What are benzodiazepines and are there natural alternatives?
Written by: Dr. Diana Rangaves, Google Scholar, holds a Doctorate from the University of California, specializes in pharmacotherapy management, and founded ClinicalConsultantServices.com and DianaRangaves.com
CBD: How it Works to Treat Anxiety
The cannabis plant contains more than 100 known cannabinoids, natural compounds in the cannabis plant that seem to have therapeutic effects. The research into the potential health benefits of the different cannabinoids is still new, so not much has been confirmed yet. So much research is underway that more answers to the benefits of cannabis will surface through the completion of larger studies. Perhaps the most researched of cannabis’ cannabinoids at the moment is cannabidiol, more commonly known as CBD.
CBD is the second-most prominent cannabinoid found in cannabis, only second to THC. While THC has made the plant popular because of its psychoactive effects that cause users to feel “high,” CBD is non-psychoactive. Therefore, CBD will not make users feel intoxicated. Instead, it is becoming more known for its other possible health effects, including its ability to relieve anxiety. As mentioned, more research is necessary to fully understand how CBD works and what it is capable of, but many studies have compelling evidence linking CBD to anxiety and stress relief to date. Additionally, heaps of anecdotal evidence exist from CBD users applauding its ability to ease anxiety in both themselves and their pets.
Understanding What Causes Anxiety in the Body
Our emotions come from the central nervous system's actions by way of an intricate network of neurotransmitters and their stress responses. The primary neurotransmitters that play a role in anxiety are GABA, dopamine, serotonin, and epinephrine. GABA and serotonin help to calm us, whereas dopamine and epinephrine cause stimulation. Therefore, these are the neurotransmitters targeted when trying to reduce or solve anxiety issues and disorders.
The primary pharmaceutical drugs used to treat anxiety are serotonin reuptake inhibitors (SSRIs), which increase serotonin levels, and benzodiazepines, which activate GABA receptors. While these drugs have been found to be effective in treating anxiety, they come with some serious baggage in that they can cause some dangerous side effects, including depression, addiction, withdrawal symptoms when a person stops taking them, and sometimes even death. For this reason, alternatives are urgently needed to replace these potentially harmful treatment options.
CBD’s Influence on Anxiety
It remains to be determined how exactly CBD works on the body, including how it might function to reduce anxiety. After years of study, here is what has been confirmed. Just like when introducing any substance into the body, introducing CBD creates a physiological response by interacting with many of the body’s receptors throughout the body. In fact, CBD seems to target over 65 regions in the body. Many of the mechanisms in those regions overlap, which is what gives CBD such a large potential for so many health benefits.
CBD’s interaction with the neurons in the brain and the parts of the central nervous system connected to fear and anxiety seem to be at the root of why CBD could help relieve anxiety. These primarily include the cannabinoid type 1 (CB1) receptor, the transient receptor potential vanilloid type 1 (TRPV1) receptor, and the serotonin receptor 5-HT1A.
Our bodies include what is now known as the endocannabinoid system (ECS) with two receptors, cannabinoid type 1 (CB1) receptor and cannabinoid type 2 (CB2) receptor. Most of CBD’s interaction with these receptors is indirect, but still meaningful. Its interaction with CB1 is the one that seems to deal with anxiety.
CB1’s role in stress relief may have to do with its relationship to the excitatory neurotransmitter glutamate. Activating CB1 leads to the prevention of glutamate release, helping the body maintain a calmer state. CBD’s interaction with the CB1 receptor is indirect as it assists the body in making the compound that activates CB1. In short, introducing CBD into the body can then help relieve anxiety and stress.
Some anxiety is caused or exasperated by pain and inflammation. TRPV1 receptors may affect how the body responds to pain caused by both inflammation and other stimuli. Certain chronic pain diseases, such as fibromyalgia, can cause excessive responsiveness to even normal stimuli, leading then to an irregular pain response. All of that then leads to increased anxiety. CBD can activate TRPV1 receptors to reduce anxiety linked to inflammation and pain.
The body’s 5-HT1A serotonin receptors reside on neurons that are involved in signaling serotonin release. They help reduce anxiety as well as decrease the body’s chronic stress response. CBD activates 5-HT1A receptors directly, causing an increased serotonin level that leads to feeling a sense of well-being and happiness, thereby decreasing anxiety.
