How To Use CBD To Help Alleviate Anxiety
Dr. Bindiya Gandhi is an integrative medicine physician with expertise in functional and holistic medicine based in Atlanta, Georgia.
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Table of Contents
- CBD for Anxiety
- How to Use CBD for Anxiety
- CBD Dosage for Anxiety
- Potential Risks and Side Effects
While delta-9-tetrahydrocannabinol (THC) can have a bad rap for being intoxicating and anxiety-inducing, cannabidiol (CBD) can actually be used to relieve anxiety. Research supports this benefit, with several studies reinforcing the positive effects CBD can have on various anxiety conditions. In fact, 51% of U.S. adults who use CBD do so to help alleviate their anxiety, according to a recent Forbes Health survey of 2,000 U.S. adults conducted by OnePoll.
CBD isn’t yet legally cleared as an anxiolytic, or anxiety relief medication. Therefore, it’s up to you—and, ideally, a doctor who specializes in cannabis administration—to determine whether CBD is a safe treatment for your anxiety.
Here’s what the science says regarding CBD’s anxiolytic properties, along with experts’ dosage guidelines and advice on how to take CBD safely.
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CBD for Anxiety
The Food and Drug Administration (FDA) has yet to approve any CBD-based medications for anxiety. However, many studies indicate the substance can be an effective anxiolytic.
CBD for Generalized Anxiety
In 2011, a small trial-tested CBD on participants with generalized social anxiety disorder (SAD) and healthy control patients undergoing a simulated public speaking test (SPST), which is a common anxiety testing method  Bergamaschi MM, Queiroz RH, Chagas MH, et al. Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naïve social phobia patients. Neuropsychopharmacology. 2011;36(6):1219-1226. . Compared to a placebo, CBD significantly reduced anxiety and discomfort in the participants with SAD. In fact, their reduced anxiety levels were comparable to those of the control participants.
Eight years later, a 2019 test compared the efficacy of three CBD doses (150 milligrams, 300 milligrams and 600 milligrams) and a placebo in men taking an SPST  Linares IM, Zuardi AW, Pereira LC, et al. Cannabidiol presents an inverted U-shaped dose-response curve in a simulated public speaking test. Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999). 2019;41(1):9-14. . Compared to a placebo, 300 milligrams of CBD significantly reduced participants’ anxiety during the speech, but the 150-milligram and 600-milligram doses did not. These results highlight how dosage can be highly variable and that more CBD isn’t necessarily more effective.
Meanwhile, another 2019 study tested CBD in much lower doses than most other clinical studies—some participants consumed 25 milligrams a day while others consumed 50 milligrams or 75 milligrams a day  Shannon S, Lewis N, Lee H, Hughes S. Cannabidiol in Anxiety and Sleep: A Large Case Series. Perm J. 2019;23:18-041. . Researchers thought higher doses might be too expensive for participants to maintain in their normal lives and that low doses would still prove effective. Indeed, anxiety decreased within the first month for most participants and remained low. Sleep quality also improved, although it fluctuated more than anxiety. Only three patients reported side effects.
CBD for Anxiety and Depression
In 2020, researchers tested the effects of CBD oil at varying doses across 397 patients with a variety of ailments  Gulbransen G, Xu W, Arroll B. Cannabidiol prescription in clinical practice: an audit on the first 400 patients in New Zealand. BJGP Open. 2020;4(1):bjgpopen20X101010. . Participants with non-cancer pain or mental health-related symptoms experienced significant improvement in anxiety and depression, as well as in their abilities to complete their usual activities. The use of CBD oil suggested significant pain relief in these groups as well.
CBD for PTSD and Phobia Therapy
A small 2019 study of 11 patients found that, when consumed orally and administered alongside routine psychiatric care, CBD decreased patients’ posttraumatic stress disorder (PTSD) symptom severity  Elms L, Shannon S, Hughes S, Lewis N. Cannabidiol in the Treatment of Post-Traumatic Stress Disorder: A Case Series. J Altern Complement Med. 2019;25(4):392-397. .
Other studies suggest CBD can reduce PTSD symptoms when consumed with THC  Bitencourt RM, Takahashi RN. Cannabidiol as a Therapeutic Alternative for Post-traumatic Stress Disorder: From Bench Research to Confirmation in Human Trials. Front Neurosci. 2018;12:502. . When taken together, the two compounds create what’s known as the “entourage effect,” where THC enhances the effects of CBD as CBD tempers the effects of THC, resulting in a more well-rounded experience  Ferber SG, Namdar D, Hen-Shoval D, et al. The “Entourage Effect”. Terpenes Coupled with Cannabinoids for the Treatment of Mood Disorders and Anxiety Disorders. Curr Neuropharmacol. 2020;18(2):87-96. .
