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CBD & Xanax: Can CBD Transform The Way Anxiety Is Treated Today?

Anxiety is a natural response to a stressful situation. In our modern, fast-paced lifestyle, anxiety seems to have become an integral part of our lives. Some of us get anxious as soon as we wake up in the morning, others don’t even get much sleep because of it.

The usual anxiety-related clinical conditions, including anxiety disorders, panic attacks (with agoraphobia), and social anxiety disorder, are best treated with Xanax as the first-line therapy. Xanax is a trade name for alprazolam, a short-acting benzodiazepine, commonly prescribed for anxiety issues, and sometimes for sleep disorders.

Belonging to the class of drugs known as anti-anxiety agents or anxiolytics, benzodiazepines (more popularly known as “benzos”) is a class of psychoactive drugs used to manage anxiety disorders, specifically panic disorder or generalized anxiety disorder, with a tendency towards depression.

This kind of pharmaceutical compounds works by decreasing the abnormal excitement within the brain. Unfortunately, it is also one of the most widely abused medications in the world.

If you’re wondering why we’re talking about Xanax, you’ve probably never experienced its side effects.

  • Xanax is a psychoactive drug, known to cause addiction and mind-altering effects.
  • Stopping Xanax suddenly can cause even more severe withdrawal symptoms in the patient.
  • Even the FDA had issued a warning about its extended use, apart from the dangers of using it with opioids.
  • Alprazolam tablets had even been recalled in 2019, after repeated complaints from doctors and patients.
  • Xanax’s wide range of adverse effects on the body includes blurred vision, slurred speech, insomnia, memory loss, poor coordination, headaches, vomiting, diarrhea/constipation, breathing problems, loss of libido, etc.
  • It also tends to interact with several other medications, like all sleep-inducing compounds, seizure medications, birth control pills, heart or BP medications, other anxiolytics or antidepressants.

In this article, we’ll discuss if Xanax can be safely and effectively replaced by Cannabidiol (CBD), which is considered as a potential herbal alternative for managing anxiety issues by many.

Here are what you can expect from this article:

  1. Can CBD be used as a substitute for Xanax?
  2. Can CBD interact with Xanax, i.e. is it unsafe to take CBD while being on Xanax?
  3. Can CBD help with Xanax withdrawal symptoms?

CBD as an Anxiolytic Agent: Can CBD Replace Xanax?

Despite being a cannabis extract, CBD is a cannabinoid that has no psychoactive properties of its own. Legal CBD is extracted from hemp plants that contain only traces of the psychoactive substance THC (Δ-9 Tetrahydrocannabinol), making such extracts safe for ingestion/use. Most scientific investigations have proven its therapeutic benefits, including its anti-anxiety effects.

Here, we have cited a few of those research papers that hold scientific evidence of CBD’s efficacy as an anxiolytic agent:

  • In a 2019 study, published in the Brazilian Journal of Psychiatry, 57 healthy male patients were given either oral CBD doses of 150 mg (n=15), 300 mg (n=15), or 600 mg (n-12), or placebo (n=15), 90 minutes before a simulated public speaking test (SPST). It was seen that patients treated with 300 mg dose (i.e. containing highest of the three per/kg dose) showed a marked decrease in anxiety levels during the test, whereas no discernible improvement was observed in cases of patients given 150 mg and 600 mg doses over placebo. This proves CBD’s dose-response curve in humans is the same as in animals.
  • A similar study was conducted in 2017, but this time, it was a test of public speaking in real life. This human trial, whose paper was published in the Frontiers in Pharmacology, yielded similar results to CBD use just before the public speaking event. In this trial, 60 healthy subjects of both sexes, aged between 18 and 35 years, were randomly assigned to five groups. This time, the researchers had also used clonazepam (1mg), besides a placebo and three dosage variants of CBD (100mg, 300mg, 900mg). The test showed the same inverted U-shaped dose-effect curve.
  • Another paper, comprising a series of clinical trials, published in the Permanent Journal in 2019, assessed the extent to which CBD benefits people with anxiety disorders. Fifty-seven of the 72 adult volunteers with primary concerns of anxiety and poor sleep, who were chosen for the trial, showed a significant decrease in their anxiety levels within the first month (79.2%). Sleep quality and duration also improved within the first month in 48 patients (66.7%). However, it fluctuated over time. Minimal side effects were observed in only 3 patients.
  • In a 2011 randomized trial, published in the Journal of Psychopharmacology, CBD oil succeeded in reducing anxiety in patients suffering from social anxiety disorder. They also noticed a marked difference in the areas of the patients’ brain that involves memories, emotions, and endocrine functions.
  • In another 2011 randomized controlled trial, published in the Neuropsychopharmacology, researchers found a rapid and considerable decrease in the anxiety scores in subjects during an SPST with only a single dose of CBD. The study was designed around Social Anxiety Disorder (SAD) subjects who had never been treated for anxiety before. Nevertheless, the researchers sought larger trials to be conducted to verify their findings.

