• CBD oil offers potential therapeutic benefits to relieve anxiety. Cannabidiol has been studied as an oral product, sublingual drop, oromucosal spray, food ingredient, and inhalation agent using an aerosol, nebulizer, or vaporizer(1).
  • Existing preclinical studies suggest that cannabidiol or CBD may help manage generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, and post-traumatic stress disorder(2). This has not yet been concluded in long-term clinical studies.
  • CBD engages the body’s endocannabinoid system (ECS). This biological system regulates the function of the central nervous system (CNS), synaptic plasticity, and the endogenous and environmental stimuli responses(3).       
  • Cannabidiol may have side effects and interact with other medications. Thus, individuals must consult a healthcare professional before using any form of CBD.   

How to Use CBD for Anxiety

CBD product formulations are typically taken orally as a capsule, dissolved in oil or another organic solvent, or administered as an oromucosal spray. 

Methods to administer cannabinoids include oral administration, topical application, oromucosal delivery, or vaporization(4). 

CBD has been explored as an oral product, sublingual drop, oromucosal spray, food product component, and an inhalation agent via an aerosol, nebulizer, or vaporizer. 

These formulations and administration modes carry different absorption and distribution(5).

Edibles like CBD gummies take longer to absorb and are less likely to induce a high concentration peak. However, these edibles may eventually reach levels enough to cause concerns or possibly react with other medications. 

Absorption of CBD appears highest through inhalation, usually through smoking or vaping(6).  

Vaping, however, is an unsafe practice in general. CBD vape is not an exception, as the Centers for Disease Control and Prevention (CDC) has linked vaping products to an incidence of lung illnesses(7).  

Meanwhile, topical CBD products, including CBD creams, balms, salves, and lotions, may not be absorbed into the system in significant amounts to interfere with other drugs. However, there is little information on how much CBD eventually gets into the blood(8).

CBD users take the drug to regulate self-perceived anxiety, sleep, stress, and other symptoms, according to the National Institutes of Health (NIH)(9). 

The FDA considers CBD the same way it evaluates any other substance it regulates according to a legal framework, using rigorous scientific evidence to verify the safest dosage for drugs, food, and dietary supplements(10). 

Based on the available data, there remain concerns about the science, safety, and quality of many of these products. Further studies are needed to elucidate the crucial issues relating to the potential benefits and side effects of CBD products(11).

How Does CBD Work for Anxiety

Cannabidiol (CBD), a component of Cannabis sativa, is a pharmacologically broad-spectrum compound that has earned interest in recent years. CBD offers potential help in various health conditions and neuropsychiatric disorders(12). 

Like hemp extract and hemp oil, CBD oil is obtained from the hemp plant (a variety of Cannabis sativa plants) and works by interacting with the cannabinoid receptors in the endocannabinoid system (ECS)(13).

The ECS is a pervasive neuromodulatory system involved in the functioning of the central nervous system (CNS), synaptic plasticity, and the response to endogenous and environmental stimuli(14).

The ECS is a network of cellular receptors found throughout the brain and the human body. The brain’s cannabinoid receptors, or the CB1 receptors, regulate the levels and function of most neurotransmitters(15).

CB1 receptors regulate activities through immediate feedback and by increasing or decreasing the system’s overall activity, which requires adjustment involving temperature, hunger, or awareness(16).

The human body produces molecules called endocannabinoids. These are tiny cannabis-like molecules that float throughout the brain and share a structural similarity with molecules found in the cannabis plant(17).

Several placebo-controlled studies analyzed the potential of CBD as an antidepressant and effective treatment for anxiety-related disorders(18). 

Large case series of clinical evidence suggests that when CBD is provided acutely, the compound may help manage panic disorder, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder(19).

CBD has shown anti-inflammatory properties. Clinical studies indicate that CBD inhibits T cell proliferation, reduces the levels of pro-inflammatory cytokines, reduces migration and adhesion of immune cells, and induces T cell apoptosis(20).

Cytokines are tiny cell-signaling proteins that cells release. T-cells are a type of white blood cell.

Cytokines affect T-cell proliferation and survival at many stages of the immune response(21). Apoptosis (cell death) significantly reduces the numbers of activated T cells at the end of an immune response(22).

One study showed how CBD pretreatment decreased participants’ anxiety, cognitive impairment, and discomfort induced by simulated public speaking tests(23).

The placebo group demonstrated increased anxiety, cognitive impairment, discomfort, and alertness.

