About two years ago, Michelle Smith noticed she was having trouble falling sleep. She started to wake up more during the night. She wanted something that would calm the racing thoughts that popped up as soon as her head hit the pillow. “It’s hard for me to shut down at night,” she says. “That’s why [some] people turn to alcohol and things like that. I was trying to find something that would do that without all the [bad] side effects.”
After both a friend and her massage therapist recommended cannabidiol (CBD) for her anxiety, she decided to give it a try. “Now when I go to bed, I’m able to let go of what’s happened during the day and not worry about what’s coming up tomorrow,” says Smith, 56. “I felt relaxed the first time I took it, but it’s not a magic pill. There’s nothing about it that feels like a high. It feels like I just took a deep breath.”
Smith says her anxiety kicked into high gear as an adult after her son was diagnosed with an autoimmune disease and required two liver transplants during his childhood. The intense caregiving combined with the stress of the break-up of her marriage led to an anxiety disorder diagnosis. She was prescribed sertraline (Zoloft)—a medication that can help regulate mood. Then she went to counseling.
But over the years she began taking a more holistic approach to her mental and physical health. She was able to stop taking Zoloft and her regimen now includes eating mostly vegetarian, daily meditation, exercising at least five days a week, and CBD.
Smith is not alone in using CBD for anxiety. A 2019 Gallup poll found that one in seven Americans use CBD, with anxiety listed as one of the top four reasons for consumption (the others: pain relief, insomnia, and arthritis). But among medical professionals, there is both optimism and caution when it comes to recommending it for anxiety. There is no FDA or professional allopathic, or traditional, medical organization that formally recommend marijuana or marijuana products for any psychiatric illness.
“It’s fair to say that the (consumer) enthusiasm for CBD has outpaced the [available] hard-core scientific evidence of its efficacy,” says Peter Grinspoon, MD, a primary care physician at Massachusetts General Hospital at Chelsea and an instructor at Harvard Medical School, who is also a board member of the advocacy group Doctors for Cannabis Regulation. “We’re still trying to figure out what it actually does work for and what is just hype,” says Dr. Grinspoon.
Tinnakorn Jorruang/Getty ImagesWhat is CBD?
CBD is one of many compounds known as cannabinoids that are found in cannabis plants. Unlike tetrahydrocannabinol (THC), another compound found in cannabis, CBD doesn’t make you high. Both THC and CBD affect the brain, but they [do] so differently, says Julia Arnsten, MD, chief of the division of general internal medicine at Albert Einstein College of Medicine and Montefiore Health System in Bronx, New York.
“What we know about THC is that in addition to causing people to feel high, it’s pretty effective for neuropathic pain. CBD tends to be more relaxing, but also has a lot of other properties including being anti-inflammatory and anti-spasmodic,” says Dr. Arnsten.
What does the research say?
One thing that most researchers and medical practitioners agree on is that the lack of rigorous studies and peer-reviewed research makes it difficult to really know the effect CBD has on humans, both positive and negative. More research is needed. “We can’t really answer the question: Is CBD effective for anxiety on a population level?” says Dr. Arnsten. “We just haven’t had any randomized trials that followed people over time to see how they do.”
A review published in 2017 by the U.S. National Academy of Sciences, Engineering and Medicine looked at more than 10,000 studies about cannabis and cannabinoids and found only a few clinical trials that actually studied CBD at all. They concluded there was “limited evidence” that CBD was effective for treating anxiety. It’s also worth noting that, when independent labs look at CBD products, they may contain THC—even though the label doesn’t say so. THC consumption has been linked to higher anxiety, paranoia, psychosis, and difficulty with focus in some people, according to research published in the journal Neurology.
In a 2017 study published in Frontiers in Pharmacology, researchers found that CBD lowered the anxiety levels of participants before a public speaking test. And in a small 2019 study published in The Permanente Journal, almost 80 percent of a total of 72 participants who presented with primary concerns of anxiety or poor sleep reported a decrease in their anxiety levels within the first month of treatment in an open-label and unrandomized study.
So far, the U.S. Food and Drug Administration (FDA) has approved only one CBD product, a prescription CBD oil to treat two rare pediatric epilepsy conditions. A consumer update from the FDA in November 2019 noted that the lack of regulation means that most of the CBD purchased online is not approved and may be marketed with unproven medical claims and produced with unsafe manufacturing practices. And, in fact, a 2017 research letter published in the Journal of the American Medical Association has shown purity and dosage can be suspect.
That’s why practitioners say that consumers who want to try CBD for anxiety must be rigorous in their research and the choices they make. Without sufficient high-quality evidence in human studies, it’s hard to pinpoint effective doses, says Dr. Grinspoon. “And because CBD is mostly available as an unregulated supplement, you don’t always know what you’re getting. “If you decide to try CBD, talk with your doctor—if for no other reason than to make sure it won’t affect other medications you are taking,” he advises.
Trying CBD for the first time
Dr. Arnsten says that consumers who want to give CBD a try should be systematic in their approach to learn what works for them. “What we’re trying to do is induce a predictable effect, and the only way we’re really going to be able to assess that is by using it the same way most of the time.”
She suggests finding a company that posts a certificate of analysis, which lists the amount of CBD contained in the product plus contaminants. Find out if they test for pesticides and heavy metals. And make sure the certificates come from an outside laboratory and are posted on a regular basis.
When Smith was deciding what product to use, she relied on a close friend who also takes CBD and is meticulous about finding the best products. “CBD is everywhere now. You drive down the street and there’s a gas station that sells it. That’s like gas station sushi and it’s not good. It’s really important to do your research.”
IRA_EVVA/Getty ImagesHow to consume CBD
Conventional CBD products include edibles like gummies or cookies, oils to take internally or vape, as well as tinctures and topicals. Dr. Arnsten cautions patients against smoking or vaping, and notes that edibles may offer inconsistent doses. She says there is little data to support using topicals. Instead, she suggests using a tincture, letting it sit in the mouth and be absorbed through the gums. In a tincture, an extract is suspended in an alcohol mixture. CBD oil, on the other hand, is extracted, and then suspended in a carrier oil like MCT or coconut oil.
Each night about half an hour before bed, Smith takes half a dropperful of CBD tincture, which contains about 20 mg per dose. For someone who’s new to CBD, Dr. Arnsten suggests starting with 10 mg for a few nights, doubling the dose if more is needed. “Experiment like that. Keep a diary so that you know exactly what you took and how you felt. Fill in the diary as close to in real-time as possible.”
Look for gradual improvement over quick wins, Dr. Arnsten suggests. “CBD is not going to hit people like a benzodiazepine [a medication that has sedating effects] or a THC would. It’s not going to suddenly make you feel at peace. It’s really a matter of introducing it consistently so that it will allow you to have more restful sleep for longer or be able to be more productive during the day without getting stuck in anxiety spirals.”
These days, Smith’s son is 22 and in good health. Adjusting to this new normal has been both a blessing and a challenge for her, after spending so many years primed to go into panic mode and never knowing when the next medical emergency would strike.
“I’ve spent a lot of my time in fight or flight mode and that is exhausting, so being able to calm down and rest my body and my mind is important. People think self-care is selfish, but it’s not. It’s necessary. And for me, CBD is part of that holistic approach.”