Worry, nervousness, fear, tension, uneasiness, and apprehension are often used to define anxiety. These emotions are not new to mankind. In fact, anxiety is a normal response to a perceived threat that may be emotional, physical, or psychological. But in our fast-paced, achievement-oriented culture, anxiety and related emotional disorders are quickly escalating. They often precede more dangerous mental health disorders and are responsible for decreasing quality of life, elevating rates of unemployment, dismantling relationships, and even increasing the risk of suicide.1
Anxiety is a common feature of classic fibromyalgia. It may be mediated by trauma and can be exacerbated by both pain and sleep disorders, which are present in virtually all chronic pain syndromes. But pain, specifically, seems to be a traveling companion of anxiety. In fact, studies show a direct correlation between pain indices (especially neurological pain) and anxiety scores, suggesting a strong dependency between the two, and explaining why anxiety scores are significantly higher among those with fibromyalgia.2, 3
In a previous blog, we explained how cannabidiol (CBD), a cannabinoid compound extracted from the cannabis plant, can be an effective tool for managing the debilitating pain that is a constant companion to so many individuals with chronic pain conditions. However, this same compound, which acts upon the central nervous system, may also curb the anxiety that threatens the emotional stability of these same individuals.
Emotions such as anxiety are generated within the central nervous system through the interaction of various neurotransmitters in response to stress. Some of the neurotransmitters involved in generating anxiety include GABA, dopamine and epinephrine and serotonin. GABA and serotonin are calming neurotransmitters, while dopamine and epinephrine cause excitement. Nicknamed the “happy neurotransmitter” because of its role in producing feelings of happiness and well-being, serotonin is specifically targeted when managing anxiety disorders, leading to the common practice of prescribing selective serotonin reuptake inhibitors (SSRIs) which increases serotonin levels. But other pharmaceuticals including benzodiazepines which activate GABA receptors are also commonly used for anxiety. Unfortunately, SSRIs and benzodiazepines possess their own bag of undesirable (and sometimes frightful) side effects, causing many individuals to seek alternatives, such as CBD.
CBD Influences Anxiety-Regulating Receptors
CBD interacts with several receptors located in regions of the brain and on neurons in the central nervous system, known to regulate fear and anxiety. Some of the more prevalent receptors include the cannabinoid type 1 receptor (CB1), the 5-HT1A serotonin receptor, and the transient receptor potential vanilloid type 1 (TRPV1) receptor.
When activated, the CB1 receptor can help protect the body against chronic stress, while ameliorating fear and anxiety. This receptor sits on neurons that release glutamate, an excitatory neurotransmitter. When CB1 is activated, it prevents the neuron from releasing glutamate and therefore, helps maintain a less-excitatory state. CBD indirectly activates CB1 by helping the body make the compound that will activate CB1. Reducing the activity of excitatory neurotransmitters like glutamate will help reduce stress and anxiety.4
The 5-HT1A serotonin receptor also reduces anxiety and lowers the body’s response to chronic stress. These receptors are found on neurons that signals the release of serotonin. When activated by CBD, the body responds by increasing levels of serotonin and thereby enhancing feelings of happiness and well-being and subsequently, reducing anxiety.1
The TRPV1 receptors can influence the body’s pain response to inflammation and stimuli. In fibromyalgia and other chronic pain syndromes, the body is hyper-responsive to normal stimuli causing an abnormal pain response, which increases anxiety. Activating the TRPV1 receptor with CBD can reduce anxiety associated with pain and inflammation.5
CBD Influences the Limbic System
Another means by which CBD may reduce anxiety is through its ability to decrease blood flow to the region of the brain that most directly controls our emotions and drives; namely, the limbic system. This effect was shown in a study of individuals with Generalized Social Anxiety Disorder. Those given one dose of CBD prior to an anxiety-producing performance in public speaking showed significantly reduced anxiety, cognitive impairment and discomfort during their speech, compared to similar individuals not given CBD.6
When brain scans were taken of individuals during fearful episodes, CBD was shown to limit the ability of neurons to connect and communicate with regions of the limbic system, and decrease blood flow to these areas, which reduced anxiety.7 Similarly, functional magnetic resonance imaging (fMRI) scans further showed decreased activity in the anxiety-producing regions of the brain and a reduced response to stimuli on the skin. 7 Together, these studies show that CBD acts upon regions of the brain that control emotions such as anxiety and minimizes the activity of these areas, resulting in a more balanced emotional response.