Other studies demonstrated how CBD products had shown potential help to individuals with epilepsy and psychotic disorders while contributing to the improvement of anxiety disorders, such as(24):

  • Generalized anxiety disorder (GAD)
  • Social anxiety disorder (SAD)
  • Obsessive-compulsive disorder (OCD)
  • Panic disorder (PD)
  • Post-traumatic stress disorder (PTSD)

Pros and Cons of CBD Oil for Anxiety: Is CBD Effective?

Aside from understanding how to use CBD oil for anxiety, learning the health benefits of CBD oil can help individuals determine how it affects the human body.

A study showed that CBD may have the potential to help reduce anxiety in clinical populations(25). However, results must be interpreted cautiously due to this study’s open-label and nonrandomized nature.   

The American Psychiatric Association (APA) reiterated how anxiety had become a normal stress response(26). 

Characterized by persistent fear of imminent threats, excessive anxiety may result in maladaptive behavior and impairment to an individual(27).

Anxiety, in conjunction with other stressors, has become prevalent. These factors which cause anxiety may also have a detrimental impact on everyone’s mental health and well-being(28).

Meanwhile, CBD may alleviate anxiety symptoms by addressing many distinct pathways involved in nerve activity that are either steady or hyperactive(29).

CBD is a plant-based cannabinoid that does not produce the euphoric effects of tetrahydrocannabinol (THC)(30). 

Due to CBD’s various central nervous system activities, the compound may possess a broad range of therapeutic capabilities that may help with neuropsychiatric illnesses(31). 

CBD may help increase gamma-aminobutyric acid (GABA) levels in the brain, which is critical for brain relaxation(32). 

Additionally, CBD possesses a diverse pharmacological profile, including interactions with several receptors involved in regulating fear and anxiety-related behaviors(33). 

These receptors include the serotonin 5-HT1A receptor, cannabinoid type 1 receptor (CB1R), and the transient receptor potential (TRP) vanilloid type 1 (TRPV1) receptor(34).

How to Take the Best CBD Oil for Anxiety

CBD oils may come in various strengths, indicated by mg of CBD (milligrams of CBD) included in the container.

The dosage of CBD oil may be modified drop by drop. Choose between a high dose or low dose CBD oil to achieve more potency.

To extract the maximum benefit from CBD oil, apply a few drops beneath the tongue (sublingually) and hold for 15–20 seconds.

CBD is absorbed into the bloodstream through the mucosal membrane beneath the tongue, bypassing the digestive system and liver metabolism. This process results in a more rapid onset of effects than when the substance is ingested.

CBD is hypothesized to produce an entourage effect when combined with other cannabinoids. This effect is characterized by an improved positive contribution of the compound facilitated by terpenes and terpenoids(35).

Terpenes and terpenoids are bioactive chemicals present in essential oils and have a variety of biological actions, including anticancer, anti-inflammatory, antibacterial, antioxidant, and antiallergic properties(36).

How Much CBD Should an Individual Take? 

There is not enough conclusive scientific data to determine the appropriate CBD dosage for anxiety. Although research suggests that CBD products may help manage anxiety disorders such as generalized anxiety disorder, more research is needed(37). 

The FDA has not approved the administration of any dose of CBD as a treatment for anxiety or other mental health conditions. 

Sativex is a CBD product for multiple sclerosis and analgesia for pain relief in cancer(38). However, Epidiolex, which contains only CBD in an oral solution, is approved by the U.S. Food and Drug Administration for seizures associated with Lennox–Gastaut or Dravet syndromes, and now also Tuberous Sclerosis Complex(39). 

Studies showed positive findings from clinical trials of pharmaceutical-grade CBD(40). Investigations demonstrated how the effects of CBD at doses considerably higher than in OTC preparations may help reduce anxiety symptoms.

What Does It Mean to Take CBD Oil for Anxiety Sublingually?

CBD products such as CBD tinctures and oils may be administered conveniently using a dropper and applied under the tongue. A dropper allows the user to measure the amount of CBD for more accurate dosing.

Tinctures are the classic sublingual medications that deliver results in 15 to 30 minutes. Sublingual CBD administration is the second most absorbable method, with effects ranging from 2 to 4 hours(41).

Still, healthcare professionals and research agencies must perform more extensive clinical trials to determine a suitable CBD dosage for specific health concerns like anxiety. 

For example, the Anxiety and Depression Association of America (ADAA), an institution that works to treat, prevent, and cure anxiety disorders and depression, conducts clinical trials to understand CBD’s impact better when taken sublingually for anxiety(42).

