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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.

Commissions we earn from partner links on this page do not affect our opinions or evaluations. Our editorial content is based on thorough research and guidance from the Forbes Health Advisory Board.

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 [1] 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 [2] 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 [3] 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 [4] 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 [5] 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 [6] 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 [7] 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 [8] Das RK, Kamboj SK, Ramadas M, et al. Cannabidiol enhances consolidation of explicit fear extinction in humans. Psychopharmacology (Berl). 2013;226(4):781-792. [9] 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 [10] 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 [11] 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 [12] 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 [13] 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.

Here’s How to Determine How Much CBD You Should Take

Many people use CBD for pain and anxiety relief. But how do you know if you’re taking too much?

Taylor Leamey writes about all things wellness. She holds a bachelor’s degree in both Psychology and Sociology and is a certified sleep coach.

It’s safe to say that CBD is pretty mainstream now — you can buy it in grocery stores. No longer is it considered a trendy health hack but a legitimate option for pain and anxiety relief. But even with the largely widespread acceptance, there are still a lot of questions about how much and how often you should take CBD.

CBD products do not have federal oversights or regulations. In fact, up to 70% of CBD products you buy on the internet either have more or less CBD than listed on the label. Finding the ideal CBD dosage for pain or anxiety can be difficult. Here’s how to make it easy.

What can you use CBD for?

Research, though limited, indicates that CBD has legitimate health benefits. While there is no FDA regulation, research has shown that full-spectrum and broad-spectrum CBD effectively treat pain and anxiety. There’s only one FDA-approved CBD product, called Epidiolex, that’s available by prescription. Epidiolex treats seizure disorders such as Lennox-Gastaut syndrome and Dravet syndrome.

However, there are several other benefits and uses of CBD products.

The most common uses of CBD

  • To lessen symptoms of anxiety and depression for things like muscle pain or migraines
  • To reduce chemotherapy-induced nausea
  • Relieve inflammatory diseases
  • Help with behavioral symptoms of dementia or Alzheimer’s disease
  • Managing multiple sclerosis and improving mobility

The CBD market is continuously expanding with new products. However, there are four main types of CBD product categories. All of which will vary in potency and dosage per unit.

Oils and tinctures

CBD oils generally come in either a liquid or capsule form. You can take the extracts independently or use the dropper to add them to food or drinks. Liquid tinctures are usually taken directly under the tongue.

“Tinctures are generally taken at higher concentrations than oils. This means that if you were taking 1 milliliter of tincture, you would need to drop the concentration down to 0.5 milliliters. A good rule of thumb is to start with a small dose (0.25 milliliters) and slowly increase your dose over time,” says Reda Elmardi, a registered dietician and certified nutritionist.

Edibles

Edible CBD products are quickly becoming very popular, likely because of their convenience and flavor profiles. With edibles, you have several options in flavor, potency and prices. They have everything, from gummies to cookies, chocolates and even granola bars.

Topical

CBD is also available in topical creams and salves applied directly to the skin. Popular forms are lotions, creams or ointments. Topical CBD products are good options for muscle pains, joint inflammation or nerve pain.

Topical CBD is one of the more difficult forms for determining dosage. Not only does potency vary by product, but also varies by how much you use each application. It’s important to follow manufacturer instructions carefully.

How to determine the best CBD dosage for you

CBD products express dosage in milligrams. Epidiolex starts with a dosage of 2.5 milligrams taken twice a day. After a week, you can increase the dosage to 5 milligrams twice a day. Federal regulation makes determining dosage straightforward.

For the rest of the products on the market not regulated by the FDA, there are no established guidelines for CBD concentration, which makes determining how much you should take a little more difficult. There are a few key factors you need to keep in mind — your weight, what you’re treating and the concentration of the product.

The ideal dosage for you will vary depending on what you’re using it for and what form you’re taking. Don’t forget that different forms also mean how quickly it takes effect. Generally, edibles, oils and capsules will take roughly 30 to 60 minutes to take effect. Smoking or vaping CBD will bring it on significantly quicker since the CBD absorbs into your bloodstream rather than your digestive system.