This information came from a review of 49 studies that reported strong support for the use of CBD to treat generalized anxiety disorder, social anxiety disorder, and panic disorder. The majority of the studies in this review, which included both preclinical and human studies, used acute CBD dosing on healthy participants, meaning that establishing if regular CBD use on patients with clinical anxiety disorders would respond similarly remains necessary.
CBD can also shift levels of GABA+. GABA receptors make neurons less excitable, meaning it helps calm things down in the brain, leading to a calmer feeling. CBD doesn’t bind directly to GABA receptors, but it can influence their charge difference. Because GABA receptors are similar to electrical gates, their charge makes a difference in how they function. CBD can cause an increase in GABA potential, which could lead to a calmer state of mind.
The way CBD interacts with the body’s limbic system is another way it could be helping to relieve anxiety. CBD seems to reduce blood flow into the limbic system, located in the brain. The limbic system directly modulates emotions and bodily drives. One particular study on patients with Generalized Social Anxiety Disorder provided evidence for this relationship. Study participants given CBD before public speaking, one of the most popular ways to cause anxiety, had reduced anxiety and cognitive impairment and feelings of discomfort while giving their speech compared with participants who were not given CBD.
Another study gave participants CBD then took brain scans when they were experiencing fear. CBD seemed to decrease the blood flow to the limbic system, limiting neuronal communication to reduce anxiety. Functional magnetic resonance imaging scans were also taken and revealed less activity in brain areas that produce anxiety.
Furthermore, a 2019 study gave CBD to participants dealing with anxiety and sleep issues, finding that nearly 80 percent of participants’ anxiety improved. Seventy percent of participants reported improved sleep initially, but less over time.
Even more recently, a 2020 observational study of nearly 400 CBD users in New Zealand found that participants who used CBD for anxiety reported that in just three weeks of use, they felt less anxiety symptoms and they were better able to perform daily functions.
Studies like these suggest that CBD interacts with brain regions that modulate emotions, including anxiety, limiting activity in those regions. The end result seems to be overall reduced anxiety. Many more similar studies exist as well, though so far, there is not much information on long-term CBD use. As such, more information on the role of CBD in treating anxiety is still needed.
Experts and medical professionals who collaborate with patients with anxiety using medical cannabis also have educated guesses about why CBD could help to treat anxiety. The body produces substances called endogenous cannabinoids (endocannabinoids). The cannabinoids produced by the cannabis plant are technically known as exogenous cannabinoids. Lynn Parodneck, an MD who treats patients with medical marijuana, has hypothesized that the people whose bodies do not make enough endocannabinoids on their own may receive the most benefit from exogenous cannabinoids like CBD.
The amount of anecdotal evidence for CBD’s positive effect on anxiety is also encouraging. While this is not the stuff of science per se, it is noteworthy that so many people agree that CBD seems to be helping them deal with anxiety. It has now become a more widespread practice to give CBD to pets with anxiety as well, and pet owners tend to rave about the results they see in their furry family members. Dogs that once quivered in fear from fireworks and thunderstorms no longer have those reactions thanks to CBD, they say. Anecdotal reports in such large numbers tend to encourage scientific research that could eventually confirm their findings.
Is CBD Safe to Use for Anxiety?
Research shows CBD to be safe to use in that it is not habit-forming and lacks serious and severe side effects. The side effects most commonly seen are diarrhea, and changes in weight and appetite, those even those don’t happen that often. In 2011, one review of CBD reported that even taking a high dose of 1500 mg of CBD daily was an amount well-tolerated by humans. A 2019 study recently reported that long-term CBD use appeared to be safe, though only more evidence through long-term studies can confirm this.Because the use of common pharmaceutical anti-anxiety treatments, like benzodiazepines, have been shown time and again to be dangerous, it seems that CBD would be a better option, as long as it works. The main thing to be aware of when taking CBD, for anxiety or anything else, is that it can have harmful interactions with certain medications. That research is still largely underway, but what has been found so far in terms of CBD and drug interactions is that it could be quite dangerous if taken simultaneously with blood thinners and the benzodiazepine clobazam. When taking other medications, it’s always best to consult with your doctor when adding a new substance to your life, including CBD.