Some experiments were also conducted on young children to find the efficacy and safety of CBD use on youngsters.

Ø According to a 2020 trial, (published in the Neuropsychiatrie: Clinical, Diagnostic, Therapy, and Rehabilitation), a teenager, with multiple substance-abuse disorder, severe depression, and social anxiety, exhibited substantial improvement when treated with CBD use even after regular medications had failed.

  • A 2019 study that assessed CBD’s efficacy in treating social anxiety and avoidant-personality disorders in Japanese teens (aged 18 – 19 years) was published in the Frontiers in Psychology. The researchers of this double-blind, placebo-controlled study gave the teens 300 mg CBD or placebo daily for 4 weeks and found a significant decrease in their anxiety levels and other related symptoms.
  • Another 2016 Case Report, published in The Permanente Journal, exhibited how well CBD oil can help improve the quality and duration of sleep, besides fighting anxiety, in a sexually abused 10-year-old girl with PTSD (post-traumatic stress disorder) who had little parental presence even before the age of five. This study showed that CBD was indeed effective and a far safer treatment against anxiety and sleep issues in PTSD patients as young as 10 years old.

Does CBD interact with Xanax and other Benzodiazepines?

Taking two chemical compounds may lead to negative effects if their paths cross somewhere.

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In the cases of most pharmaceutical drugs and CBD, several liver enzymes of the CYP450 family are required to be metabolized.

Drugs may interact with CBD if…

  • Any pharmaceutical drug requires the same sub-group of enzymes to metabolize
  • The drug inhibits that enzyme’s functions
  • The medication induces those enzymes’ effects

Alprazolam is known to be metabolized by the CYP3A subfamily of enzymes, particularly the CYP3A4 isozyme. Again, CBD is a well-known inhibitor of the CYP3A enzyme system.

This could only mean one thing: CBD would not let the body metabolize benzodiazepines, forcing the latter to remain in your system for a longer period than originally intended, thus aggravating its side effects.

Studies relating to CBD-drug interactions in this connection…

  • A 2016 study, published in the Cannabis and Cannabinoid Research, mentions the CYP3A4 enzyme (used for CBD metabolism) might be the reason for CBD to interact with clobazam – a benzodiazepine that is also metabolized by CYP3A4.

While this only indicates that alprazolam could interact with CBD, other studies prove that CBD’s efficacy in helping a patient wean off Xanax – for good!

CBD & Xanax-Caused Withdrawal Symptoms

Withdrawal symptoms, like convulsions (seizures), muscle cramps, vomiting, sweating, tremors, and strange behaviors, may be observed if Xanax is suddenly stopped after prolonged use.

The best option is to wean off it gradually.

However, some pieces of evidence show CBD can help with the withdrawal symptoms.

The idea is to taper down benzodiazepines’ dose as you titrate CBD’s doses are upwards. After the benzo’s effects have completely been flushed out of the body, CBD can be safely stopped, as it produces no tolerance, dependence, or addiction issues, as with most drugs.

Here are a few studies that show CBD can help fight withdrawal symptoms produced by Xanax…

  • A 2018 study, published in the Neuropsychopharmacology, shows CBD can be used to treat drug addiction. The researchers established how CBD helps in relapse prevention by fighting the addiction triggers and offering overall therapeutic effects (including anxiolytic effects).

This experiment may only be indicative, but the next one more direct:

  • In this 2019 retrospective analysis, published in the Cannabis and Cannabinoid Research, researchers gauged the efficacy of both THC and CBD in patients who were treated with benzodiazepines They found that of the 146 patients put on medical cannabis, almost 45.2% of the patients stopped using benzodiazepines after three consecutive courses of medical cannabis (2-month courses each).

The researchers were, however, quick to add that the “study should not be misinterpreted as causative” and these findings don’t suggest patients should replace benzos with medical cannabis on their own.

Another interesting point is that CBD seems to take the same route as benzodiazepines (GABA-A receptor inducement) to influence the brain to stop the excitement causing anxiety.

Hopefully, with more research and clinical trials, anxiety treatment can enter a new phase in the future when life will be simpler, easier, and more side-effect-free for people with anxiety issues.

Ivan writes about Cannabis at The Cannabis Radar. He has a degree in Nutrition Sciences from University of Oklahoma Health Sciences Centre. He likes to spend his spare time reading to his daughter or spending time with his wife.

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