Some studies also suggest CBD can enhance the effects of exposure therapy—which assists patients in dissociating certain cues with a fear response—and cognitive behavioral therapy  Das RK, Kamboj SK, Ramadas M, et al. Cannabidiol enhances consolidation of explicit fear extinction in humans. Psychopharmacology (Berl). 2013;226(4):781-792.  Blessing EM, Steenkamp MM, Manzanares J, Marmar CR. Cannabidiol as a Potential Treatment for Anxiety Disorders. Neurotherapeutics. 2015;12(4):825-836. .
How to Use CBD for Anxiety
Without clear FDA guidance, optimal CBD use for anxiety varies from person to person. You may find one method works better for you over another. You can consume CBD in the following forms:
- Oils and tinctures, which come in dropper bottles and are consumed by mouth
- Gummies, which are chewable, sweet and often fruit-flavored
- Sprays, which come in bottles with a nozzle to be sprayed in the mouth
- Capsules, softgels or tablets, which are taken individually by mouth like a pill
- Vapes, which heat CBD oil without igniting it, resulting in an inhalable vapor
- Flowers, which are dried hemp plants that are typically ignited and smoked
- Creams and gels, which introduce CBD topically (through the skin) as a more localized treatment
You may have to try different forms to determine what works best in addressing your anxiety. For instance, when it comes to the absorption of CBD in your bloodstream, vaping and smoking are more effective than edibles like gummies.
CBD Dosage for Anxiety
You also have to find the right CBD dosage for your anxiety. Experts suggest starting small and working your way up depending on how your body reacts.
Many clinical trials jump right to testing high doses. Successful doses evaluated for anxiety relief specifically include:
- 600 milligrams in patients with SAD in a speech simulation  Bergamaschi MM, Queiroz RH, Chagas MH, et al. Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naïve social phobia patients. Neuropsychopharmacology. 2011;36(6):1219-1226.
- 300 milligrams in male patients in a speech simulation  Linares IM, Zuardi AW, Pereira LC, et al. Cannabidiol presents an inverted U-shaped dose-response curve in a simulated public speaking test. Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999). 2019;41(1):9-14.
However, other trials suggest much lower doses are also quite effective in treating anxiety.
- 25 to 75 milligrams for generalized anxiety and/or sleep problems  Shannon S, Lewis N, Lee H, Hughes S. Cannabidiol in Anxiety and Sleep: A Large Case Series. Perm J. 2019;23:18-041.
- 33 to 49 milligrams a day for PTSD, in addition to routine psychiatric treatment  Elms L, Shannon S, Hughes S, Lewis N. Cannabidiol in the Treatment of Post-Traumatic Stress Disorder: A Case Series. J Altern Complement Med. 2019;25(4):392-397.
Another study involving hundreds of patients noted success with doses from 40 milligrams to 300 milligrams a day, further supporting the idea that CBD dosage varies significantly, depending on a person’s symptoms and physiology.
Potential Risks and Side Effects
The World Health Organization deems CBD a safe and generally well-tolerated substance. Studies report very few adverse effects, if any.
However, taking CBD while on other medications may pose a risk, as these substances may interact and cause unwanted effects, such as weight gain, drowsiness, upset stomach and change in appetite.
Cheryl Bugailiskis, M.D., a cannabis specialist at Heally, a telehealth platform for alternative medicine, also warns people with preexisting liver injuries and people taking medications that can cause liver injuries should practice caution when using CBD.
How to find the proper CBD dosage for you, according to medical cannabis experts
This article was medically reviewed by Mia Hazle, MD, a psychiatrist in the Division of Addiction Psychiatry at Beth Israel Deaconess Medical Center.
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How concentrated your CBD oil is will determine how many drops you should take. chonticha wat/Getty Images
- How much CBD you should take depends on your weight, body chemistry, and condition.
- For example, CBD dosages for anxiety range from 400 to 600 mg a day.
- Determining your CBD dosage will take some trial-and-error and you should discuss it with a doctor.
CBD is one of more than 60 active compounds found in the cannabis plant. It’s used to treat childhood epilepsy, but is also being studied as a way to manage and treat conditions including anxiety, schizophrenia, diabetes , Parkinson’s disease, and multiple sclerosis.
