to determine just how effective it is. Factors like the severity of depression and anxiety, as well as genetics play a role. And the benefits aren’t universal either.
CBD can be very effective for some people and not make a dent in others. Though it shouldn’t be a stand-alone treatment, it may be a beneficial co-pilot to other anti-anxiety meds or antidepressants, particularly in the time before the effects of antidepressants start to kick in.
Who Should Consider CBD for Anxiety & Depression (and Who Shouldn’t)?
If you’re considering CBD, before you make a move, talk with your primary care physician or mental health provider. Remember, CBD is not a substitute for talk therapy or medication. It’s also not a magic cure-all and may work better for some people than for others.
What Forms of CBD Are Most Effective?
Oils or Tinctures: Keep in mind, not all CBD plant extracts and formulations are created equal (blame it on the wild west unregulated substances create). However, experts believe the most effective form of CBD is an oil or tincture (alcohol-based solution) that’s placed under the tongue. These sublingual preparations ensure the cannabinoids get distributed throughout the body. This method bypasses the gut, which is why experts often prefer it to edibles, most of which get destroyed by the gastrointestinal system. Every person will react a little differently due to their individual biology, metabolism, and DNA, natch.
Dry-herb Vaporizing: For patients who are feeling all kinds of jittery and need more immediate relief, some experts recommend vaping CBD through a dry-herb vaporizer, which heats up dried CBD flowers (unlike traditional vape pens which require oil-based cartridges). These are relatively safe because they avoid the by-products produced from burning plant material and can be set to a desired temperature that allows you to get the most benefit from the CBD you are consuming.
How Much CBD Should I Take?
That’s one of the great mysteries; the optimal CBD dose is not an exact science. And doctors agree there isn’t one universal dosage of CBD because different people (and different animals, for that matter) respond to different dosages of CBD.
What experts also agree on is that CBD works best when taken on a regular basis—daily, often two-to-three times a day—because the effects can take time to build—sometimes even months (though, some people report feeling less angsty right away).
And, the best way to know what works for you is to start on a low dose and titrate up if needed (follow the recommended dosage instructions on the bottle and talk to your doctor). It may not take as long as for someone with mild symptoms to feel the effects as someone who is dealing with more severe anxiety or depression. Ultimately, the goal is to find the lowest, most effective dose. Work with your doctor and give yourself time to figure it all out.
What Are the Potential Risks and Side Effects of Using CBD?
CBD is thought to be relatively safe—a position that’s backed by the World Health Organization—but there can be some mild side effects including:
changes in appetite
There is one major caveat: CBD may cause interactions with certain other drugs, including those for heartburn, migraine, and hypertension—both by enhancing their effects or negating them. This is because medications and natural plant supplements are metabolized by the same liver pathways, and they affect the same serotonin receptors in the brain, so it’s a complex interplay. The bottom line: Talk to your doctor to be sure you're not overconsuming one or the other.
How Do I Find a Doctor Who’s Trained/Familiar With Using CBD?
CBD and cannabis-related curriculum is not (yet) taught in medical schools, so it can be a challenge to find a doctor who’s knowledgeable about the landscape. Most physicians don’t know much about the science behind medical cannabis and how to integrate it within a patient’s treatment plan.
So, you’ll need to do a bit research. Look for integrative and holistic physicians who understand how to support and educate you in the use of phytomedicines.
The Society of Cannabis Clinicians has a provider finder on their website where you can look for health-care professionals in your area who are well-versed in CBD. The Association of Cannabis Specialists is another great resource for researching cannabis clinicians near you. Another option: Hit up your local CBD dispensary. Oftentimes, they may be able to tell you which physicians are sending their patients in to buy CBD.
- CBD & Social Anxiety: Journal of Psychopharmacology. (2010). “Neural basis of anxiolytic effects of cannabidiol (CBD) in generalized social anxiety disorder: a preliminary report.” journals.sagepub.com/doi/abs/10.1177/0269881110379283
- The Benefits of CBD: Frontiers in Immunology. (2018). “Translational Investigation of the Therapeutic Potential of Cannabidiol (CBD): Toward a New Age.” ncbi.nlm.nih.gov/pmc/articles/PMC6161644/
- Therapeutic Effects of CBD for Anxiety: Neurotherapeutics. (2015). “Cannabidiol as a Potential Treatment for Anxiety Disorders.” ncbi.nlm.nih.gov/pmc/articles/PMC4604171/
- The Benefits of CBD for Public Speaking: Neuropsychopharmacology. (2011). “Cannabidiol Reduces the Anxiety Induced by Simulated Public Speaking in Treatment-Naïve Social Phobia Patients.” ncbi.nlm.nih.gov/pmc/articles/PMC3079847/
- CBD Effects on Sleep & Anxiety: The Permanente Journal. (2019). “Cannabidiol in Anxiety and Sleep: A Large Case Series.” thepermanentejournal.org/issues/2019/winter/6960-cannabis.html