CBD and Anxiety: A better future for patients awaits?

Today we would like to highlight a very important pilot study done in Australia led by Orygen, about the use of CBD in treatment resistant anxiety in young people.

The Cannabidiol Youth Anxiety Pilot Study(1) is a small open label study that found a 42.6% reduction in anxiety severity and impairment, as reported by the Medical Cannabis Network/Health Europa(2) and in the Journal of Clinical Psychiatry. The study consisted of 31 participants between 12-25 years of age with anxiety disorders resistant to standard treatment, and showed a clinically significant reduction in symptoms and severity unrelated to standard therapies allowed in the study (Cognitive Behavioral Therapy, CBT, and Selective Serotonin Reuptake Inhibitor, SSRI).

Although designed as an open label, single arm (without control group) study with a small sample size determined on feasibility rather than statistical power (per the authors), the results of this study cannot be overlooked and justify even further studies in the potential role that Cannabidiol could have in treating anxiety disorders.

At a high level, the subjects received a high purity CBD product with titrated doses of up to 800mg/day for up to 12 weeks; subjects had to be in treatment for at least 6 weeks prior to enrollment with an antidepressant medication and/or CBT without improvement in their anxiety severity.

The intention-to-treat analysis was astonishing:

– There was statistically significant reduction (P<0.0001) of Overall Anxiety Severity and Impairment Scale (OASIS) scores from baseline of 42.6% in the studied population:

•  40% of participants had a reduction of 50% or more on their OASIS scores from baseline, and
•  60% of participants had a reduction of at least 33% on their OASIS scores from baseline.

The authors also examined whether the reduction in anxiety severity was dependent on the antidepressant medication taken, and found that participants without prescribed antidepressants had greater reductions in scores compared to those with antidepressant prescription (P=0.02); however, for both populations (prescribed antidepressant, and those without prescription) there were statistically significant improvements in their OASIS scores.

There were no serious adverse events (AEs) recorded, although those with antidepressant prescriptions were more likely to develop at least one AE. The authors then explain that this finding could be associated with the fact that many SSRIs are metabolized via the cytochrome P450 enzymes, and CBD is an inhibitor of this enzymatic complex.

Despite the limitations of the study, the results are a beacon of hope for individuals with treatment resistant anxiety, and also highlight the paramount importance of continuing doing well designed clinical trials to test this and other assumptions on the effects of CBD in anxiety disorders, and perhaps in other psychiatric afflictions as well. It gives a more than reasonable justification to continue on the clinical trial route, and sets the stage so bigger trials can be done in this population.

Anxiety is one of the ever rising mental health problems faced in many developed nations; although currently there are many different treatment options, about 50% of the population do not respond to first line treatment(3), usually antidepressants (SSRIs). Other treatment options include benzodiazepines, which aren’t advised to be used long-term due to the dependency and misuse potential; some other treatment options include atypical anti-psychotic medications, but there are secondary effects associated with use that can turn away patients from these drugs. CBD could represent a safe and effective treatment option for those suffering from any of the anxiety disorders described in the medical literature. Clinical Trials will be needed to determine the best dosage and treatment regime for this, and other populations affected.

The future of the cannabis plant and its responsible use is in clinical research. Are you ready for this revolution in psychiatric treatments? Here at Axis Mundi CRC we are ready and cannot wait to serve and contribute to this revolution in psychiatric care!

By Angerlyk Frytz, MD.

References:

(1) Cannabidiol halves treatment-resistant anxiety symptoms in young people [Internet]. Health Europa. 2022 [cited 2022Aug8]. Available from: https://www.healtheuropa.com/cannabidiol-halves-treatment-resistant-anxiety-symptoms-in-young-people/117069/

(2) Berger M, Li E, Rice S, et al. Cannabidiol for treatment-resistant anxiety disorders in young people: an open label trial. J Clin Psychiatry. 2022;83(5):21m14130. https://doi.org/10.4088/JCP.21m14130

(3) Ansara ED. Management of treatment-resistant generalized anxiety  disorder. Ment Health Clin. 2020 Nov 5;10(6):326-334. doi:  10.9740/mhc.2020.11.326. PMID: 33224690; PMCID: PMC7653736.

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