Question 1

My patient asks about CBD for anxiety - what should I tell them?

Accepted Answer

CBD (cannabidiol) is a non-intoxicating phytocannabinoid with preliminary evidence for anxiolytic properties. A 2024 systematic review and meta-analysis of 8 RCTs found a statistically significant pooled effect (Hedges' g = -0.92, 95% CI -1.80 to -0.04), but the wide confidence interval reflects substantial variability across small studies (Han et al., 2024, Psychiatry Research). No large RCTs exist for any DSM anxiety disorder. Study doses (150-600mg) far exceed commercial products (10-50mg). Epidiolex (pharmaceutical CBD) approved for seizure disorders only. Labeling analysis found ~70% of commercial products mislabeled (Bonn-Miller et al., 2017, JAMA; PMID 29114823). THC: higher doses frequently worsen anxiety and impair fear extinction. Framework: acknowledge patient interest, emphasize SSRI/CBT evidence depth, do not recommend CBD as first-line.

Question 2

What does the clinical trial evidence show for CBD in anxiety?

Accepted Answer

CBD (cannabidiol) is a non-intoxicating phytocannabinoid with preliminary evidence for anxiolytic properties. A 2024 systematic review and meta-analysis of 8 RCTs found a statistically significant pooled effect (Hedges' g = -0.92, 95% CI -1.80 to -0.04), but the wide confidence interval reflects substantial variability across small studies (Han et al., 2024, Psychiatry Research). No large RCTs exist for any DSM anxiety disorder. Study doses (150-600mg) far exceed commercial products (10-50mg). Epidiolex (pharmaceutical CBD) approved for seizure disorders only. Labeling analysis found ~70% of commercial products mislabeled (Bonn-Miller et al., 2017, JAMA; PMID 29114823). THC: higher doses frequently worsen anxiety and impair fear extinction. Framework: acknowledge patient interest, emphasize SSRI/CBT evidence depth, do not recommend CBD as first-line.

Question 3

What dosing has been studied and for how long?

Accepted Answer

CBD (cannabidiol) is a non-intoxicating phytocannabinoid with preliminary evidence for anxiolytic properties. A 2024 systematic review and meta-analysis of 8 RCTs found a statistically significant pooled effect (Hedges' g = -0.92, 95% CI -1.80 to -0.04), but the wide confidence interval reflects substantial variability across small studies (Han et al., 2024, Psychiatry Research). No large RCTs exist for any DSM anxiety disorder. Study doses (150-600mg) far exceed commercial products (10-50mg). Epidiolex (pharmaceutical CBD) approved for seizure disorders only. Labeling analysis found ~70% of commercial products mislabeled (Bonn-Miller et al., 2017, JAMA; PMID 29114823). THC: higher doses frequently worsen anxiety and impair fear extinction. Framework: acknowledge patient interest, emphasize SSRI/CBT evidence depth, do not recommend CBD as first-line.

Question 4

Are there purity concerns with commercial CBD products?

Accepted Answer

CBD (cannabidiol) is a non-intoxicating phytocannabinoid with preliminary evidence for anxiolytic properties. A 2024 systematic review and meta-analysis of 8 RCTs found a statistically significant pooled effect (Hedges' g = -0.92, 95% CI -1.80 to -0.04), but the wide confidence interval reflects substantial variability across small studies (Han et al., 2024, Psychiatry Research). No large RCTs exist for any DSM anxiety disorder. Study doses (150-600mg) far exceed commercial products (10-50mg). Epidiolex (pharmaceutical CBD) approved for seizure disorders only. Labeling analysis found ~70% of commercial products mislabeled (Bonn-Miller et al., 2017, JAMA; PMID 29114823). THC: higher doses frequently worsen anxiety and impair fear extinction. Framework: acknowledge patient interest, emphasize SSRI/CBT evidence depth, do not recommend CBD as first-line.

PsychHQ

CBD (Cannabidiol) for Anxiety: What the Clinical Evidence Actually Shows