Role of Cannabis and Cannabidiol in the Treatment of Anxiety Disorders

Marissa Cullen, PharmD, BCPP
Clinical Pharmacist, Psychiatry
UPMC Western Psychiatric Hospital

Anxiety disorders share features of persistent and excessive worry and can interfere with many daily activities. Approximately 19.1% of United States adults had an anxiety disorder in the past year and the lifetime prevalence is as high as 31%. Anxiety disorders are often treated with medication, psychotherapy, or a combination of both. Antidepressants (SSRIs and SNRIs) are the first-line treatment approach for anxiety disorders but are not effective for all patients, have a slow onset of action, and can be associated with intolerable adverse effects. Benzodiazepines are typically effective for relieving acute anxiety symptoms, but they should be limited to short-term use due to their safety profiles and risk for dependence. Limitations with prescription pharmacologic treatments can lead to patients seeking alternative treatments, such as cannabis or cannabidiol.

Cannabis and cannabidiol are now legal in many states, making them easily accessible to patients. In practice, patients report using cannabis and/or cannabidiol to treat mental health disorders, including anxiety disorders. These products are not incorporated into treatment guidelines, leaving clinicians without clear guidance on their role. Studies vary significantly in their design, methodology, and quality. Study results on the safety and efficacy of cannabis and/or cannabidiol are mixed, making application to patients especially difficult.

Speaker

AAPP is excited to have Dr. Tiffany Buckley, PharmD, BCPS, BCPP at the 2024 Annual Meeting. Dr. Buckley will provide information on how to interpret the cannabis/cannabidiol literature and determine its generalizability to patients with anxiety disorders. In addition, she will discuss the safety and efficacy these products so psychiatric pharmacists can properly educate patients and decide if there is a role for their use in the treatment of anxiety disorders.

The learning objectives for this session are:

• Distinguish between cannabis, hemp, FDA-approved cannabinoids, and synthetic cannabinoids
• Evaluate the role of cannabis and/or cannabidiol in the treatment of anxiety disorders
• Assess the safety of cannabis and/or cannabidiol when used for the treatment of anxiety disorders 

Dr. Buckley is a board-certified pharmacotherapy specialist and board-certified psychiatric pharmacist who earned her Doctor of Pharmacy degree from the University of California San Francisco. She completed her acute care pharmacy residency at Yale New Haven Health in New Haven, Connecticut, and her psychiatric pharmacy residency at the University of Maryland Baltimore.

Dr. Buckley specializes in medication management of patients with treatment-resistant psychosis. She currently practices as an Advanced Practice Psychiatric Pharmacist at University of Maryland Midtown. She is also one of the first faculty recruited to teach in the landmark Master of Science (MS) in Medical Cannabis Science and Therapeutics (MCST) at the University of Maryland School of Pharmacy. She develops innovative courses and interventions to educate students, health care practitioners, and the public about medical cannabis. Currently, Dr. Buckley is responsible for the course design and management of for Advanced Cannabis Therapeutics for Neuropsychiatric Disorders, which uses reality-based patient cases to teach students how to dissect the latest evidence to explore cannabis’s place in the treatment of psychiatric and neurological disorders.

References

1. National Institutes of Mental Health. Generalized Anxiety Disorder. Available at: https://www.nimh.nih.gov/health/statistics/any-anxiety-disorderih.gov). Accessed December 5, 2023.
2. Baldwin DS, Anderson IM, Nutt DJ, Allgulander C, Bandelow B, et al. Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology. J of Psychopharmacol. 2014; 1-37
3. Skelley JW, Deas CM, Curren Z, Ennis J. Use of cannabidiol in anxiety and anxiety-related disorders. JAPhA 2020; 60(1): 253-261.
4. Blessing Em, Steenkamp MM, Manzanares J, Marmar CR. Cannabidiol as a potential treatment for anxiety disorders. Neurotherapeutics 2015; 12: 825-836.
5. Ergisi M, Erridge S, Harris M, Kawka M, Nimalan D, et al. UK medical cannabis registry: an analysis of clinical outcomes of medical cannabis therapy for generalized anxiety disorder. Expert Rev. Clin. Pharmacol. 2022; 15(4): 487-495.
6. Van Ameringen M, Zhang J, Patterson B, Turna J. The role of cannabis in treating anxiety: an update. Curr Opin Psychiatry 2020; 33(1): 1-7.