The type of CBD product used and how it is taken are essential factors in measuring its effectiveness (43).

Risks and Side Effects of CBD for Anxiety

CBD is a physiologically active molecule. Although it is generally considered safe, understanding CBD’s effects on the body are still necessary(44). 

Despite therapeutic benefits, CBD may still cause side effects which may result in(45):

  • Dry mouth
  • Diarrhea
  • Drowsiness
  • Lightheadedness
  • Nausea
  • Damage to the liver (in rare instances)

In addition, researchers have discovered the molecular mechanisms through which cannabidiol, or CBD, inhibits the psychoactive ingredient tetrahydrocannabinol (THC) of cannabis which causes psychiatric side effects(46).

Furthermore, CBD may interact with various products, including over-the-counter drugs, herbal supplements, and prescription medicines. 

This interaction may increase the risk of unwanted symptoms of toxicity. Certain medications may need to be changed or discontinued to avoid side effects. 

CBD should be taken with caution or with the assistance of a healthcare professional when taking other drugs, such as the following:

  • Antihistamines
  • Antiretrovirals
  • Anticoagulants or blood thinners
  • Antipsychotic medications
  • Statins 

Through interaction with other medications, CBD may compete or interfere with the enzymes in the liver. This interference may result in a condition known as altered concentration. This concentration may result in the medication not working or an increased risk of side effects, unpleasant and sometimes serious concerns(47). 

The severity of the side effects of drug interactions may depend on the dose of CBD, the dose of another prescription, and the individual’s preexisting health condition(48). 

Thus, individuals concerned with their health and wellness must consult a doctor or healthcare professional before using any form of CBD.

How to Choose the Best CBD Oil

When determining what form of CBD product to buy, individuals may choose between full-spectrum CBD oil (pure CBD), broad-spectrum CBD oil, or a CBD isolate.

Full-spectrum contains the whole plant extract that includes flowers, THC, and all cannabinoids. Broad-spectrum CBD contains all cannabinoids except for THC. An isolate, on the other hand, is a form of CBD that contains only a single cannabis extraction, such as CBD(49). 

Given a wide selection of CBD oil products available on the market, consumers’ main concerns include selecting high-quality CBD oil for various anxiety levels.

When choosing the right CBD oil for specific health conditions like anxiety, individuals should:

  • Choose a product verified as authentic and safe by a third-party laboratory. 
  • Ensure a product’s potency and purity by making sure that findings are made public via COAs (certificates of analysis).
  • Check the COA against the product’s label for the information listed on the certificate.
  • Confirm that the product is free of harmful contaminants like pesticides, molds, or heavy metals.
  • Select a product according to preference and choice for a better user experience. 

Finding the Safest CBD Oil

Since the FDA has not approved CBD for anxiety, users must carefully check the quality and dosage, which may vary widely between products and manufacturers.

To help secure the safest CBD products, individuals should:

  • Determine if there is authentic evidence of third-party lab testing compliant with ISO 17025 standard, allowing laboratories to verify the competence and produce reliable results(50).
  • Consider CBD products that use hemp farming in the United States.
  • Review the CBD products as it is only federally legal if derived from hemp and contain less than 0.3 percent THC(51).
  • Check on the ingredients used in the production. Ensure that there are no pesticides, molds, and heavy metals in the product.
  • Verify the seller’s certifications, such as a U.S. Hemp Authority certification to provide best practices, high standards, and self-regulation for confidence in hemp and CBD and the production process(52).
  • Review feedback from customers published on authoritative websites.
  1. The Essential Medicinal Chemistry of Cannabidiol (CBD)
    https://pubs.acs.org/doi/10.1021/acs.jmedchem.0c00724
  2. Cannabidiol as a Potential Treatment for Anxiety Disorders
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604171/
  3. An introduction to the endogenous cannabinoid system
    https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC4789136/#
  4. Cannabinoid
    https://www.sciencedirect.com/topics/medicine-and-dentistry/cannabinoi
  5. The Essential Medicinal Chemistry of Cannabidiol (CBD)
    https://pubs.acs.org/doi/10.1021/acs.jmedchem.0c00724
  6. The Essential Medicinal Chemistry of Cannabidiol (CBD)
    https://pubs.acs.org/doi/10.1021/acs.jmedchem.0c00724
  7. Everything You Need to Know About Vaping CBD Oil https://www.verywellmind.com/everything-you-need-to-know-about-vaping-cbd-oil-4801288
  8. CBD and other medications: Proceed with caution https://www.health.harvard.edu/blog/cbd-and-other-medications-proceed-with-caution-2021011121743
  9. Reasons for cannabidiol use: a cross-sectional study of CBD users, focusing on self-perceived stress, anxiety, and sleep problems https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7893882/
  10. Better Data for a Better Understanding of the Use and Safety Profile of Cannabidiol (CBD) Products https://www.fda.gov/news-events/fda-voices/better-data-better-understanding-use-and-safety-profile-cannabidiol-cbd-products
  11. ibid
  12. Cannabidiol as a Potential Treatment for Anxiety Disorders
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604171/
  13. Page 103 of Healing With CBD
    https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/ view
  14. An introduction to the endogenous cannabinoid system
    https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC4789136/#
  15. Ibid
  16. ibid
  17. ibid
  18. Cannabidiol as a Potential Treatment for Anxiety Disorders
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604171/
  19. ibid
  20. Antioxidative and Anti-Inflammatory Properties of Cannabidiol https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7023045/#
  21. Cytokine control of memory T-cell development and survival
    https://www.nature.com/articles/nri1052
  22. Apoptosis in activated T cells: what are the triggers, and what the signal transducers?
    https://pubmed.ncbi.nlm.nih.gov/17102629/
  23. Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naïve social phobia patients
    https://pubmed.ncbi.nlm.nih.gov/21307846/#
  24. Cannabidiol as a Potential Treatment for Anxiety Disorders
    https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC4604171/
  25. Cannabidiol in Anxiety and Sleep: A Large Case Series
    https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC6326553/
  26. What Are Anxiety Disorders? https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders
  27. The impact of anxiety upon cognition: perspectives from human threat of shock studies
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3656338/
  28. Anxiety disorders https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961
  29. Cannabidiol as a Potential Treatment for Anxiety Disorders https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604171/
  30. ibid
  31. ibid
  32. ibid
  33. ibid
  34. ibid
  35. The “Entourage Effect”: Terpenes Coupled with Cannabinoids for the Treatment of Mood Disorders and Anxiety Disorders
    https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC7324885/
  36. Terpenes and terpenoids as main bioactive compounds of essential oils, their roles in human health and potential application as natural food preservatives https://www.sciencedirect.com/science/article/pii/S2590157522000153
  37. Cannabidiol as a Potential Treatment for Anxiety Disorders
    https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC4604171/
  38. Potential Adverse Drug Events and Drug–Drug Interactions with Medical and Consumer Cannabidiol (CBD) Use https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678684/
  39. ibid
  40. Lack of evidence for the effectiveness or safety of over-the-counter cannabidiol products
    https://journals.sagepub.com/doi/full/10.1177/2045125320954992
  41. Healing with CBD https://drive.google.com/file/d/1AGlxnhS2SoFeOXEuysv75bd_C9pEnwsU/view
  42. Sublingual Cannabidiol for Anxiety
    https://adaa.org/find-help/find-information/clinical-trials/sublingual-cannabidiol-anxiety
  43. ibid
  44. CBD and other medications: Proceed with caution https://www.health.harvard.edu/blog/cbd-and-other-medications-proceed-with-caution-2021011121743
  45. ibid
  46. Cannabis study reveals how CBD offsets the psychiatric side-effects of THC
    https://www.sciencedaily.com/releases/2019/09/190930131115.htm
  47. CBD and other medications: Proceed with caution
    https://www.health.harvard.edu/blog/cbd-and-other-medications-proceed-with-caution-2021011121743#
  48. ibid
  49. Full-Spectrum CBD: What It Is and Best Products https://www.healthline.com/health/full-spectrum-vs-broad-spectrum-cbd#fa-qs
  50. ISO/IEC 17025 TESTING AND CALIBRATION LABORATORIES
    https://www.iso.org/ISO-IEC-17025-testing-and-calibration-laboratories.html
  51. Cannabidiol (CBD)-what we know and what we don’t https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476
  52. HEMP CERTIFICATION IS HERE
    https://ushempauthority.org/
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Medically Reviewed by

Dr. Abraham Benavides, MD

 Written by  Stanley Clark

Abraham is a resident Family Physician, cannabis consultant, CBD author, and pioneer in advancing cannabis medical education. He is an alum and full-tuition merit scholar of the George Washington University School of Medicine & Health Sciences. Currently, he is doing...

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