However, how much CBD you need for these conditions, or otherwise, is unclear. That’s because CBD is not regulated by the FDA and therefore lacks any official dosing guidelines.
That said, preliminary research provides a basic understanding of how much CBD can be effective for certain conditions and groups of people. Here’s what researchers know so far about CBD’s dosage and effects.
Important: Unlike THC — another common compound in marijuana — CBD is non-intoxicating and won’t make you feel “high.”
How to determine CBD dosage?
How much CBD you should take depends on multiple factors like body weight and genetics. Usually finding the right dose comes down to good, old-fashioned trial and error.
However, before experimenting with different CBD doses, you should talk to your doctor since there are no regulated dosing guidelines. Plus, studies on CBD’s effects include a wide range of doses, from “lower” doses of 10mg to 100 mg to “higher” doses of 100 mg to 1,500 mg, making it even more difficult to determine the proper dose on your own, says Anthony Ferrari, PhD, the Chief Science Officer of Your CBD Store, a nationwide CBD retail and research company.
How much CBD is in a drop of CBD oil? CBD oil typically comes in dropper bottles with a single drop containing about 0.05 ml. A product’s packaging will tell you how much CBD is in the bottle, which can help you determine how much CBD is in a single drop. For example, if a 20 ml bottle containing 2,000 mg of CBD contains 400 drops, then each drop would contain around 5 mg of CBD.
Further muddling the dosing equation is the fact that some CBD products, known as isolates, contain only CBD, while others are “full-spectrum” and contain other cannabinoids, like THC. The additional cannabinoids in full-spectrum formulas might modulate CBD’s effects, thus altering how much you need to take, Ferrari says.
Factors that influence how much CBD you should take include:
- Bodyweight: Studies examining CBD’s effects use different doses depending on their body weight. These doses typically range from 5 to 20 mg per kilogram of body weight.
- The condition being treated: “The clinical trial data as it stands usually suggests a lower dosage for ailments such as anxiety and a higher dosage for ailments such as sleep, chronic pain, and epilepsy,” Ferrari says.
- Your individual body chemistry: Individuals respond differently to varying dosages of CBD due to their individual genetics and brain chemistry, says Jordan Tishler, MD, president of the Association of Cannabis Specialists and CEO of medical cannabis practice inahleMD. For example, a dose that might make one person feel slightly drowsy might cause unmanageable fatigue in another.
CBD dosage based on conditions
Clinical trials on CBD are limited and existing studies use a wide range of doses to treat various conditions. Here’s what we know so far:
Studies examining CBD’s effects on anxiety use varying doses, typically ranging from 400 mg to 600 mg per day. In a small 2017 study, test subjects reported reduced anxiety after taking a 300 mg dose of CBD.
In a couple of small studies, CBD doses ranging from 600 mg to 1500 mg per day were shown to reduce some symptoms of psychosis due to schizophrenia.
Can you take too much CBD?
CBD is generally considered to be safe and well-tolerated in doses up to 1500mg per day. While there’s a real risk of fatal overdose when using drugs like opiates or alcohol, taking too much CBD is more likely to result in sleepiness and perhaps an upset stomach.
Side effects are typically mild and include:
- Dry mouth
In rare instances, CBD could cause liver damage. A 2019 animal study found that liver damage occurred when mice were given high doses of CBD — the human equivalent of 200 mg of CBD per kilogram of body weight. It’s not clear if these findings are applicable to humans.
“If you are pregnant, breastfeeding, or taking any other medications, you should discuss your CBD journey with a primary care physician, Ferrari says. “Everyone experiences the effects of CBD differently and you should always monitor your body’s reactions.”
Warning: Taking CBD in addition to other medications that cause drowsiness — like benzodiazepines, antipsychotics, antidepressants, antihistamines, or alcohol — may lead to increased drowsiness, accidental falls, or accidents while driving.
Emerging research suggests CBD is a promising and low-risk treatment for a number of conditions — but like all medications, you need to be cognizant of dose. Because there are no regulated dosing guidelines, it’s especially important to talk to your doctor before starting a CBD regime.
“Maintaining open communication with your physician is the key to overall success when first incorporating CBD into your routine, especially for those with complicated health issues,” Ferrari says.
Lia Tabackman is a freelance journalist covering health and science topics for Insider.com. She can be found on Twitter @LiaTabackman.