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The pathology and neurobiology of stress and anxiety disorders
In most cases, anxiety and stress present as an overlapped case requiring a prolonged management course under the supervisor of mental health therapist. As a distinctive criterion, experts have explained that stress is a risk factor for depression and anxiety disorders. About 18% of the population in the United States reportedly suffers from anxiety disorders. The onset of anxiety and stress in diagnosed subjects has been observed to be linked with different risk factors. This observation confirmed the multifactorial nature of these mood disorders. Today, the literature reviews explaining the etiology of stress and anxiety disorders in human subjects present different hypothesis ranging from molecular dysfunction, genetic predisposition, and early life exposure to risk factors. Some research findings have also demonstrated that a deficit in the endocannabinoid signaling mechanism contributes to the onset of depression and anxiety disorders.
Environmental factors, including abrupt changes in lifestyle patterns, causing a noticeable disruption in mental health, has long been implicated in the onset of stress in young adults. These disruptions burden the mental balance and initiate a cascade of events diagnosed as the onset of depression and anxiety disorders. At the molecular level, the brain evaluates stress stimuli as a change in the sensory system and activates a cascade of reactions influencing the rate of energy metabolism. Subsequently, the hypothalamic paraventricular nucleus is activated, and the limbic system releases corticosteroids as the primary stress hormone. Although research inquiries have proposed different etiology to explain the onset of stress and anxiety, these reports seem to agree with the symptoms range observed in patients with stress and anxiety disorders.
In 2014, Wiley Interdisciplinary Reviews: Cognitive Science published a report suggesting that anxiety disorders impair cognition and compromise people’s performance level on cognitively-demanding tasks. Other reports have also suggested that impaired cognition increases anxiety in patients. While under stress, people have also been observed to have reduced attentional control and poor memory formation. Stress and anxiety disorders also negatively affect learning and neuroplasticity, increase the risk of various mental health conditions, increase pulse rate, disrupt normal homeostatic mechanism, and disrupt normal sleep cycle.
The basis for the use of cannabidiol in stress and anxiety disorders
All the therapeutic benefits of cannabinoids in the management of pathological conditions in humans are mediated by the effects of the endocannabinoid system (ECS) in the biological setup. The endocannabinoid system is a neuroactive lipid signaling system consisting of a network of cannabinoid receptors, enzymes, and endocannabinoids widely distributed in the nervous system. This system is involved in the regulation of mood and anxiety disorders. Cannabidiol can modify the activity of this network by acting as an endogenous cannabinoid. This explains the scientific basis for the use of cannabidiol as adjunctive therapy in the management of mental disorders.
The endocannabinoid signaling system is prominently distributed in the brain’s limbic regions and contributes to the regulation of emotional behavior, neurotransmitter release, mood, and response to stress. Behavioral research in animal models has indicated that the endocannabinoid system plays a prominent role in the early-stage developmental regulation of emotion and in brain development. This has fueled different research inquiries into the ECS pharmacological modulation as a possible drug target in the management of anxiety and mood disorders.
Cannabidiol in improving symptoms of stress and anxiety
- CBD improves sleep quality
Sleep disruptions associated with a significant decrease in the quality of sleep cycle is a diagnostic feature presenting in patients with stress and anxiety disorders. A study examining the association between anxiety symptoms and objectively measured sleep quality in older adults was published in 2010 by The American Journal of Geriatric Psychiatry. Judging from the results from a pool of 3,040 women with anxiety disorders, the researchers concluded that anxiety symptoms are associated with poor sleep quality and elevated sleep fragmentation.
The sedative effects of cannabidiol have long been documented. However, only a few research studies have examined the sedative effects of cannabidiol in anxiety patients. The Permanente Journal published a notable study investigating CBD’s effect in a clinical population of people with sleep disorders and anxiety in 2019. This study confirmed that CBD is better tolerated in this population and also significantly improves sleep scores while decreasing anxiety scores.
- CBD promotes neurogenesis and cognitive function
Oxidative stress has been implicated in the pathogenies of Stress and anxiety disorders. The scientific evidence supporting the beneficial effects of cannabidiol in improving cognitive skills is controversial. Initially, anecdotal reports suggest that cannabis users generally experience a significant performance reduction in cognitive-demanding tasks. However, subsequent research confirmed that this dose-dependent effect is mediated by delta-9-tetrahydrocannabinol (THC) content of the cannabis plant. Since anxiety disorders are characterized by cognitive impairment, it is logical to expect that pro-neurogenesis agents can improve the presenting symptoms by improving cognition.
In 2015, the British Journal of Pharmacology published a research report detailing the role of cannabinoids in adult neurogenesis. Results from this research suggest that cannabidiol promotes the formation of new neurons and can subsequently improve cognitive abilities and positively affects the learning process. However, there are limited data reports on CBD’s use in improving cognition of patients with anxiety disorders.
- CBD improves the prognosis of anxiety disorders
Beyond symptoms improvement, there is an accumulating research evidence supporting CBD’s use as a complementary therapy in the treatment of anxiety disorders. Derived from plant sources, CBD and cannabis products are known to be better tolerated in anxiety patients when compared with synthetic benzodiazepines, serotonin re-uptake inhibitors, and monoamine oxidase inhibitors. As reported in 2015 by study research in the Journal of Neurotherapeutics, preclinical evidences conclusively suggest that CBD can effectively reduce anxiety behaviors with a lack of anxiogenic effect, minimal sedative effects, and a significant safety profile.
Although there is scientific evidence supporting the use of cannabidiol in stress and anxiety disorders, there is a need for clinical trials in many subjects. This is necessary to establish standard doses of treatment and closely study the safety concerns of CBD use in humans.