CBD dosage will vary by condition

In general, the CBD dosage is dependent on the disease and its ability to be managed by CBD. The research that is available on CBD treatments has very varied dosage levels. Clinical studies have varied in oral doses from 100 to 800 milligrams a day. Others administer lower levels around 40 milligrams. A 2019 study investigating CBD for anxiety found that 300 to 600 milligrams reduced anxiety symptoms. However, that study was limited to 57 adult males.

“For generalized anxiety or sleep disorders, 25 to 75 milligrams per day is recommended, while for PTSD, 33 to 50 milligrams per day is recommended. In severe anxiety, a patient’s dose might be increased to 300 to 600 milligrams. If the patient is experiencing pain due to chemotherapy, 50 to 60 milligrams is recommended, with a maximum daily dose of 600 milligrams,” says Kimberly Langdon, a board-certified MD.

How much CBD is best for you will depend on your body. Your body weight and existing medications will influence the ideal dosage for you.

Can you take too much CBD?

A clinical review of studies confirmed that people tolerate doses as high as 1,500 milligrams a day. We want to stress that the research around CBD dosage is still really young, so there is not much to point to about how much is too much for people. More research is needed to definitively conclude the ideal dosage for each condition.

Not a ton of known side effects associated with CBD products. Though fatigue, diarrhea and appetite changes have been reported. The FDA states that CBD can cause liver damage and potentially impact the other prescription medications you’re taking.

If you’re starting your CBD journey, it’s best to slowly build your dosage so you can monitor how it affects you.

“The idea is to start very low (i.e., 5 milligrams per use) and increase daily usage by 5 milligrams every two days until you start feeling results. Then, stop increasing and keep using the same number of milligrams or drops. For many people, the amount that provides modest benefits in the first couple days will, after consistent use, provide more and more benefit over time,” says Dr. Dustin Sulak, an integrative physician and leading cannabis clinician.

How to calculate CBD dosage

For some forms of CBD, determining how much is each unit is simple. Capsules or gummies tend to have an expressed milligram content, making dosage much easier than oils or creams.

Oils or tinctures with a dropper bottle list the CBD content for the total liquid bottle. So instead of eating a gummy that’s 50 milligrams, it will look more like 7,500 milligrams of CBD in the 30-milliliter bottle. Some bottles will offer serving sizes — like one drop — to indicate dosage. This allows you to have greater control over how much you are intaking, but even still, it’s not a perfect science.

Some bottles with a traditional nutrition label on the back will tell you exactly how much is in one dropper. If you are unsure, it’s a good idea to reach out to the company to find out. It can be difficult to figure out how much you’re intaking for the bottles that do not break down by serving size and offer only the total amount. It is difficult, but not impossible; it just takes a little bit of math.

Say you have a 30-milliliter bottle of CBD oil, and each drop is 0.05 milliliters.

To determine how many milligrams of CBD per milliliter, you divide the total milligram content by how much the bottle is. In this example, the math would look like this:

7,500 milligrams divided by 30 milliliters = 250 milliliters.

There is 250 milligrams of CBD per milliliter for this product. Next, you want to know exactly how much CBD is in each drop.

250 milliliters x 0.05 milliliters = 12.5 milliliters per drop.

This calculation works with any bottle of CBD. Once you know how much CBD is in each drop, you can accurately take your ideal amount. “To ensure the best results, keep track of how much you take, how many times a day you take it and rate your symptoms daily (by rating 1 to 10, 10 being best) to see if they are getting better or worse,” Sulak advises.

Too long, didn’t read?

CBD is a continually evolving field in both products and research. While research is lacking, what is available suggests that CBD does have therapeutic benefits and is generally very well tolerated by people. Still, more research is needed to really dig into the long-term side effects and best dosage markers for the average person.

In place of federal regulations, use your best judgment regarding how much CBD you are taking. Talking to your doctor about dosage is always a good idea when in doubt.

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.