Cannabinoid treatments for anxiety: A systematic review and consideration of the impact of sleep disturbance

Cannabidiol's (CBD) safety profile and broad action has made it a popular treatment option for anxiety and co-occurring sleep disturbance. However, its efficacy in healthy and clinical populations, treatment duration, formulation and doses for optimal therapeutic benefits remains unclear. Selected databases were examined from inception to October 2022. Study selection, data extraction and Cochrane Risk of Bias assessments were conducted according to PRISMA guidelines and registered on the PROSPERO database (CRD42021247476) with 58 full-text studies meeting the eligibility criteria and administered CBD only or with Delta-9-tetrahydrocannabinol (THC) across healthy and clinical populations. In healthy populations and certain non-cannabis using clinical populations, CBD had greater anxiolytic effects without prominent effects on sleep. An inverted U-shaped dose relationship, and CBD ratio to THC in combined treatments likely moderated these effects. Mechanistically, observed CBD effects occurred via primary modulation of the endocannabinoid system and secondary regulation of neuroendocrine function. Additional research is needed to understand CBD mechanisms of action across diverse groups.

Automated summary

Research has found that Cannabidiol (CBD) has anxiolytic effects in healthy and certain clinical populations, but minimal impact on sleep. The dosage and ratio of CBD to THC in combination treatments may moderate these effects. The primary mechanism of action for CBD appears to be modulation of the endocannabinoid system and secondary regulation of neuroendocrine function.