CBD Protects the Brain
CBD is considered neuroprotective, meaning it protects brain tissue from damage. Since emotions such as anxiety are controlled by brain function, a healthy brain becomes critical for managing anxiety. One of the most important ways by which CBD protects brain tissue is through influencing the production and activity of inflammatory cells to reduce inflammation in brain tissue. CBD is also a potent antioxidant and helps maintain a strong blood-brain-barrier, which protects the brain from threats in the body, including damaging free radicals, toxins, and dangerous organisms. Inflammation, unbalanced brain chemicals, damaging free radicals, overstimulation, and abnormal cell growth or activity can contribute to anxiety, but CBD acts in all these areas to help support healthy brain function and reduce anxiety.8
In research studies, CBD is very well-tolerated and effectively reduces anxiety when administered short-term. 1 It also prevented panic attacks, decreases the body’s sympathetic response to stress, reduces the body’s response to fear, and even prevents anxiety associated with chronic stress. As a safe compound with no significant side effects at large doses, CBD may be an exciting option for controlling both pain and anxiety associated with fibromyalgia and other chronic pain conditions.
There is also emerging data showing a synergistic effect between omega-3 fatty acids, such as EPA and DHA from concentrated fish oils, and CBD. The combined anti-inflammatory and pain-relieving properties seem to provide an even greater overall effect on the central nervous system in lowering chronic pain perception. This was the genesis for the formulation on the CannabOmega product I am now using extensively with my patients. If you are suffering from any chronic pain condition it may be something you should consider giving a try.
- Blessing, E. M., Steenkamp, M. M., Manzanares, J., & Marmar, C. R. (2015). Cannabidiol as a Potential Treatment for Anxiety Disorders. Neurotherapeutics, 12(4), 825–836. http://doi.org/10.1007/s13311-015-0387-1
- Gormsen, L., Rosenberg, R., Bach, F. W., & Jensen, T. S. (2010). Depression, anxiety, health-related quality of life and pain in patients with chronic fibromyalgia and neuropathic pain. European Journal of Pain, 14(2). doi:10.1016/j.ejpain.2009.03.010
- Uçar, M., Sarp, Ü, Karaaslan, Ö, Gül, A. I., Tanik, N., & Arik, H. O. (2015). Health anxiety and depression in patients with fibromyalgia syndrome. Journal of International Medical Research, 43(5), 679-685. doi:10.1177/0300060515587578
- Ruehle, S., Rey, A. A., Remmers, F., & Lutz, B. (2012). The endocannabinoid system in anxiety, fear memory and habituation. Journal of Psychopharmacology (Oxford, England), 26(1), 23–39. http://doi.org/10.1177/0269881111408958
- Madasu, M. K., Okine, B. N., Olango, W. M., Rea, K., Lenihan, R., Roche, M., & Finn, D. P. (2016). Genotype-dependent responsivity to inflammatory pain: A role for TRPV1 in the periaqueductal grey. Pharmacological Research, 113, 44-54. doi:10.1016/j.phrs.2016.08.011
- Bergamaschi, et al. (2011). Cannabidiol Reduces the Anxiety Induced by Simulated Public Speaking in Treatment-Naïve Social Phobia Patients. Neuropsychopharmacology, 36(6), 1219–1226. http://doi.org/10.1038/npp.2011.6
- Schier, A. R., Ribeiro, N. P., Adriana Cardoso De Oliveira E Silva, Hallak, J. E., Crippa, J. A., Nardi, A. E., & Zuardi, A. W. (2012). Cannabidiol, a Cannabis sativa constituent, as an anxiolytic drug. Revista Brasileira de Psiquiatria, 34. doi:10.1016/s1516-4446(12)70057-0
- Fernández-Ruiz, J., Sagredo, O., Pazos, M. R., García, C., Pertwee, R., Mechoulam, R., & Martínez-Orgado, J. (2013). Cannabidiol for neurodegenerative disorders: important new clinical applications for this phytocannabinoid? British Journal of Clinical Pharmacology, 75(2), 323–333. http://doi.org/10.1111/j.1365-2125.2012.04341.x
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- Tags: anxiety, cbd, chronic illness, Chronic Pain, Chronic Pain Management, fibromyalgia, functional medicine, integrative medicine