Cannabidiol in anxiety and sleep: a large case series

Authors: Shannon Scott, MD, Nicole Lewis, ND, Heather Lee, PA-C, Shannon Hughes, PhD.

Who Was It? Seventy-two adult patients who presented to a psychiatry outpatient clinic with primary concerns of anxiety (65.3%) or poor sleep (34.7%). These psychiatric patients had been diagnosed by a mental health professional with a sleep or anxiety disorder. They were undergoing treatment for these conditions at the clinic which included psychiatric care and medications. The average age of patients with anxiety was 34 years and 59.6% with a primary anxiety disorder were men, while the average age of sleep-disordered patients was 36.5, most of whom were women (64%). Care was ongoing across several months. This study was retrospective, meaning it looked back in time at subject records after treatment was already completed.

What Was Done? In addition to their psychiatric care and medications, patients were given oil-based CBD in capsule form. Most patients were given 25 mg/day, with a small number receiving 50mg or 75 mg/d. CBD was only taken once per day; patients with anxiety disorders took their CBD in the morning, while those with sleep disorders took it at night. Patients visited the clinic monthly and completed validated surveys to assess their sleep and anxiety. Sleep and anxiety was also assessed at baseline, before CBD treatment started, and was measured over three months, although not all subjects took CBD for the entire study period.

What Happened? Compared to baseline, at the first monthly assessment after starting CBD 79.2% of patients experienced an improvement in anxiety while 66.7% experienced an improvement in sleep. During this month-long period all subjects were taking CBD. At the second monthly assessment, approximately the same proportion of subjects had reduced anxiety while 56.1% of subjects had improved sleep. The reduction in anxiety and sleep were mostly constant from the second to the third monthly assessment. CBD was well tolerated with only four patients reporting side effects, including fatigue, dry eyes, and disinhibition.

Fringe Commentary: In this retrospective study, CBD at doses of 25-75mg per day was associated with a decrease in anxiety and sleep in the vast majority of subjects with either a primary anxiety or sleep disorder. This improvement is striking, but it must be considered that patients were also being given psychiatric and medical treatment, so it is not possible to attribute the benefits exclusively to CBD. However, it suggests that CBD at relatively low doses is an effective treatment for both sleep and anxiety disorders.

Many patients presenting for musculoskeletal therapy are experiencing sleep problems and/or anxiety as comorbid conditions. CBD has shown to improve sleep and anxiety in humans and animal studies have shown that it can reduce pain in models of osteoarthritis, myofascial pain syndrome, and other pain conditions. Although human studies of CBD and pain are limited at present, CBD has been shown to reduce neuropathic pain in humans. This means that CBD, which is safe for both short and long-term consumption, should be considered as an adjunct treatment for patients undergoing musculoskeletal care with comorbid sleep and or anxiety concerns. 

Citation: The Permanente Journal

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