CBD for anxiety and insomnia
Millions of Americans are turning to CBD to combat anxiety and insomnia.
"According to a August 2019 Gallup poll, 20% of CBD users cite relief from anxiety while 11% cite relief from insomnia as primary reasons for use, trailing only pain relief as the leading driver."
Yet, in spite of widespread usage, there is still a scarcity of clinical data supporting if and how CBD may be beneficial for anxiety or insomnia. The few small controlled trials and case series around CBD use for anxiety or sleep on PubMed, a biomedical and life science literature database maintained by the US National Library of Medicine, conclude with the same sentiment – that “CBD has a promising role in the management of anxiety and sleep disorders. However, more clinical and longitudinal studies with standardized approaches to dosing and outcome measurements are needed to determine the appropriate dosing strategy for CBD and its place in therapy.”
Given the remarkable lack of formal clinical studies, there is still a lot of confusion about how CBD works, what it exactly does, not to mention the basics, namely when, what and how much to take. So, what do we already know about these topics based on existing medical research? And, more importantly, what are we doing to learn more? Read on to find out.
"Serotonin, otherwise known as the “hormone of happiness”, plays an important role in emotion, mood, and anxiety. CBD may be directly activating the serotonin receptors."
The Anxiolytic Effects of CBD
While CBD is believed to have neuroprotective, antidepressive, and anxiolytic benefits, the mechanisms of action by which CBD decreases anxiety are still unclear. Most evidence points towards a calming effect in the central nervous system, with studies supporting CBD’s ability to interact with serotonin receptors and GABA receptors in the brain. Serotonin, otherwise known as the “hormone of happiness”, plays an important role in emotion, mood, and anxiety. CBD may be directly activating the serotonin receptors, thereby delivering an anti-anxiety effect, though the scale of this impact is still being explored. CBD may also increase the serotonin supply in a second way, essentially, by enabling more serotonin to remain in the synapses in the presence of cannabidiol. GABA, on the other hand, is the main ‘inhibitory’ neurotransmitter, reducing excess activity in the brain and promoting relaxation. There is evidence that CBD may be modifying the way the GABA receptor works, amplifying its natural calming effects.
Cannabidiol in Anxiety and Sleep: A Large Case Series is likely the most recent and broadest sample study conducted on humans to this point. This case series was designed to determine whether CBD helps improve sleep and/or anxiety in a clinical population. The 2019 study concluded that CBD may hold a benefit for anxiety-related disorders. With nearly all patients receiving daily doses of CBD 25 mg/day in capsule form, anxiety scores declined in nearly 80% of the study participants within the first month and remained decreased during the study duration. Sleep scores improved within the first month in two-thirds of the patients, but then fluctuated over time. On another positive note, CBD was well tolerated in almost all patients, in line with other studies that concluded that CBD appears to be better tolerated than routine psychiatric medications.
Other research, focused on the effect of CBD on sleep quality and the sleep-wake cycles in animal models, found an increase in the total percentage of sleep in rats after administration of mid-to-high-dose CBD injections as compared to placebo. However, there are conflicting findings suggesting that cannabinoid concentration, dose, and route of administration may have varying effects on sleep quality and insomnia symptoms.
"We are truly in the midst of a massive – perhaps the largest – uncontrolled human experiment, with tens of millions of people turning to CBD for relief."
Basically, while there is promise, we simply don’t know enough as to why CBD may help these prevalent conditions, nor do we have sufficient data on the most effective modes of administration. That’s exactly why the Wholistic Research and Education Foundation has partnered with University of California, Irvine (UCI) in 2020 to conduct Cannabinoid Anxiety Relief Education Study (C.A.R.E.S.), a first of its kind exploratory survey on CBD and cannabis efficacy in reducing anxiety and co-morbid conditions such as sleep. The preliminary findings from data collected from the nearly 7500 C.A.R.E.S. participants are summarized on the Wholistic website, with the deeper analysis of types of cannabis products used, use patterns based on demographic and behavioral differences as well details on dose, frequency, timing of use, and delivery methods most associated with therapeutic benefit expected to be published later in 2021.
We are truly in the midst of a massive – perhaps the largest – uncontrolled human experiment, with tens of millions of people turning to CBD for relief. In the absence of evidence-based guidance from their healthcare professions, many literally seek counsel from natural food or vitamin shop clerks. To make matters worse, there is a large and growing black market, as well as conflicting regulatory guidelines for CBD supplements which vary from state to state. Given the urgency of the current state of affairs, I see it as our ethical responsibility to act to support research for the safety, tolerability, and efficacy of CBD, and do so expediently. The opportunity to benefit millions as well as prevent potential harm is up to all of us.